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地点:16个秘鲁和玻利维亚的初级卫生保健中心。目的:评估显微镜检工作在秘鲁和玻利维亚的利用情况,确定临床审查这种改善质量方法是否可以提高此项工作的利用效率。设计:我们评价临床审查干预前后两个6个月内秘鲁和玻利维亚能有效利用痰检的疑似结核病(TB)患者的比例,干预包括标准设定、衡量临床实施和反馈。结果:干预前,秘鲁只有31%(95%CI27—35)的TB疑似者进行了痰检评估,玻利维亚有30%(95%CI25—35)的TB疑似者做了至少2次痰检。临床审查后,秘鲁和玻利维亚在2年多的时间里痰检结果的可用性分别提高了7%(95%CI1—12,P<0.05)和23%(95%CI15—30,P<0.05)。结论:尽管世界卫生组织建议所有TB疑似者应在治疗前做痰检,但可用于进一步评估的痰检结果仅占三分之一,这可能严重阻碍了TB患者的发现。临床审查可以带来一些改善。我们建议定期监测镜检服务的利用效率,并做一些调查,明确在此工作中组织和结构方面存在的问题。
Location: 16 primary health care centers in Peru and Bolivia. Purpose: To assess the use of microscopy in Peru and Bolivia and to determine whether clinical review of this quality improvement approach can enhance the efficiency of this work. Design: We evaluate the proportion of suspected tuberculosis (TB) patients in Peru and Bolivia who have been able to make effective use of sputum tests within two months of clinical review of interventions, including setting standards, measuring clinical practice and feedback. Results: Before intervention, only 31% (95% CI 27-35) of TB suspects in Peru had a sputum test, and 30% (95% CI 25-35) of TB suspects in Bolivia did at least 2 sputum tests. After the clinical review, the availability of sputum tests in Peru and Bolivia increased by 7% (95% CI 1-12, P <0.05) and 23% (95% CI 15-30, P <0.05), respectively, in more than two years. CONCLUSIONS: Although WHO recommends that all TB suspects be sputum tested prior to treatment, only one-third of sputum tests available for further evaluation may seriously hinder the findings of TB patients. Clinical review can bring some improvements. We recommend regularly monitoring the utilization of microscopy services and conducting some surveys to clarify the organizational and structural issues in the work.