Keywords: assessment of blindness, cataract surgical services KHO KHAN TRONG THL/C HANH KE DON THUOC VA NHU CAU DAO TAO VE SL/ DUNG THUOC HOP LY AN T O A N CUA CAN BO Y TE THUOC MOT SO
Trang 1TCNCYH 65 (6) - 2009
prevalence cf Pterigyum in one eye is 12.9%, and in both eyes is 4.85% The bilateral aphakia rate is 3.04%, monocular aphakia rate is 2.99% The cataract surgical coverages are 8 0 0 % (per persons) and 55.2% (per eye) The successful surgical rate is 74.53% Main barriers for cataract services are
unawareness (29.5%), fear of loosing sight (15.9%) and poverty (11.4%) Conclusion: Main cause of
blindness in Hanoi in 2007 is still cataract The CSSR is good but the successful surgical rate is not high Strategies for blindness prevention are promotion of health education and improvement of surgical quality to achive the goal "Vision 2 0 2 0 "
Keywords: assessment of blindness, cataract surgical services
KHO KHAN TRONG THL/C HANH KE DON THUOC VA NHU CAU DAO TAO VE SL/ DUNG THUOC HOP LY AN T O A N CUA CAN BO Y
TE THUOC MOT SO BENH VIEN 5 MIEN BAC, VIET NAM
Hoang Van Minh, Nguyen Tran Thj Giang Hffdng, Vu Thj Vffng, Kim Bao Giang, Le Thi Hoan, Tran Thanh Tung,
Trddng Dal hgc Y Ha Noi
(J Viet Nam, hldn cdn thieu cic nghien cdu ve mde do khd khan trong qua tnnh ke dan ciia cin bd d
cic tuyen dieu trj khic nhau Muc tieu: md ti nhdng khd khan chinh trong qui tnnh ke dan cua cic bic sy
thudc mgt sd khoa/don vj tai mdt sd benh vidn cic tuyen d mien Bac Viet Nam vi xic djnh nhu cau dio tao
ctia hg ve cic van de cd lien quan den sd dung thudc hgp ly, an toin Boi tugng va phuang phap nghien
cdu: md ta dt ngang sd dung phuang phip tu dien phieu thUc hien vdi cic cin bd dieu trj mdt sd khoa/ dan
vi Ndi, Nhi, Lay d 10 benh vien thudc 3 tuyen d mien Bac Ket qua: khd khan chinh cua cic can bg tuyen
huyen khi thuc hanh ke dan bao gam: thieu thdng tin ve thudc (68,5%o), thieu kie'n thdc dugc lim sing (47,5%o); thieu xet nghiem ho trg (59%o) Nhu ciu dio tao ve cic vi'n de cd lien quan den sd dung thudc hgp
ly an toin ciia cin bg d tuyen trung uang: 80,0%o; tuyen tlnh 92,4%o; tuyen huyen: 95,2%o Ket luan: cin bg y
te tuyen huyen gap nhieu khd khan trong qui trinh ke dan vi cd nhu cau cao han ve dao tao sd dung thudc hgp ly an toin so vdi cin bg y te tuyen dnh vi tuyen trung uang
Tff khoa: ke ddn, sff dung thudc hdp ly an toan
I D A T V A N D F nhflng cd I n h hfldng den sflc khce ca n h i n ngfldi
sfl dung bdi hien tfldng tfldng tac thud'c va p h l n
6 Viet Nam tlnh trang sfl dung thud'c khdng ,jng khdng mong mud'n cua thud'c ma cdn lam hdp ly - an t o l n dang I I mdt v i n d l dang bao tang nguy cP khang thud'c cung nhfl gay ra tdn ddng khdng chl trong cdng ddng ma ngay c l d kem cho ban than ngfldi benh va he thd'ng y t l
c i c Cd sd y t l Da cd mdt sd b i o c l o dieu tra d l H I U qua cua viec sfl dung khang sinh khdng hpp cap d i n viec sfl dung thud'c khdng hpp ly tai cac |^ da d i n den tlnh trang khang thud'c gia tang d i n
cd sd y te', n h i t la dd'i vdi thud'c khang sinh [ 1 , 2] rnde bao dpng d cac chung vi khuan gay benh Sfl dung thud'c khdng hdp ly - an toan khdng thfldng gap [5] Cd nhieu nguyen nhan cd the d i n
Trang 2den tlnh trang sfl dung thudc khdng hpp ly - an
t o l n tai cac co sd y t l , vf du nhfl cac can bd d i i u
trj t h i i u kien thflc, thieu thdng tin, cd sd y t l t h i i u
thud'c, benh nhan khdng tuan thu d i i u tri, anh
hfldng cua q u i n g cao thud'c Tuy nhien, d Viet
Nam, hien cdn thieu c i c nghien cflu ve mflc dp
khd khan trong q u i trinh ke ddn cua c l n bd d cac
t u y i n d i i u trj k h l c nhau
VI cae ly do tren, chung tdi tie'n hanh d l tai
nghien cflu vdi muc tieu:
Mo ta nhifng khd khan chinh trong qua trinh
ke dan cua can bg y te thugc mgt sd kboa/dan
vi Ngi, Nhi va Lay d mgt sd benh vien cac tuyen
d mien Bac Viet Nam, nam 2008 va xac dinb
nbu cau dao tao ciia cac can bg duac dieu tra
ve cac van de co lien quan den sif dung thudc
help ly an toan
NGHIEN CL/U ,
1 Bdi tuang nghien cdu: C I c can bd dieu trj
mdt sd khoa/ddn vj Npi, N h i , Lay d mdt sd' benh
vien eac tuye^n d mien B i c
2 Thief ke nghien cii'u: Nghien cflu md t l c i t
ngang
3 Bia diem nghien ciifu:
- Tuyen trung fldng: benh vien Bach Mai
- Tuye'n tinh: 3 benh vien (benh vien tinh Ha
Nam - vung Ddng bang sdng Hong, benh vien
tinh Viet Tri - vung Ddng Bac, benh vien tinh Hoa
Binh - vung Tay Bac)
- T u y i n huyen: Tai mdi tlnh difpc Ifla chpn, 2
benh vien huyen dfldc d i i u tra
4 C6 miu va chgn mau: t i t ca c l n bd d i i u trj
(bic sy, y sy) thudc cac khoa/ddn vj ndi, nhi, lay
tai c i c benh vien nghien cflu dflpc d i i u tra
5 Ky tbuat va cong cu tbu thap thong tin: sfl
dung be cau hdi tfl dien Cae can be d i i u tri dflpc
mdi d i n hdi trfldng de d i i n p h i i u t r i Idi difdi sfl hfldng d i n cua cac nghien cflu vien
6 Quan If va phan tich sd lieu: sd' lieu dfldc
nhap vao may tfnh bang p h l n m i m Epi - info vdi cac tep Check de ban che sai so Phan mem Stata
10 dflpc sfl dung trong xfl ly v l phan tfch sd lieu
III KETQuA Tdng sd cd 137 c l n bd tham gia d i i n p h i i u , bao gdm 44 c l n bd t u y i n trung fldng (32.1%), 58
c l n bd tuye'n tinh (42,3%) va 35 c l n bd tuye'n huyen (25,5%) Cd 56 can bd nam (40.9%) v l 81
c l n bd nfl (59,1%) Chu yeu c i c c l n bd difpc d i i u tra cd dd tudi dfldi 50 tudi (83,2%) Phln Idn c i c
c l n bd d i i u tra cd trinh dp b i c sy (42,3%) So c l n
bd cd trinh dp sau dai hpc tai tuye'n trung flpng la tflpng dd'i cao (thae sy: 45,5%; t i i n sy: 1 5,9% v l phd g i l o sfl: 4,6%) T"/ le c l n bd cd trinh dp sau dai hpc d tuyen tlnh cung dat gan 5 0 % (chu ye'u la chuyen khoa 1) va tuyen huyen la 14.3% (tit c l deu I I chuyen khoa 1) Tai t u y i n huyen, 34,3% sd
c l n bd difdc dieu tra cd trinh dp y sy Hp dflpc Ifla chpn vao d i i u tra vl cung trflc t i i p tham gia vao
cdng tac d i i u trj Tai t u y i n trung flpng, Xy le can bd
cd tren 30 nam cdng t i c la tfldng dd'i cao (36,4%)
Tai t u y i n tlnh va tuye'n huyen, p h l n Idn c i c c l n bd dflpc d i i u tra cd dfldi 10 nam cdng t i c (55,2% d tuyen tinh va 5 0 % d tuyen huyen)
B l n g 1 trinh bay nhflng khd khan chfnh m l
c i c c l n bd d i i u trj thfldng gap trong qua trinh ke don 1 8,3 % c l n bp dfldc d i i u tra cho r i n g hp
t h i i u kil'n thflc chan doan va d i i u trj (tuyen trung fldng: 18,2%; tinh: 10,3% va huyen 31,4%) Cd 32,9% c l n bd dflpc d i i u tra (trung fldng: 18,2%; tlnh: 22,4% va huyen 68,5%) cho rang hp t h i i u thdng tin ve thud'c trong qua trinh ke ddn Ty le can bd dflpc d i i u tra cho rang hp thieu k i l n thflc
v l dflpc lam sang la 4 0 , 9 % Ty le n l y cao d c l 3 tuye'n, dac biet d t u y i n tuyen huyen (45,7%) Cd 19% can bd dflpc d i i u tra cho rang hp cd khd
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Trang 3TCNCYH 65 (6) - 2009
khan trong qua trinh ke ddn do benh-.vien t h i i u
thud'c Ty le n l y cao n h i t d tuye'n huyen
(28,6%), tiep theo I I d tuye'n tinh (17,2%) va
cud'i cung la t u y i n trung fldng (10,7%) C a n 3 5 %
c l n bd difpc d i i u tra cho rang hp cd khd khan
trong q u i trinh ke ddn do benh vien thieu cac
xet nghiem hd trp Ty le nay dac biet cao d
tuyen huyen (60%) so vdi tuyen tlnh (29,3%) va tuyen trung fldng (25%) Mdt sd khd khaQ khac trong q u i trinh ke ddn lien quan dfldc cac can
bd dfldc d i i u tra ke d i n bao gdm sfl tuan thu cua benh nhan kem (ty le chung la 50,4%) va viec
b i o hiem y te khdng che tran thanh toan (Trung fldng: 29,5%, t l n h : 4 1 , 3 % ; va huyen: 54,3%)
Bang 1 Kho khan cbinb trong qua trinh ke dan cua cac can bg dugc dieu tra
Cac kho khan
Thieu kie'n thfle c h i n d o l n , d i i u trj
Thie'u thdng tin v l thud'c
Thie'u k i l n thflc dflpc l l m sang
Benh vien thie'u thud'c
Benh vien thie^u xet nghiem hd tro
Benh nhan tuan thu kem
Bao hiem khdng c h l tran thanh toan
Tdng sd
Trung ffdng
n (%)
8 (18,2)
8 ( 1 8 , 2 )
19 (43,2)
6 ( 1 3 , 5 )
11 (25,0)
22 (50,0)
13 (29,5)
44 (100)
Tfnh
n (%)
5 ( 1 0 , 3 )
13 (22,4)
21 (36,2) 10(17,2) 17(29,3)
28 (48,3)
24 (41,4) 58(100)
Huyen
n (%)
11 (31,4)
24 (68,5) 16(45,7) 10(28,5)
21 (50,0)
19 (54,3)
19 (54,3)
35 (100)
Chung
n ( % ) 25(18,3)
45 (32,9)
55 (40,9) 26(19,0)
49 (35,8)
69 (50,4)
55 (40,9)
137 (100)
B l n g 2 t h i hien ty le c l n bd dfldc dieu tra da tham gia c i c khda dao tao lien quan den ke ddn trong 3 nam trd lai day Nhin chung, cac can bd tuye'n tinh va huyen cdn it dfldc d i e tao ve sfl dung thud'c hdp
ly, an toan cung nhfl c l e v i n d l dflpc l l m s i n g (T'/ le dfldc dao tao d i u dfldi 50%) Rieng dd'i vdi khda dad tad ve d i i u trj tieu c h l y thi sd' c l n be tuyen huyen dfldc d i e tao n b i l u hdn sd vdi can bd cua cac
t u y i n tren
Bang 2 Cac khda dao tao lien quan den ke dan ma cac ddi tUgng dieu tra da tbam gia trong 3 nam trd lai day
Cac khoa dao tao
Sfl dung thud'c hpp ly, an toan
Dflpc l l m s i n g
D i i u tri viem phe quan
Dieu trj viem loet da day - t l trang
D i i u trj ly trflc trung
D i i u trj benh viem phdi tre em
D i i u trj tieu c h l y tre em
Trung ffdng (%)
80
70
40
60
40
30
30
Tinh (%)
50
30
30
30
10
30
30
H u y e n ( % )
50
40
10
20
10
20
50
B i i u dd 1 t h i hien k i t qua d i i u tra v l nhu cau dao tao v l cac v i n d l cd lien quan den ke ddn tai cac benh vien nghien cflu Phan Idn c l n bd dflpc dieu tra d i u the hien mong mudn dfldc tham gia cac khda
Trang 4dao tao v l cac v i n d l cd lien quan den ke ddn, dac biet I I c i c c l n bd tuyen huyen Ty le p h l n tram c l n
bd tuyen huyen mong mud'n dfldc dao tao v l sfl dung thud'c hop ly, an toan la 9 5 , 2 % (trung fldng: 8 0 % , tlnh: 92,4%) ); v l dfldc lam s i n g la 88,3% (trung fldng: 86,2%, tlnh: 79,7%); va ve c i c phac dd dieu trj lam s i n g chuan la 9 0 1 % (trung fldng: 74,0%, tlnh: 82,4%)
95,2% Q Trung udng B Tinh D Huyen '•
a
<o-80,0%
92,4%
^^
86,2%
79,7%
88,3%
! •
90,1%
82,4%
74,0<
Su dung thudc hop ly, an toan Dupc iam sang Cac phac dd dieu tri lam sang chuan
Bieu dd 1 Nhu ciu dao tao cua cac can bo duac dieu tra
I V B A N L U A N
Trong nghien cflu nay, phan ldn cac can bd
thudc cac khoa phdng d i i u trj dfldc lfla chpn da
tham gia dien phieu Cd the t h i y cd sfl chenh
lech gifla cac tuyen ve so Ifldng cung nhfl trinh dp
chuyen mdn cua dpi ngu can bd Tuyen cao hPn
thi ed so Ifldng c l n bd ddng hPn, n h i i u c l n bd cd
trinh dp chuyen mdn cao va nhieu kinh nghiem
cdng t i c Dieu nay p h l n anh dung thflc trang
ngudn nhan Iflc trong he thd'ng y te nfldc ta hien
nay va d l y cung la yeu to quan trpng cd anh
hfldng de'n viec ke ddn thud'c cho benh nhan
Cac can bp y te tuye'n huyen neu len n b i l u
khd khan trong qua trinh ke ddn hdn so vdi cac
can bd y t l tuyen tlnh va t u y i n trung fldng C I c khd khan chfnh cua c i c c l n bd tuye'n huyen bao gdm thieu thdng tin v l thud'c (68,5%), thidu kie'n thflc dflpc l l m s i n g (47,5%); thie'u xet nghiem
hd trd (59%) Nhfl vay, de cd the n l n g cao viec sfl dgng thud'c hdp ly, an t o l n tai tuye'n huyen,
c l n cd n h i i u bien phap can dflpc trien khai nhfl cung c i p c i c thdng tin cap n h l t cd lien quan de'n ke ddn (ban tin thfldng k'/ v l thud'c, p h i c dd
d i i u trj ), thflc hien c i c xet n g h i l m hd trd khi
ke ddn (nhfl khang sinh dd, xet nghiem chflc nang gan than) Ket qua nay cung n h i t quan vdi k i t qua nghien cflu cua Pham Huy Dung va cdng sfl nam 1999 [4] va cua N g u y i n M i n h Hieu nam 2005 [3]
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Trang 5TCNCYH 65 (6) - 2009
Ke't q u i nghien cflu v l thflc trang dao tao v l
cac v i n d l cd lien quan.de'n ke ddn cua cac c l n
bd dflpc d i i u tra trong nhflng nam qua cung
phan I n h thflc te la cac c l n bd d tuyen cao cd
n b i l u cP hpi tham gia c i c khda dao tao hdn so
vdi c l e c l n bd tuye'n dfldi K i t qua nghien cflu
v l nhu cau dao tao k h i phu hpp vdi k i t qua ve
thflc trang dao tao Nhu cau dao tao v l cac v i n
d l cc lien quan d i n sfl dung thud'c hdp ly an
toan cua can bd d c l 3 tuyen I I kha cao, v l nhu
cau cua can bd tuyen huyen la cao n h i t Ke't q u i
nay gpi y den viec tang cfldng dao tao va d i o
tao lai cho c l n bd y te cac tuyen, dac biet la
c i p t h i i t dd'i vdi can bd tuyen huyen ve c i c v i n
d l cd lien quan de'n thflc hanh ke don Viec cd
difpc nhflng p b l e dd d i i u trj chuan cho cac
benh thdng thfldng cung la met trong c i c bien
p h i p nang cao sfl dung thud'c hop ly, an toan
trdng benh vien K i t q u i nay cung n h i t q u i n vdi
k i t q u i nghien cflu cua Pham Huy Dung va CS
nam 1999 [4]
V KET LUAN
Sfl dung ky thuat phdng v i n tfl d i i n phieu
cho 1 37 c l n bd y t l chuyen nganh ndi, nhi, lay
thudc t u y i n trung fldng, tuyen t l n h , tuyen huyen
tai 10 benh vien cho t h i y : cac khd khan chinh
cua cac c l n bd tuyen huyen khi thflc h i n h ke
ddn bao gdm t h i i u thdng tin v l thud'c (68,5%),
thieu k i l n thfle dflpc lam sang (47,5%); thie'u xet
nghiem hd trd (59%) Nhu cau dao tao v l c i c
v i n de cd lien quan d i n sfl dung thud'c hdp ly
an toan cua can bd d t u y i n trung fldng: 80,0%;
t u y i n tlnh 9 2 , 4 % ; tuye'n huyen: 9 5 , 2 % Nhfl v l y , can bd y te tuye'n huyen gap n h i i u khd khan trong qua trinh ke ddn va cd nhu cau cao hdn v l dao tao sfl dung thud'c hdp ly an toan so vdi can
bd y te' tuyen tlnh va tuye'n trung flpng
T A I L I E U THAM KHAO
1 Dffdng Le Quyen (2005), "Tim hieu viec sfl
dung thud'c cho benh nhan ndi tru tai benh vien Huyen Ba Vi - Ha Tay," Khda luan td't nghiep
B I c s'/ da khoa - Dai hpc Y Ha Ndi
2 Bo Y te' (2005), "Tai lieu tap h u i n : Hfldng dan sfl dung thud'c hdp ly trong dieu trj," 268
3 Nguyin Minh Hie'u (2006), " K i l n thflc,
thflc hanh ke ddn k h l n g sinh cua c l n bd tram y
te xa trong d i i u tri tre dfldi 5 tudi mac n h i i m khuan hd h i p c i p tfnh tai huyen Binh Xuyen tlnh VTnh Phuc nam 2 0 0 3 "
4 Pham Huy Dung, va cong sff (2000), "Bao
cao thflc h i n h ke ddn thud'c td't nam 1999," T i i lieu hdi thao sfl dung thud'c hpp ly, Vien Chie'n Iflpc va Chfnh s i c h y te' Ha Ndi
5 Sam, I Tomquist, Bjorn Wenngren, Nguyen Thi Kim Chuc, Mattias Larsson, et al (2000),
" A n t i b i o t i c resistance in V i e t n a m : An epidemiological indicator of inefficiency and inequitbale use of health resources, in: EE Efficiency, equity - oriented stragegies for health"
Summary
DIFFICULTIES ASSOCIATED WITH DRUG PRESCRIPTION PRACTICE AND
TRAINING NEEDS REGARDING RATIONAL USE OF DRUG OF HEALTH STAFFS FROM
SELECTED HOSPITALS IN THE NORTH OF VIETNAM
In Vietnam, there remains very little information on difficulties associated with drug prescription practice of health professionals This study aims to describe the drug description's difficulties encountered
by health staffs from selected hospitals in the North of Vietnam while and to assess their training needs regarding rational and safe use of drug This was a cross - sectional study using self - administered