广州市耐多药肺结核患者自付医疗费用及影响因素分析OA北大核心CSTPCD

Objective:To investigate the current situation and influencing factors of the direct self-paid medical expenses of multidrug-resistant tuberculosis(MDR-TB)patients in Guangzhou City,providing a basis for optimizing medical reimbursement policies for MDR-TB patients.Methods:A self-designed questionnaire was used to conduct face-to-face or telephone interviews on factors related to MDR-TB in 284 patients who completed treatment receive treatment in the MDR-TB clinic of Guangzhou Chest Hospital from January 1,2020 to December 31,2022.The direct self-paid medical expenses and information of examinations of patients(including laboratory examination fees,anti-tuberculosis drug fees,non tuberculosis drug fees,hospitalization fees,etc.)were collected through the hospital information system.Descriptive statistical analysis,Chi square test,and other methods were used to analyze direct self-paid medical expenses of MDR-TB patients with different age,gender,family income,occupation,and education levels.Stepwise multiple linear regression was conducted to analyze the influencing factors of direct self-paid medical expenses(α=0.05).Results:The median(quartile)direct self-paid medical expenses of 284 MDR-TB patients was 99 927.25(40 136.45,202 526.91)RMB yuan,the top three were anti-TB drug expenses,laboratory examination expenses,and non-anti-TB drug expenses,with median(quartile)of 46 676.27(5590.92,150 869.86)RMB yuan,22 130.59(15 609.23,31 417.06)RMB yuan,and 12 751.68(7977.07,19 418.64)RMB yuan,respectively.In the multi-factorial analysis model,the protective factors for self-paid medical expenses of MDR-TB patients were Guangzhou City household registration(OR(95％CI)=0.95(0.84-0.99)),and full face-to-face medication management(OR(95％CI)=0.73(0.65-0.87)),and the risk factors for self-paid medical expenses of MDR-TB patients were having adverse drug reactions(OR(95％CI)=1.33(1.19-1.46)),using linezolid(OR(95％CI)=2.23(1.92-2.59)),and having hospitalization(OR(95％CI)=1.57(1.32-1.91)).Conclusion:The self-paid medical expenses of multidrug-resistant tuberculosis patients in Guangzhou are high,and the management of multidrug-resistant patients'medication should be standardized to reduce adverse drug reactions and optimize medical reimbursement policies.