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題名 | 山地鄉結核病主動篩檢結合健保山地醫療保健服務計畫--北部山地鄉2017年執行成果檢討與建議=Review of Active Tuberculosis Screening Program Combined with Health Care Service Plan in Mountainous Townships in North Taiwan, 2017 |
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作者 | 謝鶯玉; 魏欣怡; 劉明經; 林秋華; 黃湘婷; 姜淑莉; | 書刊名 | 疫情報導 |
卷期 | 36:6 2020.03.24[民109.03.24] |
頁次 | 頁74-82 |
分類號 | 412.452 |
關鍵詞 | 山地鄉; 結核病; 胸部X光巡檢; 複判; Mountainous township; Tuberculosis; Chest X-ray screening; Double check mechanism; |
語文 | 中文(Chinese) |
中文摘要 | 臺灣山地鄉為結核病高發生率地區,疾病管制署持續於山地鄉執行結核病胸部X光巡檢業務。為提昇山地鄉民眾篩檢可近性等因素,於2017年開始推動「山地鄉結核病主動篩檢結合健保山地醫療保健服務計畫」,委由健保整合性醫療照護系統(Integrated Health Care Delivery System, IDS)之醫療院所承接。該委辦計畫可避免相關醫療資源重複耗用,有助於地方衛生單位結合在地化醫療資源,直接提供結核病篩檢及診療服務。 該年推動委辦期間,衛生局發現X光片篩檢異常比率較2016年低,研議後進行X光片複判,初複判的判讀一致性為高度吻合。然2017年主動發現之6名確診個案,初判均為異常無關肺結核,但5名經由X光片之複判後確診,另1名原判讀為左側腫瘤與左肺肋膜積水,由於衛生單位的高度警覺轉介就醫驗痰而確診。顯示目前衛生單位仍應適時評估IDS委辦單位提供之服務與X光片照射及判讀品質。胸部X光片判讀結果為影響主動篩檢成效的關鍵,因此,應建立與委辦單位間之評核與回饋機制,強化X光片之照射與判讀品質;配合衛生單位即時追蹤異常個案與確實匡列高風險族群,方能大力提升篩檢效益。 |
英文摘要 | People who live in mountainous townships are high-risk groups for tuberculosis infection. Taiwan Centers for Disease Control (TCDC) has been carrying on chest X-ray screening program in mountainous townships. Since 2017, TCDC mandated the local hospitals in the Integrated Health Care Delivery System (IDS) to carry out the chest X-ray program to promote the accessibility. The mandated program is aimed to integrate medical resources and avoid wasting, which helps the local public health departments to provide tuberculosis disease screening, diagnostics and treatments directly. During the executive period in 2017, the local public health department found that the abnormal findings of the chest X-ray screening were remarkably lower than those in 2016 and decided to launch recheck mechanism and used the Kappa statistics to test inter rater reliability. The calculated result of Kappa was 0.7, indicating fair agreement. However, 5 tuberculosis cases were determined by recheck mechanism and 1 was determined by alert of public health workers. It revealed the public health sectors should regularly evaluate the service provided by the mandated IDS hospitals and the quality of X-ray interpretation. The quality of chest X-ray interpretation is the key factor of the effectiveness of active screening. Therefore, we suggested building a mechanism for evaluation and review for the mandated hospitals to ensure the quality of X-ray interpretation. Meanwhile, the public health sectors should promptly follow cases with abnormal results and actively conduct screening among high risk populations to obtain the best screening effectiveness. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。