Đánh giá hoạt động của các phòng chẩn trị y học cổ truyền tỉnh khánh hòa

MUC LUC CAC BANG Ket qua kham va dieu tri ciia he tho'ng hgi Dong y Phan bo so' Iifdng mlu cac PCT Phan bd so' lUdng mlu nhiing nggdi hanh nghe Phan bo so'lu'dng mlu ciia ngudi dan 16

BAO CAO KET QUA D ^ TAI

NCKH CAP TiNH

DANH GIA HOAT DQNG CUA CAC PHONG CHAN TRI Y HOC CO TRUYEN

TiNH KHANH HOA

Cd quan quan ly: Sd KHOA HQC & CONG NGHE KHANH HOA

Cc^ quan chu tri: SCf Y TE KHANH HOA

Cd quan thrfc hien: HQI DONG Y KHANH HOA

Chu nhiem de tai: TSDK NGUYEN THl/CfNG

Nha Trang, thang 07 nm 2009

B A O CAO K E T QUA D E TAI

MUCLUC i NHUNG CHLT VIET T A T iv

MUC LUC CAC BANG vi

MUC LUC CAC BIEU DO viii

DAT VAN DE 1

CHVONGI 3

TONG QUAN

1.1 Tinh hinh hoat dgng YHCT tu nhan tren the gidi 3

1.2 Tinh hinh hoat dgng YHCT tu nhan tai Viet Nam 4

1.3 Tinh hinh hoat dgng YHCT tu nhan tai Khanh Hda 8

1.4 "Phdng chdn tri YHCT" theo Phap lenh hanh nghi y,

dugc tu nhan 16

1.4.1 PCT-YHCT la mgt hinh thirc to chirc hanh nghi YDHCTtunhan 16 1.4.2 Dieu kien va pham vi hanh nghe ddi vdi mgt

PCTYHCT 17 1.5 Dao dire hanh nghi YHCT Viet Nam 20

CHVONGII

DOI TlTgnVG VA PHU'ONG PHAP NGHIEN CUtJ 21

2.1 Dia ban nghien ciiu 21

2.2 Doi tugng nghien ciin 21

2.3 Thilt ke nghien ciiu 21

2.4 Cd mdu va phuong phap chgn mau 22

2.5 Cac ky thuat ap dung trong nghien cim 28

2.6 C6ng cu sir dung 28

2.7 Xir ly va phan tich s6 lieu 28

CHVONGIII

KET QUA NGHIEN CUtJ 29

3.0 Khai quat ve cac mau khao sat 29

3.1 Ket qua khao sat mang ludi to chiic ciia cac PCT

YHCT tinh Khanh Hda 30

3.1.1 Kit qua thu thap tir mau "Cac PCT" 30 3.1.2 Ket qua thu thap tir mau "Nhung ngudi hanh nghl"36

3.1.3 Kit qua thu thap tir mau " Cac chuyen gia" 38 3.1.4 Ket qua thu thap tir mau "Nhung ngudi dan

sdng tren dia ban nghien ciiu" 40 3.2 Danh gia thuc trang hoat dgng

cua cac PCT - YHCT Tinh Khanh Hda 42

3.2.1 Kit qua thu thap tir mau "Cac PCT" 42 3.2.2 Ket qua thu thap tir mau "Nhimg ngudi hanh nghe"51

4.1 Mang ludi t6 chirc cac PCT-YHCT tinh Khanh Hda 69

4.1.1 Su thanh lap he thing cac PCT - YHCT tinh KH 69 4.1.2 Dac dilm he thong PCT - YHCT tinh KH 70 4.1.3 Nhan xet chung ve s6 lugng cac PCT va dgi ngu

cac thdy thuoc YHCT tinh Khanh Hda 72 4.2 Danh gia thuc trang hoat dgng cua cac PCT ! 74

4.2.1 Su chgn lua noi dieu tri ctia ngudi dan khi dau 6m 74 4.2.2 Ly do ngudi benh chgn den PCT 76 4.2.3 Nhimg phuong phap dieu tri tai PCT 77 4.2.4 Nhirng loai benh dugc dieu tri tai PCT 78

4.2.5 Nhirng bien chiing trong qua trinh dieu tri 80 4.2.6 Thai do cua thay thu6c va nhan vien PCT

d6i vdi benh nhan 80 4.2.7 Gia djch vu YHCT tai PCT 80

4.2.8 Vai trd cua PCT trong cdng ding 81 4.2.9 Viec chap hanh cac qui dinh v l pham vi hanh nghl.82

4.2.10 M6i quan he giira PCT vdi Tram y t l ciing

dia ban xa/phudng 83 4.3 Nhirng van de can uu tien giai quyet 83

CHVONG V

KET LUAN 87

5.1 v l mang ludi to chirc cac PCT- YHCT tinh Khanh Hda 87

5.2 Ve thuc trang hoat ddng cua cac PCT- YHCT tu nhan

tinhKhanhHda 88

HAN CHE CUA DE T A I 90

KIEN NGHI

Nhung giai phap kha thi nham nang cao hieu qua hoat ddng

cua cac PCT - YHCT tinh Khanh Hda 91

A Nhdm giai phap nham giai quyet nhirng van de can uu tien

thuc hien 92

B Nhdm giai phap mang tinh chien luge lau dai 94

DE X U A T H U 6 N G NGHIEN CUtJ TIEP THEO 96

T A I LIEU THAM K H A O 97

PHU LUC 100

Cum tir dtfcJc thay the

Thi xa Cam Ranh, Huyen Dien Khanh, Thanh pho' Nha Trang, Huyen Ninh Hoa, Huyen Van Ninh, huyen Cam Lam

Nghi dinh so 103/2003/ND-CP ngay 12 thang 9 nam 2003 ciia Chinh phii quy dinh chi tie't mgt so'dieu cua Phap lenh hanh nghe y, dggc tg nhan

Phdng chan tri Phieu khao sat Phap lenh s6 07/2003/PL - UBTVQH ngay 25 thang 02 nam 2003 ciia Uy ban Thudng vu Qudc hgi quy dinh vl hanh nghe y, dugc tu nhan

Phap lenh hanh nghe y, difdc tg nhan nam 1993 S6 lugng

Tile Thong tu^ s6'01/2004/TT-BYT ngay 06 thang 01 nam 2004 ciia Bg Y te'hgdng dan ve hanh nghe y, dgdc tif nhan Thong tu* so' 07/2007/TT-B YT ngay 25 thang 5 nam 2007 ciia Bg Y te' hu'dng dan ve hanh nghe y, y hoc co truyen

va trang thiet bi y te' tg nhan

MUC LUC CAC BANG

Ket qua kham va dieu tri ciia he tho'ng hgi Dong y

Phan bo so' Iifdng mlu cac PCT

Phan bd so' lUdng mlu nhiing nggdi hanh nghe

Phan bo so'lu'dng mlu ciia ngudi dan (16 1)

Phan bd so' lufdng mau ciia ngudi dan (16 2)

Phan bd s6 lugng cac mau khao sat

Th6ng tin ca nhan ve nhirng ngudi dimg dau cac PCT

F

S6 lugng ngudi giiip viec cd trong 1 PCT

Trinh do chuyen m6n cua nhiing ngudi giiip viec

Qui md t6 chiic cac PCT

F

S6 lugng PCT dugc thanh lap theo thdi gian

Viec hgc tap nang cao trinh do chuyen mdn tai PCT

Mdi quan he giira PCT vdi Tram y te

Thdng tin ca nhan ve nhiing ngudi hanh nghe

Y kien chuyen gia so sanh cac PCT tu nhan vdi cac co sd

dieu tri bang YHCT ctia Nha Nude

Su chgn lua each dieu tri bang Ddng y cua ngudi dan

Cac loai benh dugc dieu trj tai PCT

Nhirng loai benh ma PCT chira cd hieu qua

Nhung bien chimg trong qua trinh dilu tri tai PCT

Ket qua khao sat viec chdp hanh cac qui dinh v l hanh nghi

F ,

So lugng benh nhan den kham tai 01 PCT qua cac nam

F S

S6 tien lam tir thien tai 01 PCT qua cac nam

Cac nhdm benh din vdi PCT ciia ngudi hanh nghi

Nhiing phuong phap dieu tri sd trudng

Y kien ngudi hanh nghi vl cac vdn de cdn uu tien giai

quyet

Y kien chuyen gia ve ly do ngudi benh chgn din kham

Nhan xet ciia chuyen gia ve chat lugng kham chira benh va

thai do phuc vu benh nhan tai PCT

Y kien cac chuyen gia ve vai trd xa hdi ciia PCT

F F \ F •> \ F

Y kien ciia chuyen gia ve cac van de can uu tien giai quyet

Ly do ngudi dan chgn den PCT tu nhan

Nhiing loai benh khien ngudi dan tim den cac PCT

Nhirng phuang phap dieu tri tai PCT

Thai do ciia thay thude va nhan vien PCT

Y kien cua ngudi benh ve vai trd cham sde sire khoe cdng

MUC LUC CAC BIEU DO

Trinh do chuyin mon ciia nhimg nguoi hdnh nghi

Su chgn lua cdeh diiu tri bdng Ddngy ciia nguoi ddn

Cdc nhom binh dugc diiu tri tgi PCT (theo khao sat tai

PCT)

Cdc nhdm benh chira co hiiu qud tgi PCT

So lugng binh nhdn din khdm tgi 01 PCT qua cdc ndm

F \

So tiin Idm tic thien tgi 01 PCT qua cdc ndm

F F Cdc nhom binh khiin ngudi ddn tim den PCT (theo

phong van benh nhan)

Phdng chan tri y hgc cd truyin (PCTYHCT) la mdt trong cac hinh

t \ t \

thirc td chiic hanh nghe y dugc hgc c6 truyen tu nhan dugc qui dinh trong

Phap lenh so 07/2003/PL - UBTVQHI1 ngay 25 thang 02 nam 2003 cua

•> F > ,

Uy ban Thudng vu Qu6c hgi (PL- 07) quy dinh ve hanh nghe y, dugc tu

nhan

Qua viec ban hanh PL- 07, Nha nude da khuyen khich viec phat trien

y, dugc tu nhan ndi chung, YHCT tu nhan ndi rieng, tao dieu kien cho

nhirng ngudi hanh nghe YHCT tu nhan tham gia kham chira benh, cham

sde siic khde cho cdng d6ng bang cac phuong phap cua YHCT Tinh

Khanh Hoa den thang 01/2007 da cd 169 ngudi dugc cap phep hanh nghe

loai hinh PCT Trung binh hang nam, he thdng cac PCT cua hgi vien

Ddng y da kham chira benh cho 577.000 lugt benh nhan [2] Qua kiem tra

F \ F

danh gia cua Sd y te, hoat ddng cua cac PCT trong tinh hau het la dimg cac

qui dinh ciia phap luat, tuy nhien van cd 1 s6 cd sd cdn vi pham ve dieu

kien va pham vi hanh nghe [11,12]

F > >

Trong nude da cd mgt s6 c6ng trinh nghien ciiu, dieu tra ve vai trd

cua Ddng y d ca sd, ve tac dgng cua c6ng tac xa hoi hda YHCT hoac

danh gia nhu cau sir dung phuang phap dieu tri bang YHCT tat cong

dong [3, 7, 14, 16, 17, 21] Cac c6ng trinh neu tren true tilp hay gian tiep

cd khao sat mang YHCT tu nhan Tuy nhien, da sd' cac cong trinh do deu

di sau nghien cii^ mang YHCT trong he tho'ng y te Nha nifdc, chga phan

biet rach rdi giu'a 2 mang YHCT trong y te cong lap vdi mang YHCT

ngoai c6ng lap; chua tha'y cdng trinh nao nghien cii^ chuyen vetd chii'c

So lieu do Phong nghiep vu Y - So Y te cung cap

trinh ay chga danh gia he't hieu qua hoat dgng ciia gidi YHCT ben ngoai

cac td chuTc y te Nha nxidc bao gom cac hgi vien Hgi Dong y va nhicng

ngu'di hanh nghe YHCT tif nhan khac

Trong bo'i canh tinh Khanh Hda dang ciing ca ngdc phan da'u thgc hien Quyet dinh so 222/2003/QD-TTg ngay 03/11/2003 ciia Thii tgdng Chinh phu phe duyet Chinh sach Qudc gia ve Y Dggc hgc cd truyen de'n nam 2010, trong do cac chi tieu kham chtfa benh bang Dong y d cac tuyen gom cd tuyen Trung gdng 10%, tuyen tinh 20%, tuyen huyen 25%

va tuye'n xa 40%, thi song song mang YHCT cdng lap, dieu de tha'y la he tho'ng PCTYHCT tg nhan d dia ban xa phgdng trong tinh cd vai trd rat quan trgng

Vl nhifng Iy do dd, chiing tdi tien hanh nghien ciiu de tai: ''Ddnh

gid hogt dpng cua cdc phong chdn tri y hpc cd truyin tinh Khdnh Hoa"

vdi 3 ndi dung la:

Mpt, Khao sat mang ludi td chiic cua cac PCTYHCT tinh Khanh Hda

Hai, Danh gia thuc trang hoat ddng cua cac PCTYHCT tinh Khanh Hda

Ba, Tren co sd nhirng khao sat va danh gia dd, de xuat cac giai phap kha thi

de nang cao hieu qua hoat ddng ctia cac PCT- YHCT trong tinh

TINH HINH HOAT DONG YHCT TlT NHAN

1.1 Tinh hmh hoat dgng YHCT tw nhan tren the gi&i

Theo To chiic Y tl Thi gidi (WHO) thi d cac nude dang phat triln,

ngudi dan cd xu hudng sir dung YHCT trong viec cham sde stic khde cho

minh O cac nude cdng nghiep hda, cd khoang 50% dan so dang sir dung y

hgc bd trg va thay thi (YHBT & TT, Complementary & Alternative

F

Medicine) dudi hinh thiic ket hgp vdi y hgc hien dai [25] Ngudi ta diing

hinh anh mdt ngdi sao 5 canh de md ta mdt nen y hgc tuong lai cua nhan

loai gdm 5 ITnh vuc miii nhgn, dd la: YHCT phuong Ddng, y hgc mdi

trudng, y hgc di truyen, y hgc tai sinh dua vao cac te bao gdc va y hgc nano

F F

[5] Qua dd chiing ta thay rd tren the gidi ngudi ta danh gia cao vai trd cua

YHCT trong viec cham sde siic khde Tir cac ndi dung ve cham sde siic

khde ban dau cua WHO den mdt sd cac nghien ciin ciia cac td chiic va ca

nhan khac [23, 24, 26, 27] dlu neu cao vai trd cua YHCT, YHBT & TT va

cac hinh thiic td chiic kham chira benh khdng do Nha nude dau tu trong

cham sde siic khde tai cdng ddng Tac gia Gerry Bodeker cho biet cac

^ F

khuynh hudng chi dao trong cham sde siic khde cdng ddng tren tdan the

gidi se la su kit hgp YHHD va YHCT, YHBT & TT, va cung cho bilt rdng

nin YHCT chau A dang dugc qudc tl cong nhan va str dung, hien nay dang

dugc toan cau hda mdt each manh me [25] Gerry Bodeker da khao sat ve

lanh vuc YHCT tu nhan tai 23 nude tren thi gidi, cho bilt thay thude

YHCT tu nhan da dugc cdng nhan su hgp phap, viec sir dung YHCT cua

dan chiing tai ITnh vuc y tl tu nhan dang cd khuynh hudng phat trien

Ve mat lich sti, cac PCTYHCT cd tiln than tir Tap doan Ddng y

dugc thanh lap ngay sau khi cd Quylt dinh thanh lap Hdi nghien cim

Nam dugc ngay 27 thang 8 nam 1946, try sd tai s6 nha 75 pho Hang B6

- Ha ngi [19] Sau khi Hgi D6ng y dugc thanh lap theo Quylt dinh s6

399/NV/QD ngay 03 thang 6 nam 1957, he thong Tap doan D6ng y dugc

• > y F

phat trien manh nhd cd Nha nude bao trg Ddng thdi vdi dd, he thdng

- ^ t t

cac kinh tieu thuoc Ddng y ciing dugc chuyen d6i thanh Hgp tac xa

D6ng dugc, thu6c nam, thuoc dan tgc Sau khi Chi thi 118/CT/TW ngay

doan mdi ra ddi, nhieu tinh thanh phd da thanh lap Trung tam thira ke

ling dung Ddng y dam nhan viec kham chira benh bang D6ng y Trong

qua trinh chuyen d6i ca che quan ly cua Nha nude, ngay 06 thang 9 nam

1989 Bd Y tl ban hanh Quylt dinh so 508/BYT/QD vl Dilu le Phdng

chdn tri YHDT Cdng vdi tir khi cd ca che khoan 10 va thuc hien cd

^ F

phan hoa cac doanh nghiep Nha nude thi he thdng cac PCT trong ca

nude Cling dugc thay ddi hinh thirc quan ly va bat dau cd xu hudng suy

giam Nhiing PCT cd bl day kinh nghiem ket hgp vdi cdng tac thira ke

tot van duy tri ton tai nhung hdu hit cac PCT dlu gap nhilu khd khan do

m., F F

cac nguyen nhan: 1/ Nha nude chi hd trg ca che chinh sach cdn he thdng

PCT tu san, tir tieu, tu quan 2/ Ddi ngu Luong y cd nhilu kinh nghiem

giam dan do tudi cao [19] "Phap lenh hanh nghi y, dugc tu nhan" ldn

ddu tien dugc ban hanh ngay 13 thang 10 nam 1993 va sau dd dugc thay

the bdng "Phap lenh hanh nghe y dugc tu nhan" so 07/2003/PL ngay 25

* Cira hang

nghe YHCT tu nhan dugc tao dieu kien tham gia td chiic Hgi D6ng y, phat huy chuyen m6n kham chira benh, cham sde sire khde cho cdng ddng bang cac phuong phap cua YHCT Din thang 4/2004, ca nude cd 4.000 Td chdn tri YHCT tai cac Tram y tl xa (40%); cd 7.000 PCT- YHCT tu nhan tren tdng so 10.732 phudng/xa trong ca nude [13] Din thang 10 nam 2008, trong 63 tinh thanh phd ca nude thi cd 7 tinh cd Trung tam thira kl iing

CO quan chuyen mdn cua Hdi Ddng y Phan ldn cac PCT thuc hien che do

tu quan Cd PCT ket hgp vdi cac nha chiia Cdn d cap xa phuong, PCT tdn tai dudi 2 hinh thiic: PCT ciia cac cap Hdi Ddng y hoat ddng trong Tram y

te va PCT ciia hdi vien Ddng y

Theo tren, hoat ddng YHCT tu nhan tai Viet Nam hien nay chii yeu

la d cac PCTYHCT phii hau nhu kin ca nude Trung uong Hdi Ddng y Viet Nam danh gia chung trong nhiing nam qua cac PCT da gdp phan tich cue trong cham soc, bao ve siic khoe nhan dan; da tap hgp dugc nhieu Luong y

t \ F F

gidi, td chiic kham chira benh ddng thdi lam cdng tac thira ke, tam dac, truyen nghe cho the he sau, ddng thdi cdn tham gia lam tir thien va cac cdng tac xa hgi tai dia phuong [19]

Ngay 04 thang 7 nam 2008, Ban Bi thu Trung uong Dang (khda X)

da ra Chi thj sd 24-CT/TW vl phat triln nin Ddng y Viet Nam va Hdi Ddng y Viet Nam trong tinh hinh mdi, neu rd mdt trong cac nhiem vu va

giai phap la day manh xa hdi hda, khuyen khich cac td chiic, ca nhan trong

Nhieu cdng trinh nghien ciiu ve hoat ddng cua YHCT phuc vu siic khde cdng d6ng da cho thay su ddng gdp ngay cang rd net ciia mang YHCT tu nhan

Trong 2 nam 1999-2000, tai tinh Phii Yen, tac gia Le Van Thi^c va cdng sg da dieu tra vai trd ciia Ddng y d cd sd Ket qua cho tha'y: (a) benh nhan de'n kham va chiJa tri tai cac cd sd Ddng y chiem ti le kha cao (39,6%) (b) Tai cac cd sd D6ng y, thu6'c dggc sii dung chii ye'u la thud'c thang.(c) Phan dong nggdi dan da cd y thu'c de'n viec sii dung thuoc Nam

de chiia benh cho ban than va gia dinh, nhgng sg hieu biet ciia hg ve tac dung chiia benh ciia cac cay thud'c cdn han che' (d) Nggdi dan khi bi benh tg mua thud'c de dieu tri ma khdng kham chiem ti le rat cao (42,5%) [7]

Tac gia Huynh Lien Doan d Khoa YHCT Trgdng Dai hgc Y DUdc thanh pho' Ho Chi Minh va cong sg da btfdc dau danh gia nhu cau sti dung phifdng phap YHCT trong cham soc siIc khoe ban dau tai cdng dong d 2 phuong thugc thanh ph6 H6 Chi Minh Ke't qua nghien ciiu cho tha'y gan 50% dan s6' nghien cii^i cd thdi quen sii sung YHCT, chu ye'u la cac phgdng phap khdng diing thud'c, li do thich diing YHCT la vi cd hieu qua, ddn gian, it to'n kem, va 83% cd nguon hieu bie't ve YHCT tir gia truyen [3]

Cdn d phia Bac, tac gia Tran Thiiy trong mgt c6ng trinh nghien cii'u ve "Tinh hinh YHCT ciia mdt tinh dbng bang sdng Hong" [17] dd

nhan Igc y te YHHD chiem da so' tai cong dbng (92,58%) nhgng viec cung cap dich vu YHCT chii ye'u do y te'tg nhan dam trach Tai cac Tram

y te dich vu YHCT dggc suf dung rat it, hinh thu'c cdn ngheo nan, chii ye'u

do cac can bg YHHD ke't hdp them vao dieu tri tai cong dbng, cac can bg

y te d day khong dii kha nang de cung cap dich vu YHCT phuc vu nhu cau cham soc siJc khde ciia nggdi dan tai cdng dbng Tai cac hg gia dinh, YHCT du'dc siJ dgng vdi ti le tu'dng dd'i cao, trong do chii ye'u la sii dung thud'c nam Viec siir dung YHCT tai hg gia dinh chii ye'u do nggdi dan tg dam nhan va mgt phan do cac Igdng y d trong va ngoai dia phgdng cung cap 2/ Cd 2 ngubn cung cap thud'c YHCT chinh, mua la chii ye'u va tg kie'm Cac che pham YHCT cdn it, nhin chung khdng dap u'ng dggc nhti cau ciia ngiTdi dan tai cdng dbng ca ve hinh thilc va hieu Igc dieu tri 3/ Cac ye'u to' tac dgng din viec sii dung YHCT tai cong dbng la: nhu cau thgc tiln ve cham soc sii'c khde ciia ngu'di dan, kie'n thu'c va kinh nghiem

vl YHCT ciia ngu'di dan, tinh san cd ciia ngubn thuo'c YHCT va ngubn dich vu YHCT, uy tin cua thay thuoc trong dieu tri va tg van, sg can nhac ciia ngirdi dan ve tinh hieu qua va tinh an tdan, tinh kinh te cua YHCT trong dieu tri va nhu cau trbng cay thuoc nam

Nam 2003, tai Binh Dinh, Vd Ngoc Phai va Trirdng Quang Dat khi nghien cti'u ve tac ddng ciia cdng tac xa hgi hoa YHCT de'n hieu bie't trbng-siJ dung thud'c Nam va day an huyet ciia nhan dan mgt so' xa huyen

phap dieu tri bang YHCT va trbng thud'c Nam da dggc nang cao [21, 22]

Tan man tren internet cd mgt so' bai bao lien quan It nhieu de'n mang hanh nghe YHCT tg nhan Qua cac bai viet nay, c6ng tac xa hgi hda YHCT da dufdc md ta dan rd net, ke't qua ciia xa hgi hoa YHCT da

da dang hoa cac hinh thu'c cung cap dich vu cham soc siIc khoe nggdi dan, bao gbm ca trong Ilnh vgc ciia Nha ngdc, ciia tap the va ciia tU nhan [16] Lien quan de'n cac hinh thilc dich vu y te ngoai cdng lap, trong dd cd YHCT, da cd bai vie't ve cac benh vien cd td chilc phd'i hdp c6ng-tg thi khu vgc ph6'i hdp c6ng-tg du'dc benh nhan danh gia td't hdn la khu vgc cdng ve chat lu'dng phuc vg, thai do, chat lu'dng can bg, trang thie't bi [14]

1.3 Tinh hinh hoat dgng YHCT twnhan tai tinh Khanh Hoa

Theo tai lieu do Phdng Nghiep vu Y Sd Y te cung cap thi tinh de'n ngay 22 thang 01 nam 2007, Sd Y te da cap phep hanh nghe tg nhan ve kham chiJa benh bang YHCT loai hinh PCT cho 169 ngUdi trong ca tinh

Sd cung da cap phep hanh nghe kinh doanh thud'c YHCT cho 14 nggdi, trong dd cd 12 ngu'di kinh doanh thud'c phien va 2 ngu'di san xuat- kinh doanh thuo'c thanh pham Bang 1 du'di day trinh bay sg phan bd' cac PCT tai cac huyen trong tinh, dbng thdi tam lien he theo so' lieu tdng dieu tra dan so'fan mdi nhat ngay 01/10/1999 (vi so'lieu ve dan sdchu'a du'dc cap nhat) de hinh dung mgt each tgdng dd'i ti le so dan cd 01 PCT

DK

21

131 6,23

NT

94

324 3,44

NH

15

213 14,2

- Bang 1 cho thay binh quan trong tinh ciJ khdang 5.790 nggdi dan thi cd 01 PCT, nhgng phan bd' khong deu, d thanh phd' Nha Trang cd mat

do PCT tap trung cao nhat vdi khdang 3.440 nggdi dan cd 01 PCT, trong khi d cac huyen, thi thi mat do PCT tha'p hdn 2-3 fan, huyen Ninh Hda cd de'n khdang 14.200 ngiTdi mdi cd 01 PCT

Den thang 12/2007, con sd PCTYHCT tg nhan tang len la 186, trong dd cd 10 PCT do bac si YHCT phu trach, 16 PCT do y sT YHCT phu trach va 160 PCT do lirdng y phu trach [15]

Mang hanh nghe YDHCT tg nhan nhg tren cdng vdi mang YHCT trong he tho'ng Nha niTdc tao thanh mang liTdi kham chu'a benh bang YDHCT tai Khanh Hda, dem so vdi mang y diTdc hgc hien dai (YDHHD) vln cdn thieu rat nhieu ve cd sd vat chat va nhan Igc, ngubn Igc tai chinh dau tur phat trien [13] Cu the: Tai Sd Y te cung nhg tuyen huyen khdng

cd can bg chuyen trach theo ddi hoat dgng kham chiia benh bang YDHCT Nhan Iiic YDHCT ca tinh ve YHCT cd 01 bac si chuyen khoa 2 YHCT, 05 thac s i , bac si chuyen khoa 1 YHCT, 19 bac si YHCT, 43 y sT YHCT, 07 dieu diTdng YHCT va 172 lirdng y thi trong dd mang hanh nghe YDHCT tiT nhan ddng gdp 10 bac sT YHCT, 16 y si YHCT va 160

* Ten cac huyen, xem bang NHCTNG CHlT VIET TAT

liTdng y - Toan tinh khdng cd benh vien YHCT; 2/5 benh vien tuye'n tinh

cd khoa YHCT; 4/6 Trung tam y te huyen, thj xa cd td YHCT; 00/16 Phdng kham da khoa khu vgc cd td YHCT; 19/137 Tram y te xa/phgdng/thi tran cd td YHCT Trong nam 2006, ti le lUdt benh nhan kham chiia benh (KGB) bang YHCT so vdi tdng sd Iggt benh nhan den KCB chung tai benh vien Dieu dgdng- Phgc hbi chiJc nang la 12.500/40.543 bang 30,83%; tai benh vien da khoa tinh la 17.584/435.005 bang 4,04% Neu xem hoat ddng KCB tai Khoa YHCT Benh vien tinh va Benh vien Dieu dgdng - Phgc hbi chiJc nang la dai dien cho hoat ddng KCB bang YHCT tai tuye'n tinh ciia Khanh Hda thi ti

le lirgt benh nhan KCB bang YHCT ke ca kham benh va dieu tri ngi trii, ngoai trii so vdi tdng so' Iggt benh nhan de'n KCB chung tai 2 benh vien tren la 30.084/475.548, tire la bang 6,33% So lieu thong ke 10 thang dau nam 2007 tai 2 benh vien tren la 22.109/399.801 bang 5,53% Nhg vay cac ti le nay cdn rat thap so vdi chi tieu tai Quyet dinh 222/2003/QQD- TTg yeu cau ti le KCB bang YHCT tai tuye'n tinh la 20%, tuye'n huyen la 25% va tuye'n xa la 40% tdng Iggt nggdi dggc kham va dieu tri [15]

Song hanh ciing nganh y te, ve phia Hdi Ddng y, tinh de'n 31 thang

12 nam 2007, so' liTdng hgi vien la 656 nggdi, trong dd cd 165 * nggdi cd dang ky hanh nghe du'dc Sd y te' cap phep (theo Bao cao tdng ke't nanl

2007 ciia Hgi Ddng y) Dd'i chieu vdi tho'ng ke cap phep hanh nghe YHCT ttr nhan den thang 12/2007 d tren cho tha'y mgt phan sg phiTc tap

* Cac BSYHCT va 1 si YSYHCT la can bo duong chirc, hanh nghi YDHCT tu nhan dang ngoai gia

•* 165 PCT tu nhan cua hoi vien + 5 PCT eua tl chiic hoi cSp tinh va huyen, tong cong

he thing Hoi Dong y co 170 PCT tinh din 31/12/2007

trong Igc Iggng hoat ddng YHCT tg nhan trong tinh Rd rang cd tbn tai \

sd nhiing nggdi da dang ky hanh nghe nhgng chga la hgi vien Hdi Ddng

y, dbng thdi cdn 1 so' ddng hgi vien Dong y chga dang ky hanh nghe

Cung khong loai trii kha nang cd nhieu nggdi (la hoac khdng la hgi vien

Hdi Dong y) dang hanh nghe ma khong dang ky hdp phap Thuc vay, tir

thang 7 de'n thang 9 nam 2008, Tinh Hgi Ddng y Khanh Hda da khao sat

tho'ng ke trong tdan tinh, thay cd 256 trudng hgp hanh nghi khdng gidy

F t \ ,»

phep nhu the Cg the la: cd 133 ngudi hanh nghe kham chira benh ; 26

ngudi budn ban dugc lieu , 97 ngudi chiia benh bang bai thude gia truyen

(tai lieu ngi bg Hdi Ddng y- thang 10/2008)

Cd the ndi, he thong cac PCTYHCT tai Khanh Hda hien nay gan

nhg "dbng nghia" vdi mang hanh nghe YHCT tiT nhan Khanh Hda, vi

loai hinh nay chiem hau nhiT dai da so' trong s6' cac cd sd da dggc cap

phep Va nhg vay, ti le 170/186 bang 91,4% cua 170 * PCT ciia he thing

t F ^ ^ F

hdi Ddng y tren tdng sd 186 PCT dugc cap phep hoat ddng tren toan tinh

(den thang 12/2007) cho phep sti dung nhirng thdng tin hoat ddng ciia he

F ' % t

thdng Hdi Ddng y lam can cii tham khao chii yeu cho hoat ddng chung cua

mang hanh nghe YHCT tu nhan tai Khanh Hda, ben canh cdng tac trgng

tam la kham chira benh cdn cd nhiing hoat ddng xa hdi khac

Rat khd de cd sd lieu chinh xac ve hoat ddng kham chira benh ciia

cac PCTYHCT tu nhan ndi chung vi cdng tac thdng ke bao cao chua chat

^ (NH27 + NT32 + DK18 + CL2 + CR54=133)

' (CR6 + N T 1 3 + N H 7 = 26)

' (VN18 + NH01 +NT34 + DK04 + CL10 + CR24 = 97)

che Nhung cd thi tham khao so lieu cua he thing Hdi Ddng y trong 2 nam

2006 va 2007 theo Bang 2 sau day:

Bang 2: Ket qua kham va dieu tri ciia he tho'ng hdi Ddng y 2 nam 2006

Trong do Diing

thud'c (Iirgt)

405.842

So' thang

thud'c sijf

dgng (thang) 728.000 929.724 Tang 27,77%

Miln giam

(liTdt

benh nhan)

34.766 59.882 Tang 72,24%

Qui ra tien miln giam

(dbng )

905.803.000 251.585.300 Giam 72,26%

Tinh hinh benh tat chii ye'u la nhdm benh dau nhiJc, chd'ng dau liTng man do thoai hda cot s6'ng, cam mao, phong tha'p, cao huyet ap, suy nhggc than kinh, di chiing liet nufa nggdi do tai bie'n mach mau nao, liet day than kinh so' VII, dau than kinh tga, rdi loan kinh nguyet, suy nhggc

cd the, cac benh ve dirdng hd hap, benh du'dng tiet nieu- sinh dgc v.v Cdng tac kham chiia benh trong he tho'ng hdi du'dc trien khai td't, chga cd phan anh nao ve sai sdt chuyen mdn, cac cd sd phat huy td't viec mien giam phi cho benh nhan

Nguon: Bao cao tong ket nam 2007 cua Hoi Dong y

Ve mat td chirc, cac PCT chiu sg quan ly nha nude v l chuyen mdn

F

Ciia nganh y te va tuan theo cac quy dinh khac cua phap luat cd lien quan,

vi dg cd nghTa vu nop thue do hoat ddng dich vg kham chira benh Ngudi

F ^

chil CO sd neu la hdi vien Ddng y thi sinh hoat hdi theo Dieu le, Hdi thuc

hien chiic nang tap hgp, tuyen truyen, bdi dudng chuyen mdn va doan ket

hdi vien Nam 2008, Hdi hanh nghi y tl tu nhan tinh Khanh Hda ra ddi, da

va se thu hiit mgt s6 chii PCT gia nhap vao hgi mdi nay Sd Y te' thiTdng

xuyen td chiJc tap huan va thanh kiem tra cac hoat ddng YHCT trong

khudn khd quan ly hanh nghe y dgdc tg nhan ndi chung Theo Bao cao

ngay 22 thang 5 nam 2006 cua Doan kiem tra Sd Y te [11], thi nhin chung

mang nhiing co sd hanh nghe YDHCT tu nhan trong tinh deu chap hanh

diing nhiing qui dinh ve dieu kien va pham vi hanh nghe; tuy nhien van cdn

nhiing sai pham nhu:

- Co sd hanh nghe khdng hgp phap cdn dien ra d nhieu noi

- Vi pham cac che do chuyen mdn cdn kha phd bien nhu qui che

nhan thude, qui chi thuoc ddc, qui dinh vd khuan trong cham cim, luu hanh

thude thanh phdm khdng cd sd dang ky, thude qua han sir dgng

- Biln hieu khdng dung qui djnh, khdng dang ky danh sach ngudi

giiip viec

- Viec mac ao blouse va deo bang ten khi lam viec chua chap hanh

nghiem, viec md so sach theo ddi hoat ddng chuyen mdn d mdt sd co sd

chua diing yeu cau

Mdt nam sau, theo bao cao ngay 27 thang 4 nam 2007 ciia Doan

Thanh tra Sd Y t l [12], trong ting so 17 co sd YHCT dugc kiem tra thi hau

hit dlu cd ddy du co sd phap ly dl hoat ddng, ngudi hanh nghe cd du cac

tieu chudn qui dinh; dilu kien hanh nghi ngay cang dugc cac co sd chu

trgng hon, ca sd khang trang, sach, dep; chdp hanh kha tot cac qui ehl

chuyen mdn va hanh nghe diing trong pham vi cho phep, trang bi cac

phuang tien tiet trimg khii khudn dat yeu cdu, niem yit gia diing qui dinh,

md day dii cac loai sd sach theo ddi hoat ddng chuyen mdn, nhieu co sd

dau tu trang bi hien dai phuc vg tdt cho cdng tac kham, chdn ddan benh va

dieu tri Tuy nhien, van cdn nhieu thieu sdt, hdu hit cac sai pham da neu d

dgt kiem tra nam 2006 van tdn tai nhu la: cd 03 co sd hanh nghi cham ciiu

* ' F

ma chil ca sd khdng cd bang cap chuyen mdn, khdng cd giay chiing nhan

dil dieu kien hanh nghe, mdt sd co sd xoa bdp cd nhan vien hanh nghe ma

khdng cd chung chi dao tao do co quan cd tham quyen cap

Tai Hgi Ddng y tinh cdn Iiru tri? mdt sd'tai lieu de cap ve mang y te'

tir nhan, nhir danh sach va dia chi cac hgi vien cd md PCT, cac bao cao

hoat ddng kham chiJa benh, cac bao cao tam dac nhifng bai thud'c hay

cay thud'c quy da ap dgng tai PCT, cac bao cao ciia mgt so' PCT dien hinh

v.v Nam 1997, bao cao thgc tap t6't nghiep ctia hgc vien Nguyin

Thgdng, ldp Dai hgc Quan tri kinh doanh, ma sd'2219/DTTX/KH Trgdng

Dai hgc md ban cdng thanh phd' Hd Chi Minh vdi de tai: " Dit bao so'

lifcfng benh nhan va doanh thu tai Phdng chan tri Tinh Hoi y hoc cd

truyen Khdnh Hoa " [9] fan dau tien da khao sat ve md hinh td chiJc va

hoat dgng ciia mgt PCTYHCT gan lien vdi td chiJc Hgi Bao cao cho

tha'y day la mgt cd sd kham chiia benh, bao che', che' bie'n thud'c YHCT

quy m6 nhd gbm cd 3 bd phan: Bd phan chan tri, bg phan diTdc va bg

phan quan ly vat tur tai chinh Lufdng benh nhan de'n day binh quan 453

nggdi/ 1 thang; trong do dieu tri bang cac phgdng phap khdng diing thud'c

la chii yeu (80,5%) Cac loai benh thirdng gap la dau nhii:c (44,49%), suy

nhirgc (19,38%)

I Mgt van de cd lien he hiiu cd vdi hoat ddng ciia YHCT Khanh Hoa

ndi chung d ca 2 mang cdng lap va ngoai cdng lap la khau dao tao nhan

Igc Co quan chtic nang dao tao can bg y te ndi chung, YHCT ndi rieng

cho tinh la Trudng Cao dang Y te, cho den nam 1998 da dao tao 2 ldp

luong y, tdng cdng 52 hgc vien ^ Tir dd den nay, 2008, chua dao tao them

Hdi Ddng y cd chiic nang bdi dudng chuyen mdn YHCT, tinh den thang

7/2007 da md tdng cdng 51 ldp, bdi dudng cho 1.796 hgc vien [8], nhung

F y

cac Giay chirng nhan bdi dudng chuyen mdn cua Hdi la khdng dii tinh phap

ly de hgc vien cd the dang ky la ngudi dung dau mdt co sd hanh nghe

t y

YHCT theo luat dinh hien hanh Ndi com la cdn tdn dgng mdt Ldp Luong

y thira ke (khoa II) do Trudng Trung hgc Y te (nay la Trudng Cao dang Y

te) phdi hgp vdi Hdi Ddng y td chiic, cd 49 hgc vien theo hgc tir nam 1997

F F • ' • •

den nam 1999 da hoan tat chuang trinh dao tao nhung chua thi tdt nghiep

dugc do vudng nhirng qui dinh ve "Xac dinh trinh do chuyen mdn" tai

Chuang II - Thdng tu so 13/1999/TT-BYT cua Bd Y tl ban hanh ngay 06

thang 7 nam 1999 hudng dan thuc hien Phap lenh hanh nghe y dugc tu

nhan thugc ITnh vuc y, dugc cd truyen [1]

' Tai lieu Imi trd tai Hoi Dong y tinh

1.4 "Phong chin trj YHCT" theo Phap lenh hanh nghe y, dw(yc

cdng lap trong he th6ng y te Nha nude va mdt mang ngoai cdng lap d khu

vuc tu nhan va cac hdi nghe nghiep nhu Hdi Ddng y, Hdi cham ciiu, Hdi

> F

hanh nghe y te tu nhan v.v

Trong cuon "So thao lich sir YHCT Viet Nam" [20], trang 61-62 cd

F F F •

doan viet: "Din ndm 1988, 37/44 tinh, thdnh phd da cd mgt benh vien y

hgc ddn tgc, 259 Khoa y hgc ddn tgc trong cdc binh viin da khoa cd nude,

F F tic trung uomg, tinh thdnh den huyen Cd hom 4.000 ca soy te cdc co quan

cdng ndng truong, xi nghiep, cdc Trgm y te xd dung thuoc Nam vd chdm

F F ciru kit hgp vdi Tdyy trong viic chica binh Ngodi hi thdngy hgc ddn tgc

cua Nhd nude, cdn co 350 phdng chdn tri cua cdc Hgi y hgc cd truyen ddn

F F ' ' T

tgc cdc cdp trung uomg, thdnh phd, tinh, huyen vd 2.454 td chdn tri y hgc

ddn tgc tu nhdn " Qua dd, chiing ta thay khai niem "Phdng chan tri"

khdng dung de chi mdt don vi td chiic nao thude y te Nha nude, ma ndi eg

the dd la mdt don vi td chiic ciia cac Hdi y hgc cd truyen dan tdc cac cap,

F t t ^ F \

cdn neu la cua tu nhan thi ggi la "Td chan tri" Them nOa, trong bai viet ve

"Tinh hinh y hgc cd truyen Viet Nam" ciia GS Tran Thiiy nam 2002 cd

F \ •>

doan: " Ngodi hi thdng Nhd nude, dd cd nhieu phdng chdn tri YHCT tu

nhdn a cde cdp tic trung uomg din dia phuong dugc mo ra, phuc vu nhu

cdu khdm chica benh bdng YHCT cua ngudi ddn " [18] Nhu vay, theo dd

thi "PCTYHCT" la mdt co sd kham chira benh bdng YHCT ndm ngoai he

thong y t l Nha nude, va khai niem "Phdng chan tri" dugc md rdng chung

cho khu vuc tu nhan, khdng chi ndi rieng trong he thdng hdi Y hgc cd truyen dan tdc

Ngay 25 thang 02 nam 2003, Uy ban Thgdng vg Qud'c hgi ban hanh Phap lenh so' 07/2003/PL-UBTVQHll ve hanh nghe y, dggc tiT nhan (PL-07) Tai Dieu 21 Phap lenh da quy dinh rd: "Phdng chan tri y hgc cd truyen" la mdt trong 5 hinh thiic td chii'c hanh nghe YDHCT tg nhan Do vay, thuat ngii "Phdng chan tri y hgc cd truyen" du'dc sii dgng trong de tai nay la tuan theo quy dinh ciia PL- 07, la ndi de'n mgt cd sd hanh nghe YDHCT tir nhan, khong phai la 1 cd sd y te ciia Nha nu'dc

1.4.2 Dieu kien va pham vi hanh nghe dd'i vdi mgt PCTYHCT

Sau khi PL- 07 ra ddi, mgt s6' van ban phap luat lien quan viec trien khai thgc hien da dgdc ban hanh nhg:

- Nghi dinh sd 103/2003/ND-CP ngay 12 thang 9 nam 2003 ciia Chinh phii quy dinh chi tiet mgt sd dieu ciia Phap lenh hanh nghe y, dtrdctirnhan(ND-103)

- Thdng tu' sd 01/2004/TT-BYT ngay 06 thang 01 nam 2004 cua Bg

Y te hirdng din ve hanh nghe y, dirdc tir nhan (TT- 01); nhirng sau

dd diTdc bai bd va thay bang Thdng tiT so' 07 nam 2007 dgdi day

- Thdng tu' so' 07/2007/TT-B YT ngay 25 thang 5 nam 2007 ciia Bd Y

te hu'dng din ve hanh nghe y, y hgc cd truyen va trang thiet bi y te tirnhan (TT-07)

Cac van ban phap luat neu tren day da quy dinh cg the cac dieu kien va pham vi hanh nghe ddi vdi mgt PCTYHCT Neu ND -103 cua Chinh phii quy dinh chi tiet thi hanh mgt s6' dieu ciia PL - 07 trong dd cd

ngi dung lien quan de'n PCTYHCT thi cac Thong tu' ciia Bg Y te hgdng din cu the viec thgc hien, cd dieu chinh bd sung theo tinh hinh thgc te Cac quy dinh tai TT- 07 ve cd ban vln tho'ng nhat vdi TT- 01; ngoai ra

cd mdt so' diem mdi nhg dd'i vdi cac cd sd cd cac dich vg khdng diing thud'c ciia YHCT nhiT cham cufu, xoa bdp, day an huyet, xong hdi thud'c v.v thi cd them nhu'ng quy dinh cg the hdn ve dien tich phdng dc, kich thgdc giu'dng cham ciIu, vd khuan tiet trung, an toan trong he tho'ng phdng xong hdi thud'c v.v , hoac cd them cac dieu kien dd'i vdi nggdi hanh nghe la nggdi ngdc ngoai, cac quy dinh dd'i vdi trgdng hdp ngu'di diJng dau cd sd hanh nghe ma vang mat

Cap nhat nhiing qui dinh ve dieu kien va pham vi hanh nghe dd'i vdi mgt PCTYHCT dang cd hieu Igc thi hanh tai thdi doan 2007 - 2008 nhiT sau:

A/ Di^u kien ve nhan sif va cd sd vat chat:

a/ Nggdi diJng dau phai cd chiing chi hanh nghe kham, chu'a benh bang YHCT dggc dang ky PCTYHCT

b/ Nggdi lam cdng viec chuyen mdn phai bao dam dii cac dieu kien theo quy dinh nhg bang cap chuyen mdn, nang Igc hanh vi dan sg, siJc khde; hdp dbng lao dgng, khong dang cd van de ve phap luat, v.v

c/ Phdng kham benh phai bd' tri rieng biet vdi dien tich It nhat la lOm^ cho mgt thay thuo'c kham benh, bao dam thoang mat, ve sinh, dufdc trang

bi du ban, ghe' va cd ndi de nggdi benh ngbi chd kham benh

d/ Cd tu thud'c chia 6 hoac dung cg dgng thud'c cd nap day kin va du'dc de tren gia ke, cd nhan rd rang, de ndi thoang mat, bao dam ve sinh

B/ Pham vi hanh nghe

a/ Kham benh, chiia benh ngoai trii theo dung pham vi chuyen mdn hanh nghe trong Gia'y chiJng nhan dii dieu kien hanh nghe Trgdng hdp neu cd suf dgng phirdng phap chifa benh bang cham ciJu, bam huyet thi phai cd

du dieu kien quy dinh ve co sd nha cira va trang thie't bi phii hdp vdi pham vi hanh nghe nhg dien tich phdng tdi thieu 4m^; kich thgdc giu'dng (cao x dai x rdng) it nhat 70cm x 200cm x 70cm; dgng cu cham ciJu phai dam bao vd triing; phdng xong hdi thud'c phai bao dam an tdan (nhiing dieu kien cg the cd ghi rd tai diem c, khdan 4.1 muc VI ciia TT- 07)

b/ Ngu'di hanh nghe bang bai thud'c gia truyen chi du'dc kham, chiia benh bang chinh bai thud'c gia truyen do

c/ Bao che thud'c sd'ng thanh thud'c chin (thud'c phien), can thud'c thang cho nggdi benh

d/ Dggc sii dgng cac thanh pham thud'c YHCT do cac cd sd khac san xuat

da dirge Bg Y te' cap dang ky liTu hanh de phuc vu cho viec kham benh, chiia benh

6.1 Trong tru'dng hdp cd san xuat mgt sd dang ddng gdi san de phuc vu

trgc tie'p cho ngu'di benh ciia PCT thi phai dang ky vdi Sd Y te' theo dung quy dinh

1.5 Dao dwc hanh nghe YHCT Viet Nam

Y td Viet Nam la Hai Thgdng Lan Ong Le Hifu Trac (1720-1791)

da de lai nhiing Idi "Ybudn each ngon "ve dao diic nggdi lam thay thud'c

[6] Ong day nggdi lam thay thuo'c phai nang trao dbi y du'c, y thuat, het long vi ngirdi benh, doan ke't vdi dbng nghiep, dao lam thud'c la mdt nhan thuat chuyen bao ve sinh mang con nggdi, chi lay viec ciJu sd'ng mang ngirdi lam nhiem vu cua minh, khdng nen cau Idi ke cdng Chinh vi the

ma kem theo Quyet dinh s6'3923/1999/QD - BYT ngay 09 thang 12 nam

1999, Bg Y tl da ban hanh "9 dieu y huan each ngon cda danh y Hai ThtfdngLSn Ong", xem dd la dao diic hanh nghe y dggc hgc cd truyen

Viet Nam

CHlfONGII

2.1 Dia ban nghien cwu

X F

De tai dugc tien hanh tren dia ban tinh Khanh Hda, d nhiing noi cd hoat ddng cua PCTYHCT, gom huyen Van Ninh, huyen Ninh Hda, thanh phd Nha Trang, huyen Dien Khanh, thi xa Cam Ranh

Dang khi trien khai de tai thi cd sg thanh lap huyen Cam Lam, lay tii 12 xa ciia thi xa Cam Ranh ciing 2 xa ciia huyen Dien Khanh Xet ve tdng the thi cac dd'i tgdng nghien ciili khdng thay ddi nen viec chia tach

de thanh lap huyen Cam Lam khdng anh hgdng de'n ke't qua nghien ciiu

Khdng chgn 2 huyen Khanh VTnh va Khanh Sdn vi thgc te tai thdi diem nghien ciiu thi chu'a cd mdt PCYHCT nao tai 2 huyen mien niii nay

2.2 Do! twg'ng nghien cwu

Cd 4 dd'i tiTdng nghien ciTu nhg sau:

- Cac PCTYHCT

- Nhu'ng ngu'di hanh nghe YDHCT tu" nhan tai dia ban xa/ phu'dng

- Cac chuyen gia, gbm cac can bd quan ly (trong ITnh vgc YHCT), cac Tru'dng khoa YHCT tai cac benh vien huyen, thi, thanh phd'

- Nhiing ngu'di dan sd'ng tren dia ban nghien cilu, trong dd cd ddi tiTdng la cac benh nhan da den kham va dieu tri tai PCTYHCT

2.3 Thiet ke nghien cwu

- Ap dung thie't ke' nghien cii'u cat ngang md ta [ 10 ]

2.4 C& mau va phwo'ng phap chgn mau

Tuy theo dac diem yeu cau ciia mdi dd'i tgdng nghien cifu khac nhau, de tai ap dgng cac phgdng phap chgn mlu va tinh cd mlu khac nhau

-a/ Vdi 3 dd'i tiTdng la "Cac PCTYHCT", "Nhiing nggdi hanh nghe YDHCT tg nhan", "Cac chuyen gia" thi ap dgng phgdng phap chgn mlu khong xac xuat, mlu dufdc thie't ke' de cho viec la'y mlu ddn gian va thuan tien (convenience sample), theo sg Iga chgn cd tinh chii quan (judgmental sample), khdng yeu cau tinh cd mlu [4 ]

-b/ Vdi dd'i tufdng la "Nhifng nggdi dan sd'ng tren dia ban nghien cii\i" thi

ap dung phgdng phap chgn mau xac xuat, lay mlu nglu nhien (random sample)

2.4.1 Cd mlu

- a/ Dd'i tifdng la cac PCTYHCT:

Cd mlu theo de cgdng dggc duyet la 50 PCT (xap xi 29,59% tren tdng so'cac PCTYHCT dirdc Sd y tecap phep hanh nghe)

- b/ Dd'i tirdng la nhiing ngu'di hanh nghe YDHCT tif nhan, chii cac PCTYHCT tai dia ban xa phgdng:

Cd mlu theo de ctfdng du'dc duyet la 50 nggdi

- c/ Dd'i tg'dng la cac chuyen gia:

Gbm cac can bg quan ly (trong ITnh vu'c YHCT), cac Trifdhg khoa YHCT tai cac benh vien huyen, thi, thanh phd: theo de cu'dng da du'dc duyet la 30 nggdi

- d/ Dd'i tgdng la nhiing ngiTdi dan sd'ng tren dia ban nghien ciiu:

Cd mau theo de cufdng da dufdc duyet la 768 nggdi, dirdc xac dinh theo cdng thiic sau:

2 P(l-P)

vdi he s6' hieu chinh DE (Design effect) = 2 (tham khao iii cdng thilc tinh

cd mlu cho ddi tgdng ngu'di dan sii dung thud'c YHCT tii cong dbng trong

1 nghien cilu tinh hinh YHCT ciia 1 tinh dbng bang song Hbng[17]) Trong do:

n: cd mau = so' nggdi can phdng van

a: mile y nghTa thdng ke (du'dc qui iTdc bdi nggdi nghien cilu)

P: ti le ngirdi dan cd siJ dung cac dich vu YHCT tai cdng dbng

A: khoang sai lech mong mudn giiia ti le thu du'dc tir mau va ti le ciia quan the nghien ciJu

^(i-a/2) = gi^ tri Z thu du'dc tif bang Z ilng vdi gia tri a du'dc chgn

Khi chgn a = 0,05; (Z^,.,,^) = 1^96); P = 0,5; A = 0,05 thi:

„ = 1,96^, M^lOil_M = 384,16 « 384

0,05' Vay cd mlu sau khi hieu chinh vdi DE = 2 se la: 384 x 2 = 768 nggdi

* Thilt ke' nghien ciili chia lam 2 Id:

Ld 1: 384 ngufdi la benh nhan, da qua dieu tri tai cac PCTYHCT

L6 2: 384 ngirdi dan rgng rai bat ky (theo hd gia dinh)

2.4.2 PhiTdng phap chon mlu

a/ Vdi ddi tifdng la cac PCTYHCT:

Phan bd cd mlu cho cac huyen/thi/thanh phd' theo cdng thu'c:

n, =—-xn ' N

vdi: «; : sg' PCT se chgn mlu cho mdi huyen

n : cd mlu chung trong toan tinh (la 50)

A^ : tdng so' cac PCT tren dia ban tinh Khanh Hoa (169 PCT da du'dc cap phep tinh de'n thang 01/2007)

A^,: So' PCT tai mdi huyen, thi, thanh phd'

Bang 3: Phan bd so' lu'dng mlu cac PCT cho cac huyen

8

DK

21 12,43

6

NT

94 55,62

28

NH

15 8,88

4

VN

13 7,69

4

T6ng cong

b/ Vdi dd'i ttfdng la nhCfng ngifdi hanh nghe YDHCT tif nhan:

Dd la chii cac PCT nen each tien hanh gidng nhuf mgc 2.4.2a/ tren day Bang 4 difdc lafy ke't qua tinh toan tii Bang 3 de trinh bay sd lufdng mlu nhu'ng ngu'di hanh nghe dirdc phan bd nhiT sau:

Bang 4: Phan bd sd'ltfdng mlu nhifng ngufdi hanh nghe YDHCT tuf nhan Ddn vi

So' ngufdi du'dc chgn

Tien hanh chgn mlu tai 5 huyen bang phgdng phap chgn mlu nglu nhien ddn cho dii so' lu'dng mlu theo phan bd d Bang 4 Tuy cd mlu la bang nhau tai dia ban mdi huyen nhgng do chgn nglu nhien rieng biet nen dia chi cu the ciia 2 nhdm ddi tu'dng, mdt la cac PCT- YHCT va hai

la nhiing ngufdi hanh nghe YDHCT, khdng nhat thie't se triing khdp hoan toan vdi nhau

c/ Vdi ddi tifdng la cac chuyen gia, gbm cac can bo quan ly (trong ITnh vu-c YHCT) cac Tnfdng khoa YHCT tai cac benh vien huyen thi thanh pho:

Chgn mlu khdng nglu nhien theo sg Iga chgn cd can nhac

{Judgmental sampling), cd mlu la 30 ngu'di, phan bd nhg sau:

• 10 nggdi d cap tinh:

Phdng van cac vi lanh dao Sd y te', can bd phu trach YHCT thugc

Sd Y te, lanh dao Hgi D6ng y, Trufdng Khoa YHCT cac benh vien, chuyen vien ciia UBND tinh phg trach van xa, lanh dao Lien hiep cac hgi KHKT tinh

• 20 ngifdi d cap huyen, thi, thanh phd':

Mdi dia phu'dng phdng van 4 chilc danh: Giam ddc Trung tam y te', Chu tich Hdi Ddng y, Trifdng Khoa YHCT benh vien cap huyen, lanh dao UBND cap huyen phu trach van xa

d/ Vdi dd'i tifdng la nhgng ngifdi dan song tren dia ban nghien cii'u:

Tdng so 768 ngufdi du'dc phan thanh 2 Id, trong mdi 16, each lay mlu cd khac nhau, theo cac bu'dc nhif sau:

L61:

(384 nggdi) gbm nhCfng benh nhan da qua dieu tri tai cac PCT

Bifdc 1: Phan bd so'Iggng mlu

Can ciI vao so' cac PCT trong tifng huyen, tdng so' cac PCT trong tinh (la 169, tinh de'n thang 01/2007), va vao cd mlu chung trong ca tinh (384) de phan bd so' lifdng mlu cho tiing huyen

Bang 5: Phan bd so'Iifdng mau ciia Id 1

59

DK

21 12,43

48

NT

94 55,62

213

NH

15 8,88

34

VN

13 7,69

Lay mlu theo each tie'p can cac benh nhan den kham va dfeu tri tai PCT, ndi gap cd the trgc tie'p tai PCT hoac ndi khac So' lu'dng mlu tai mdi PCT du'dc la'y binh quan 1/3 tdng sdmlu ciia huyen

- Tieu chuan loai tril:

- Khong dbng y tham gia

- Da tham gia trong 16 2

L62:

(384 ngifdi), gbm nhifng ngifdi dan rgng rai bat ky theo hg gia dinh

Btfdc 1: Phan bd so' lufdng mlu

Can oil vao tdng dan so' ciia tinh, dan so' ciia tiing huyen (theo sd lieu tdng dieu tra dan so' ngay 01/10/1999, la fan mdi nhat tinh de'n thdi diem nghien cilu) va can cii vao cd mlu chung trong ca tinh de phan bd sd' lufdng mlu cho tiing huyen

Bang 6: Phan bd so' lirdng mau ciia ciia 16 2

19,82

76

DK

131 13,38

51

NT

324 33,09

127

NH

213 21,76

84

VN

117 11,95

Bgdc 2: Tai mdi huyen, chgn nglu nhien ddn 3 xa de khao sat

Bgdc 3: Tai mdi xa dgdc chgn d bgdc 2, tien hanh chgn ddi tgdng khao sat Lay mlu theo each lien tie'p, xua't phat tir trung tam xa (chd hay khu vgc tru sd UBND xa), chgn di theo 1 hgdng bat ky, fan lu'dt tir hd nay sang hd tie'p theo de phdng van dd'i tu'dng cho den khi dii so' lifdng da phan bd ve cho tirng huyen Dd'i tggng la nhifng nggdi dan trtfdng thanh bat ky, sd'ng tren dia ban nghien cilM, chii ye'u la nhifng chii hg So lifdng mlu tai mdi xa du'dc lay binh quan 1/3 tdng sdmlu ciia huyen

- Tieu chuan loai trii:

- Vang mat trong thdi diem dieu tra

- Khdng dbng y tham gia

- Da tham gia trong Id 1

* So lieu da duac tinh tron

2.5 Cac ky thuat ap dung trong nghien cwu:

- Dieu tra quan sat trgc tie'p

- Phdng van

- Dgc tai lieu san cd

2.6 Cong cu sw dung:

- Gia'y, but, may anh, may vi tinh, dTa CD-ROM, USB

- Bg cau hdi, mlu phie'u khao sat, cac bieu mlu trd'ng de dien sd' lieu, cac bang hudng dan thao luan trong cac budi hdi thao

- Cac sd kham chifa benh, cac bao cao, cac cdng trinh nghien ciJu

2.7 y.w ly va phan tich so lieu

Xijf ly tho'ng ke bang phan mem Epi-Info-2000

CHlfONGIII

KET QUA NGHIEN CUtJ

3.0 Khai quat ve cac mau khao sat

Ket qua khao sat mdi doi tugng dugc thi hien trong 01 philu khao sat/dilu tra/phdng vdn (PKS) Da cd 1 cudc khao sat dilu tra thir doi vdi ca

4 nhdm ddi tugng (Phdng chdn tri, Ngudi hanh nghi, Chuyen gia va Ngudi dan), qui md 8 PKS, mdi nhdm 2 ddi tugng Muc dich khao sat dilu tra thir

de kiem tra tinh hgp ly ciia ndi dung cac PKS, thu thap kinh nghiem thuc te

ve ky thuat, nghiep vg dieu tra, phdng vdn nhdm bd sung, hieu chinh cac PKS, dua vao ndi dung tap hudn trudc khi tiln hanh khao sat thuc tl

Cac mau khao sat thuc te eua 4 nhdm ddi tugng nghien ciin trong dl

F t

tai vdi sd lugng phan bd cho timg dia ban dugc trinh bay d Bang 7

Bang 7: Phan bd sd lugng cac mau khao sat

Ngudi hanh nghe

Ngudi dan Id 1

Ngudi dan Id 2

Chuyen gia tuyen huyen

Chuyen gia tuyen tinh

DVT phieu phieu phieu phieu phieu phieu

So lu*gng (phieu) CR*

- Trong mau "Nhiing ngudi hanh nghe": tdng sd cd 50 ngudi, gdm 45 nam,

5 nu; trong do cd 3 Bac sT YHCT, 42 Luang y va 5 Y sT YHCT; tuli ddi thap nhat la 34, cao nhat la 87, binh quan la 52

* Ten cac huy?n, xem bang NHU'NG CHU" VIET TAT

- Trong mau "Nhifng ngudi dan": tdng sd 768 ngudi, cd 311 nam, 457 nii; tudi ddi thap nhdt la 18, cao nhdt la 88; v l nghi nghiep thi cd 178 ngudi la ndng dan, 52 cdng nhan, 77 nhan vien hanh chinh, 32 hgc sinh- sinh vien,

101 ndi trg va 328 ngudi lam nhieu cdng viec khac Mau nay chia thanh 2

Id Ld 1 cd 384 cdng chiing la benh nhan cua cac PCT, Id 2 cd 384 cdng chiing la nhiing ngudi dan rdng rai bat ky sdng tren dia ban nghien ciin

- Trong mau "Cac chuyen gia": tdng sd 30 chuyen gia cd 27 nam, 3 nir; tudi nhd nhat la 35, ldn nhat la 87, binh quan 53 tudi; cd 2 ngudi cdng tac Dang, 23 la can bd quan ly, 5 la thay thude YHCT

Ket qua nghien ctiu se dugc trinh bay lan lugt theo 2 ndi dung ldn ciia de tai, dd la:

- Khao sat mang lu-oi to chirc cua cac PCTYHCT tinh Khanh Hoa;

- Danh gia thyc trang hoat dong cua cac PCTYHCT tinh Khanh Hoa

Trong moi phdn se trinh bay theo cac thdng tin thu thap dugc tir 4 mau khao sat neu tren:

- Kit qua thu thap tir mau "Cac phdng chan tri";

- Kit qua thu thap tir mlu "Nhifng ngudi hanh nghe";

- Kit qua thu thap tir mau "Cac chuyen gia";

- Kit qua thu thap tir mau " Nhiing ngudi dan sdng tren dia ban nghien cim"

3.1 Ket qua khao sat mang Iw&i to chwc cua cac PCT - YHCT tinh Khanh Hoa

3.1.1 Ket qua thu thap tir mau "Cac Phong chan tn"

3.1.1.1 Ve ngu-o-i dirng dau PCT