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Comparing Accessibility and Equity to TB Diagnosis between Rural-To-Urban Migrants and Permanent Residents in Urban Chongqing

Author: XuYan
Tutor: WangYang
School: Chongqing Medical University
Course: Epidemiology and Health Statistics
Keywords: Floating population Tuberculosis Accessibility Fairness Treatment delay Delayed diagnosis
CLC: R52
Type: Master's thesis
Year: 2007
Downloads: 120
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Abstract

The purpose of the investigation and analysis of the floating population and local residents in Chongqing TB treatment and delayed diagnosis and its influencing factors, the evaluation of the treatment and diagnosis of accessibility and fairness. (1) Data collection methods: quantitative research survey, in-depth interviews and qualitative research, observed and simulated patients method of data collection; (2) data analysis methods: quantitative data were analyzed using statistical software SPSS13.0 part of qualitative research interviews, observation data using MAXqda2 Software analyzed using framework analysis, another analysis of secondary data collected and summarized. Quantitative survey findings (1): A total of 185 newly diagnosed TB. Found the floating population busy with work did not visit the proportion was significantly higher than that of local residents and floating population to accept the check situation worse than local residents, the floating population is the first visit before spending nearly three times the local residents. The reasons for the delay, the univariate analysis found that the presence or absence of health insurance and hemoptysis starting delay significantly impact the treatment and diagnosis of the floating population factors, multivariate analysis found that the delay has a significant gender for the diagnosis of the floating population. After in asking patients suffering from tuberculosis, facing problems or worry about when the answer is worried that spread to family. Compared with the local residents, the floating population is more worried about can not be restored to health by the alienation of his family, and therefore can not find or lose their jobs. Suffering from tuberculosis are asked whether to tell family, friends, colleagues, neighbors, the majority of TB patients choose to tell their families, and less tell other people, in this regard, local residents and migrants are not a significant difference. (2) qualitative depth interviews: in-depth interviews with 17 newly diagnosed TB, local residents and migrants there are delays, interviews found that patients and medical institutions both factors affect the delay: patient aspects mainly poor economic conditions, there is no medical coverage, weak health awareness, lack of TB knowledge; medical institutions mainly pharmacies, private clinics, the hospital staff is not enough awareness about TB, tuberculosis prevention and control system are not included in or incorporated far enough. In addition, it is found that the patient's social support also have a great impact for the delay, whether relatives or friends of the patient's treatment played an important role in promoting. Most interviewers understand the lack of knowledge of TB, even sick after lack of understanding. Concerns they develop TB, the most important thing is to worry about the economic burden and the body can not recover, there are few who do not worry about the disease, they have a certain understanding more on tuberculosis, certain economic capacity. When asked whether they will inform neighbors or colleagues suffering from tuberculosis, the majority answer will not tell, but would tell their loved ones, mostly spouses. Went on to explain the reasons for this choice: fear of others afraid of him, alienating him, the fear of being looked down upon, for fear of losing their jobs or easy to find work in the future. (3) outpatient observation: two general hospitals in the respiratory department and general outpatient week hidden observation, found that the resident residents and floating population are varying degrees of the existence of delays, the delay time from several days to dozens days in duration, or even years. Patient's economic ability to pay is the main factors that determine their treatment behavior: comparison in terms of affordability patients are more prone to the phenomenon of treatment and diagnosis delay compliance throughout the treatment process is relatively poor, this floating population aspects of performance is more pronounced. Secondly, the the improper patient medical cause delays. Third, the sense of responsibility of the doctor is an important factor in the delay of TB diagnosis. In addition, hospital patient registration, the report, there are many problems, the lack of publicity also affect the patient in a timely manner to get a clear diagnosis of TB-related knowledge. (4) analog patients: the employment two \The outpatient observed no obvious discrimination the simulation patient's behavior. The simulated patient refused the check and ask directly prescription, 11 hospitals, only one hospital doctor refused the request of the patient, the remaining 10 hospitals doctors are \drugs. Promotional materials produced for patients on TB, were not seen in all 12 hospitals. Pharmacy observed the drugstore clerk asked most cough phlegm? \The drugstore clerk not to any inquiry that its recommended various drugs, drugstore clerk attitude varied simulation of the patient's condition. 13 pharmacies no clerk, simulated patients to the hospital. Conclusion This study found floating population among TB patients and 67.1% of those treatment delay, 30.3% of the people there is the case of delayed diagnosis, a higher proportion of treatment delay proportion diagnosed delay. The factors affect TB delay and fairness major four aspects: the patient's own health insurance, social support, and medical institutions. (1) prior to treatment, the patient is suspected symptoms of TB active treatment is an important factor affecting the early detection; patient dropouts in the treatment process and compliance is not high on the doctor also affect diagnostic delay is an important reasons. In this process, the floating population there are many adverse health seeking behavior. (2) higher health-care needs of the floating population and local residents in poor medical contrary, low level of protection, a serious impact on the availability of health care for these special populations and fairness. (3) the patient's social support have a great impact for the delay, whether relatives or friends of the patient's treatment, the played an important role in promoting a certain extent. The delay of the patients with good social support on the contrary, the delay of a high degree. (4) General Hospital doctors vigilance performance and sense of responsibility for TB diagnostic delay is very important problems is a lack of medical knowledge, policy, and the other is the economic compensation of the doctors involved in tuberculosis addition, doctors sputum attention enough is also one of the factors affecting diagnostic delay. Policy recommendations (1) First, solve the TB patients in particular is a floating population of patients difficult economic problems; (2) to strengthen publicity and training efforts, and improving people's awareness of TB; (3) general hospital and pharmacy in the TB control system go; (4) government-led, community-wide participatory.

Comparing Accessibility and Equity to TB Diagnosis between Rural-To-Urban Migrants and Permanent Residents in Urban Chongqing

Abstract

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