社区医生参与专案管理在梅毒母婴阻断项目中的应用
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摘要
目的探讨社区医生参与梅毒孕产妇专案管理在提高梅毒母婴阻断诊疗质量中的作用。方法运用梅毒母婴阻断质量评价指标,包括孕产妇梅毒检测率,孕产妇孕期梅毒检测率,梅毒感染孕产妇孕早期确诊率,梅毒感染孕产妇梅毒治疗率,梅毒规范治疗率,所生儿童预防性治疗率,先天梅毒报告发病率7个指标对社区医生参与梅毒孕产妇专案管理效果进行评估,实施检查监督,定期分析数据并进行持续改进。结果梅毒感染孕产妇孕早期确诊率由2017年的21. 05%提高至2018年的51. 28%,差异有统计学意义(P<0. 05),梅毒感染孕产妇梅毒治疗率从84. 21%提高到92. 31%,差异有统计学意义(P<0. 05),梅毒规范治疗率从39. 47%提高到74. 36%;所生儿童预防性治疗率从75. 68%提高到86. 48%,先天梅毒报告发病率7. 6/10万。结论社区医生参与预防梅毒母婴传播专案管理有利于针对梅毒专案管理存在的问题进行过程控制,实施有效干预措施,进行持续质量改进,有效提高了妊娠合并梅毒的早期检测率、规范治疗率,提升了梅毒母婴阻断项目的实施效果。
Objective Explore the role of community doctors in the management of maternal syphilis cases in improving the quality of Preventing Mother-to-Child Transmission( PMTCT) of syphilis. Methods 7 indicators applied to evaluate the effectiveness of community doctors' participation in the management of maternal syphilis cases are maternal detection rate of syphilis,maternal detection rate of syphilis during pregnancy,maternal early diagnosis rate of syphilis infection,maternal treatment rate of syphilis,standardized treatment rate of syphilis,infant preventive treatment rate and reported incidence of congenital syphilis. We inspect and supervise these indicators to make regular analysis and continuous improvement. Results The maternal early diagnosis rate of syphilis infection increased from 21. 05% in 2017 to 51. 28% in 2018( P<0. 05). The maternal treatment rate of syphilis increased from 84. 21% to 92. 31%( P<0. 05). The standard treatment rate of syphilis increased from 39. 47% to 74. 36%. The infant standard treatment rate increased from 75. 68% to 86. 48%. The reported incidence of congenital syphilis is 7. 6/100 000. Conclusion Community doctors' participation in the management of maternal syphilis cases is conducive to process control for problems in the management and implement effective interventions in order to make consist improvement in quality,it effectively improved early detection rate of the pregnancy complicated syphilis and standardized treatment rate and enhanced the implementation effect of PMTCT of syphilis.
Objective Explore the role of community doctors in the management of maternal syphilis cases in improving the quality of Preventing Mother-to-Child Transmission( PMTCT) of syphilis. Methods 7 indicators applied to evaluate the effectiveness of community doctors' participation in the management of maternal syphilis cases are maternal detection rate of syphilis,maternal detection rate of syphilis during pregnancy,maternal early diagnosis rate of syphilis infection,maternal treatment rate of syphilis,standardized treatment rate of syphilis,infant preventive treatment rate and reported incidence of congenital syphilis. We inspect and supervise these indicators to make regular analysis and continuous improvement. Results The maternal early diagnosis rate of syphilis infection increased from 21. 05% in 2017 to 51. 28% in 2018( P<0. 05). The maternal treatment rate of syphilis increased from 84. 21% to 92. 31%( P<0. 05). The standard treatment rate of syphilis increased from 39. 47% to 74. 36%. The infant standard treatment rate increased from 75. 68% to 86. 48%. The reported incidence of congenital syphilis is 7. 6/100 000. Conclusion Community doctors' participation in the management of maternal syphilis cases is conducive to process control for problems in the management and implement effective interventions in order to make consist improvement in quality,it effectively improved early detection rate of the pregnancy complicated syphilis and standardized treatment rate and enhanced the implementation effect of PMTCT of syphilis.
引文
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[8]方玉蓉,张万宏,石萍,等.2010~2015年武汉市孕产妇梅毒感染率及网络报告梅毒发病率的流行病学分析[J].华中科技大学学报(医学版),2017,46(6):700-703.
[9]吴颖岚,汤艳,高洁,等.湖南省孕产妇梅毒检测及干预情况分析[J].中国妇幼保健,2015,30(16):2489-2491.
[10]万言珍,张福华,代玉龙.孕妇妊娠早期优生优育相关病原体的检测分析及意义[J].中华全科医学,2016,14(10):1723-1725.
[11]Shahrook S,Mori R,Ochirbat T,et al.Strategies of testing for syphilis during pregnancy[J].Cochrane Database Syst Rev,2014(10):CD010385.
[12]Newman LM,Kamb ML,Hawkes S,et al.Global estimates of syphilis in pregnancy and associated adverse outcomes:analysis of multinational antenatal surveillance data[J].PLoS Med,2013,10(2):e1001396.
[13]Bucher S,Marete I,Tenge C,et al.A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina,Guatemala,India,Kenya,Pakistan and Zambia[J].Reprod Health,2015,12(2):1-11.
[14]刘慧慧,肖辉云,陈年年,等.广州地区孕产妇梅毒感染情况的地域分布[J].中国妇幼保健,2017,32(23):5812-5816.
[15]张凡,李波,黄印宗,等.157例妊娠梅毒孕妇规范治疗后新生儿血清学追踪观察[J].皮肤性病诊疗学杂志,2019,26(1):28-31.
[16]张晓辉,邱丽倩,陈丹青,等.浙江省2013-2014年梅毒孕产妇不良妊娠结局分析[J].中华皮肤科杂志,2016,49(8):558-562.
[2]谢幸,孔北华,段涛.妇产科学[M].第9版,北京:人民卫生出版社,2018:116-118.
[3]王临虹.妊娠梅毒和先天梅毒防治技术指南[M].北京:人民卫生出版社,2013:4-56.
[4]龚向东,岳晓丽,滕菲,等.2000-2013年中国梅毒流行特征与趋势分析[J].中华皮肤科杂志,2014,47(5):310-315.
[5]Wijesooriya NS,Rochat RW,Kamb ML,et al.Global burden of maternal and congenital syphilis in 2008 and 2012:a health systemsmodelling study[J].Lancet Glob Health,2016,4(2):e525-e533.
[6]Gomez GB,Kamb ML,Newman LM,et al.Untreatedmaternal syphilis and adverse outcomes of pregnancy:a systematic review and meta-analysis[J].Bull World Health Organ,2013,91(2):217-226.
[7]秦琴宁,花兰,张艳珍,等.不同治疗时机对妊娠期梅毒妊娠结局的影响及其危险因素分析[J].中国性科学,2018,27(5):96-99.
[8]方玉蓉,张万宏,石萍,等.2010~2015年武汉市孕产妇梅毒感染率及网络报告梅毒发病率的流行病学分析[J].华中科技大学学报(医学版),2017,46(6):700-703.
[9]吴颖岚,汤艳,高洁,等.湖南省孕产妇梅毒检测及干预情况分析[J].中国妇幼保健,2015,30(16):2489-2491.
[10]万言珍,张福华,代玉龙.孕妇妊娠早期优生优育相关病原体的检测分析及意义[J].中华全科医学,2016,14(10):1723-1725.
[11]Shahrook S,Mori R,Ochirbat T,et al.Strategies of testing for syphilis during pregnancy[J].Cochrane Database Syst Rev,2014(10):CD010385.
[12]Newman LM,Kamb ML,Hawkes S,et al.Global estimates of syphilis in pregnancy and associated adverse outcomes:analysis of multinational antenatal surveillance data[J].PLoS Med,2013,10(2):e1001396.
[13]Bucher S,Marete I,Tenge C,et al.A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina,Guatemala,India,Kenya,Pakistan and Zambia[J].Reprod Health,2015,12(2):1-11.
[14]刘慧慧,肖辉云,陈年年,等.广州地区孕产妇梅毒感染情况的地域分布[J].中国妇幼保健,2017,32(23):5812-5816.
[15]张凡,李波,黄印宗,等.157例妊娠梅毒孕妇规范治疗后新生儿血清学追踪观察[J].皮肤性病诊疗学杂志,2019,26(1):28-31.
[16]张晓辉,邱丽倩,陈丹青,等.浙江省2013-2014年梅毒孕产妇不良妊娠结局分析[J].中华皮肤科杂志,2016,49(8):558-562.