ITl'NGIIUUI&HeHIENCUOl Thifc trang kidn thtfc, thai va hanh vi tim kidm dich vii y td cua cong ddng dd'i vd^i cac bdnh mu 16a cd the phong tranh dtfdc N g u y e n Hffu L e \ Phan Trpng Diing^ Bdi D i n h Long^ Nghien ciiu "Kiin thdc, thdi do, hdnh vi tim kiem dich vu y ticua cdng ddng ddi vdi cdc binh mu Ida cd the phdng trdnh duge" tren dia bdn dnh Nghi An dugc thuc hiin bdi td chdc CBM (Chrisloffel Blinden Mission), Binh vien Mdl linh Nghi An nham ddnh gid kiin thiic, thai ve cdc benh mdt cdng nhu hdnh vi tham gia dich vu y ti' chdm sdc mdt ciia cdng ddng Sti dying phuang phdp nghiin Cliu md id cdt ngang dinh lugng vd dinh tinh tgp trung vdo cdc nhdm dd'i tugng nghiin ciiu gdm cdc nhd hogch dinh chinh sdch, nhiing ngudi triin khai chinh sdch vd cung cd'p dich vu, nhOng ngudi sii dung dich vu bao gdm ngudi ddn thudng, cde gido viin, hgc sinh vd nhiing ngUdi khuyit tgt Kit qud cho thdy kiin thiic cua cgng ddng cdng nhU ehat lugng cde dich vu ehdm sdc, khdm vd diiu tri vdn cdn nhiiu hgn chi, irong cdc vdn de vi mdt vdn dang xudt hien tuang ddi nhiiu lgi tinh Nghi An Td khda: Kiin thiie, thdi dd, md Ida phdng trdnh dugc, dich vu chdm sde mdt Knowledge, attitude and eye care service seeking behaviour of the community on preventable blindness N g u y e n Huu Le', Phan Trong Dung', Bui D i n h Long' The survey of "Knowledge, altitude and eye care service seeking behavior of the community on preventable blindness" in Nghe An province has been conducted by CBM (Christoffle Blinden Mission) coordination office in Viet Nam and Nghe An Eye Hospital by employing a cross sectional qualitative and quantitative study Participants who were recruited into the research are policy makers, policy implemeniers, service providers, and service users such as farmers, teachers, pupils and the disables Findings from the survey show that there is a big gap in community knowledge and limitation of quality in eye care services while blindness and eye diseases are existing public health problems in Nghe An province Keywords: Knowledge, Altitude, Preventable blindness Eye care service Tdc gia: 40 B|nh vi^n Mit Nghe An SdYtdNgh^An Tap chi Y td Cdng cdng, 9.2013, Sd 29 (29) • Ngiy nhSn Mi: 14.7.2013 • NgSy phSnbien: 20.7.2013 Ngiy chinh sila: 30.7.2013 • NgAydilpcchS'pnhSD dSng; 5.8.2013 ITAN6 QUAN & NGHIEN Cliu I D$t vdn de Trong sd khoang 314 trieu ngtfdi ed van de vi thi Itfc tren todn thd gidi hidn cd 45 tridu ngtfdi mii Ida vd 269 tiieu cd lhi Itfc kem 80% cdc nguydn nhdn gay mu Ida cd the phdng iranh dtfde hoac ed the dieu tri [7] Tai Vidt Nam, tinh trdn tdng sddan, ty Id nhffng ngtfdi md chiem 0,53%: d nam Id 0,29% va 0,59% d nff [1] Tinh trang mii Ida vd cdc benh tdt ve mdt tai cdc dia phtfdng trdn toan qudc theo thdi gian cd stf thay ddi, di^u phin ldn Id stf ldc dpng can thidp cua cdc chidn Itfdc chdm sdc mat khdc Kidn thtfc cua cdn bd y td, ngtfdi dan ve cdc bdnh mat khdng ddng deu giffa cac qudc gia, lanh thd va cdc viing mien [2], [4], [5] Nhffng didng lin ve tinh trang mil Ida tai dia phtfdng vd kien ihtfc, nhdn thtfc cua cdng ddng ddi vdi vi^c chdm sdc mat sd ddng vai trd nen tang cho mpt kd hoach hidu qua va kha thi [1] Chinh vi vdy, chung idi da nghidn ctfu: "Kidn thtfc, thdi dp vd hanh vi lim kidm dich vu y td cua cpng ddng ddi vdi cde bdnh mu Ida cd the phdng trdnh dtfdc" nham tao cd sd eho vide xay dtfng chidn Itfdc vd cdc chtfdng trlnh can thidp phdng chdng mfl Ida cd hieu qua vdi di^u kidn Ihtfc td ciia dia phtfdng Mye tidu ciia nghien ctfu Id ddnh gid kie'n thtfc, thdi dp ve stfc khde thi Itfc cung nhtf hdnh vi tham gia dieh vu y id chdm soc mat ciia cdng ddng trdn dia bdn dtf kidn tnen khai dtf dn chdm sdc mat, tdp trung vao cac nhdm ddi ttfdng la phu nff, tre em vd ngtfdi khuyd'l tdt PhtffAig phdp nghidn ctfu Nghidn ctfu thu thap thong lin thdng qua phtfdng phdp md ta cat ngang, kdt hdp dinh tinh vd dinh Itfdng 2.1 Ddi tugng nghien ctiu: Nhffng ngtfdi trien khai chinh sdch vd cung cap dich vu: - NhSn vien y tdlai cdc tuydn linh, huyen, xd va y Id'thdn ban - Nhdn vien vd chii hidu thude - Dai didn cong ty bap hidm - Dai didu cdc to chtfc phi Chinh phu Nhffng ngtfdi stfdung dich vu: - Ngtfdi gap khd khan ve nhin vd vien gia dinh ciia ho - Ngtfdi dan - Gido vidn vd hpc sinh 2.2 Dia diim vd cff mdu: Ky thual chpn mSu phan tang dtf^c dp dung di chpn ddi Itfdng nghidn cihi ttf thdnh phd Vinh, huy^n Yen Thanh, Thanh Chtfdng, Dd Ltfdng tinh Nghd An vdi tidu ehi: dia ban cd Bdnh vi^n Mai (TP Vinh), huydn cd dtf dn chdm sdc mat chuan bi trien khai (Ydn Thanh, Thanh Chtfdng) Tdng mau la 257, dieu tra dtfdc thtfc hidn vao thang ndm 2010 2.3 PhiAfng phdp Phtfdng phdp phdng van sau vd thao ludn nhdm da dtfdc stf dung dd thu thdp nhffng J kidn, ddnh gi^ ve kidn thtfc ciia cdng ddng cung nhtf hidn trang cdc dich vu y td chdm sdc, khdm va dieu iri mdt tai dia phtfdng Nhffng de xuat cho vide trien khai cac hoat ddng can thidp s^p tdi nhkm ndng cao kidn thtfc vd chdt Itfdng cdc dieh vu hen quan dd'n cdc vdn dl vd bdnh ve mat cung dtfdc ghi nhdn Phan lich sd lidu: ddi vdi sd lidu dinh Itfdng, ph^n mem SPSS dtfde stf dung de nhap vd phan deh sd heu Trtfdc nhdp so heu vao mdy, tdt ca cac bp cau hdi deu dd dtfde lam saeh vd kiem tra nhffng bdn ghi thidu sdlidu hole solieu batlhtfcfng Thdng kd md la dtfdc stf dung de md la bd sd lieu theo nhffng Ihdng tin can thidt Ddi vdi nghidn ctfu dinh tinh, ghi ehdp eua cdc dieu tra vidn dtfdc ddnh lai vao cdc vdn ban word vd dtfdc ma hda dd phdn tich theo cdc chu Si phan tich chinh theo muc lidu Kdt qua nghidn ctfu 3.1 Cdc vd'n di hay b^nh vi mdt thitdng gap tgi dia phiiOng 3.1.1 Ddnh gid cua cdng ddng Cde sdUeu dieu tra cho thay dau mat dd/nhiem trung mat la bdnh vi mat dtfde eho la thtfdng gdp hdn cd tai dia phtfdng, chidm 77,8% Gin mpt ntfa ngtfdi dtfdc phdng vdn de cap ddn dau mat hdt va due thuy tinh the (49,8 vd 43,2%) Bdn canh dd, khoang hdn 40% ngtfdi tra Idi phong van cung di cap tdi cdc benh ludi gid Khdng ^ kidn nao ndi den bdnh mat tieu dtfdng 3.1.2 Ddnh gid cua cdn bg y li Theo ^ kidn ctfa cdc nhan vien y td linh Nghd An, ly Id mu Ida tai linh hien Id 0,69% Udc linh Tap chi Y td Cdng cdng, 9.2013, Sd 29 (29) 41 |TiN6«HJtNsNGHIlNCltlf| Bang I Cdc vdn del b^nh ve mdt thiing ggp Cficl>^nhvliiiit Dau mJidD/nhilm iriine % N 77.8 300 C i c t i l khiic xa i l 1E.3 E>gc Ihiiy tinh Ui^ M l 43.2 B ^ h m i l hOi 128 49.8 s 1.9 Chip 18 7.0 B^dh m i l tieu du'Sng Bdng Nhdn biit cua cgng ddng ve cdc van di/binh ve mat c^ng ddng ,^, .l a i "ã' Ctn in.lôMlu 787 SM Bob nil w ã Ueilcimc J»,l ;i3 !4J J7,e 19.0 12.1 ^ l U 7!g 7JJ T9J :na 7!.7 7bJ, -Si tt^t™ 7>i BI.S 75' Jl,7 TIJ) lil.I "^ 9,8 30 = Sl bt 69 '" U d/ntc^i^''"" 79 e.e BJ) 7J SII si.a 7.9 H,9 7«J 83.: fl.' ddn cd 19.000 trtfdng hdp dang chung sdng vdi mu Ida va 60.000 trtfdng hdp suy giam thi Itfc Nhdn vidn y tdtai Nghd An ddnh gid rang cac vdn dl ve stfc khde cua mat vdn dang la mdl thdch thtfc ldn tai tinh vdi tdn dgng mu Ida dang cao vdi cde nguydn nhan due the thuy tinh la hdng diu, sd ngtfdi mac bdnh mat li^u dtfdng cd nguy cd bi mu Ida cd khuynh htfdng tdng len Benh mat d tre em cung dang gdp phan l^o them ganh ndng cho nganh y te'tinh Trong cae eude thdo ludn nhdm, cdc nhdn vidn y td' the hien stf lo ngai ciia ho ddi vdi cdc van de vl tdt khdc xa la mpt benh cd ly Id mac d Ire em d mtfc ddng quan tdm Dd'i vdi bdnh mat tre em: t^ le ngtfdi tra Idi phdng va'n nhdn bidt dau mat nhiem triing nhtf mdl bdnh mat thtfdng gdp d ire em dat ttfdng dd'i cao tdi 90% (Bang 7) 45% dd nghe ndi ddn chan thtfdng mat vd lae mat Nhdn bidt vl edc bdnh mat thdng thtfdng d tre em the hidn it hdn nhdm nhffng ngtfdi khuye't tat, ngoai trtf nhdn bidt vl tdt khd nhin - cao hdn 6,4% so vdi ngtfdi khdng cd khuydt tdt Bdng Cdc vdndi/b^nh vi mdt thUifng gdp d tre em Bdng Nhan biit cua c0ng ddng ve cdc vd'n de/b^nh ve mdt dtre em Cac bfnb \i rail T}Kdj Boa itim VSFIF I M > % -I- Dau zrAl do/nluSm trfiDg 85.7 Cac 1^1 khiic la 71.4 ^ t r •*•*•" Due ihiiy liiih xb.i 14.3 CtdTOOKirtt •"-' Cld-nUiMigmlt iii.n U Benh mil b^l 57.1 M^Ui; 11.4 47 Tang nhin ^p 4,8 r"*^"*" ' 187 24J U gidc mac 0.0 U/Lic 42.9 M^nelhjt 14 Longqutm K.3 3.2 Kien thiic cua cdng dong ddi vdi cdc van de vd b^nh vi mdt Nhan biet vl ede vdn de vd benh ve mat thtfdng gdp: bdnh m^t hdt, dau mat dd nhidm triing, edc tat khuc xa va due thiiy tinh the dtfde bidt ddn nhieu nha't va cao hdn d nhdm nff gidi, ngtfdi dtfdi 50 mdi va ngtfdi khdng khuydt lat Nhdn bidt vl due thiiy 42 Tap chi Y td Cdng cdng, 9.2013, Sd 29 (29) i9.t 893 f i SMIDA " • ' >MnA '^^m \^^M 77.4 liX ^ 8.7 85 ei.s f!« M J S9,l n.1 HJI 4iJ tM 4.V< 4!S 4:.i •4JI -' 31* »; 47 2,,B 90J ' • ' •" ST.: "" Cham sdc, dilu tri cdc van de vd bdnh vl mat d tre em: phan ldn ngtfdi tra Idi phdng vdn cho rdng tre ndn dtfdc dilu In cdng sdm cang td't cd vdn de hoac bdnh ve mat, ty le dat cao hdn nhdm nff gidi, nhdm tudi dtfdi 50 va nhdm khdng khuydt tdt Nhffng ngtfdi khdng bidt thdi didm dilu tri vdn de ve mat idt nhat cho tre chidm 12,2%, the hidn cao hdn d cde ddi ttfdng la nam gidi (13,2%) va ngtfdi cd khuyd'l tat (16,5%) Can bp y te tuydn xd vd bdc sy cdc benh vidn cdng dtfdc ddnh gia cao nhat cung cap cae dich vu ttf van, dilu tri ede bdnh vl mat d tre em ITfHfiaBMftNGHIENCIIUI (32,8 vd 22,6%) Ddnh gid chat Itfdng lot nhat cho cac dich vu ttf cde cdn bp y te' tuydn xa vd cdc bdc sy bdnh vidn edng bdi nhdm ngtfdi tre tupi dat t;y Id cac hdn lan so vdi nhdm ngtfdi tren 50 tudi Ty Id danh gid cao nhat cho dich vu Itf cdc can bd y td huydn dat khidm tdn hdn vdi ehi 7,4% Bdng Hanh vi Ihdi quen tim kiim dfcb vu khdm mdl tgi cgng dong Bdng Kiin thiic cua cgng dong ve cdc biin phdp chdm soc, dieu trj cdc vdn di/binh vi mdt d tre em 1.1") ,.T.„ ^JlT "I^ll? Titncilf H ! ^ I IS'^"'""""* I1IJ6 U,l 12.4 U l 777 >BJ BU S u m lui 1.1 0.0 [)J III BB u 0.£ r-^ii-iittfaitiia L: JJ JJ l i 4.1 IJ UlK I.S 0,1 (U 14 17 OJ 13 10,7 12 IZ." CS«fi^ civil EhteibiA 11.9 Hi u ;,' ãn 12! 16 22A 'STSB' UnUylf.l ClnMylfHqtc Bb:.ôBVHiliuK) BloftU 23 I.) u 09 41 i i ED 74 a j 22,) )t2 ».l 14J> 29,9 li! 12 Cl JJ 1.7 IJ U YU i l IU TVcMuudri 0.0 !>,ô 00 M ISJ ã4 14 J IJ u u nj DJ 01 DI IJ 3.3 Hdnh vi tim kiim djch vtf chdm soc vd diiu tri cdc vdn de hay b$nh ve mat cua cgng ddng Ngtfdi dtfde phdng van cd khuynh htfdng chi tim tdi cd sd khdm mdt cd bieu hi?n dau mat (40,9%) Dtfdi 10% cde ddi ttfdng dieu tra tri kiem tra mdt dinh ky Kidm ira mil dinh k^ hdng ndm dtfde thtfc hidn nhilu hdn d nhdm phu nff, nhffng ngtfdi hdn 50 tudi vd nhffng ngtfdi ed khuyet lalt Mdt t^ 1? khong nhd 7,4% tra Idi khong bao gid di khdm mdt Khi gap vd'n de ve mil 16,7% ngtfdi tra idi phdng vdn lim kidm cdc dieh vu chdm sdc va khdm mdt Nhffng ngtfdi gia va ngtfdi khdng khuydt tat ed khuynh htfdng tri hoan hdn ngtfdi dtfdi 50 ludi vd ngtfdi khuydt Idt (73,3% vd 72,7% so vdi 80,2 va 79,2%) Ty Id tra Idi khdng di khdm cd vdn de ve mat d nhdm phu nff, nhdm ngtfdi ludi dtfdi 50 vd nhdm khuydi tdt the hidn cao hdn khoang lln so vdi cdc nhdm khdc Trong sd nhffng ngtfdi tri hoan ihdi gian di khdm ddn hdn mdt tuan ke itf ed van de vl mdt, phan ddng vi cho rdng vl benh khdng ndng Mm (66,7%), 41.7% vi lo ngai vl chi phi, 16% qud ban hoac khdng cd ngtfdi di cung L^ qua ban dtfdc dtfa bdi nhdm phu ntf va nhffng ngu'di tren 50 tudi Tam ly e ngai kham benh dtfdng xa hay thdi gian chd ddi lau khdng phd bie'n chie'm il hdn 10%, Nam gidi, ngtfdi tren 50 tuoi va ngtfdi khuyet tat dtfa cdc ly nhidu hdn so vdi cac nhdm khac Khdng trtfdng hdp nao tra idi vi cd viec khac quan Irpng hdn Kdt qua dilu tra cho tha'y khoang 54,7% troug sdnhtfng ngtfdi cd di kham da stfdung djch vu kham benh cua cac trung tam y te tuye'n xa, 45.3% stf dung dich vu cua cac bac sy bdnh vien cdng (Bang 7), So ngtfdi den kham tai cac cd sd y td' tuyen huyen chidm ty le thap hdn (27,3%) Chi mot bp phan nhd tim kidm dich vu tai bac sy ttf (1.7%) Khdng trtfdng hdp nao dtfdc khdm bdi y ta thay lang, nhan vien nha thud'c, thay ciing, hay ban be ngtfdi than Giai thich cho viec khdng di kham cd vS'nde ve mat ly van cdn nhin thdy dtfdc de cap tdi nhieu nha't 15,4%, la'l ca sdnay la nam gidi va ngtfdi tren 50 tudi Nhffng ly khdc nhtf khdng tin ttfdng bac sy va cha't Itfdng irang ihie't bi khd khan di chuyen hay chi phi qud cao dtfdc de Tnp chi Y te Cdng cong, 2013, 56' 29 (29) 43 I Tfi'NG QUAN & NGHIEN Clfu I cap den vdi ty Id 3,8% Lo ngai vl chi phi qua cao ehi dtfdc ghi nhan d nhdm nff gidi, ba nguydn nhdn cdn lai dtfdc ndu chi bdi nhdm nam gidi Khd khan di chuydn dtfdc ndu bdi nhffng ngudi Ira Idi phdng van la nam gidi, ngudi tren 50 tudi vd ngtfdi khuye't tgi Khdng cd trtfdng hdp ndo vi e ngai thdi gian chd ddi Idu lai ed sd y id CinAtlvtmtt ,.S, u^m fnljjlf "(.Z'm 7Jm'*' t^«.„«,«.A«.( ln-lS7j 7SJ ns ns ".7 7Jil TSJ » i j 90J> 90,4 U.> >»a TticiiiHylf^ ^ M J io.0 a.i tl.O 489 >2,9 SS3 S4.7 T»iciiib6ylfliuj*i m2 174 2ili 28! 129 21,8 21.' T!iblclJlMiJi"«'in"l 4S3 J2,2 4W iOJ) 42,4 483 4iJ 2J 0,! 2.4 I I 2,1 1,1 J7 K W i f UQtiataeMcif 6.7 no LII OD 0J> 10J1 I J Kblaqntiii^CdiCi 6.7 IhO 0« S9 T.IUcifur UibUitatAUiUi Didiir^DJcMliMD V l n Din nUn H i m QiUdil S.7 BS 0;0 59 " «^ «J 0,0 J.S 26,7 Bfl 44,4 00 111,8 10.0 13.4 DJ) 9,1 0,0 59 S.J 0.0 JJ ^J Sd U?u dieu tra eho ihdy phdn ddng bdnh nhdn da dtfdc dieu in bdi cdc bae sy bdnh vidn cdng vd cac cdn bg y id'tuyd'n xa (46,1 vd 45,5%) Sdbdnh nhdn ciia can bd y td' huydn dat tJ Id thdp hdn khodng hai lln (26,1%) T^ Id tid'p cdn dich vu dilu tri tai tuydn xa ghi nhdn cao hdn d nhdm nff gidi, ngtfdi dtfdi 50 tudi vd ngtfdi khdng khuydt tdt Khdng cd stf khac bid! ddng kd nao dtfdc ghi nhdn giffa edc nhdm dd'i ttfdng dilu tra ddi vdi vide tid'p can dieh vu tff cac bdc sJ bdnh vidn cdng Vide dilu tri bdi cdc bdc sy itf chidm 3%, bdi ban be, ngtfdi than hay ttf dilu tn chiem khoang 4% Vide ttf dieu tri gap nhilu hdn d nhdm nam gidi, ngtfdi trdn 50 mdi vd ngtfdi khuydi tdt ly Id cao hdn khoang 2,5% so vdi edc nhdm khdc Khdng trtfdng hdp nao dtfdc dieu tri bdi nhdn vidn nhd thude, thay lang hode thdy ciing Kdt qua dilu tra cho tha'y da sd bdnh nhan dd mua Ihudc qud trinh hp dieu trj cdc benh ve mat (99,4%) Phan ldn thude dtfdc mua tai cac trung tam cua cdc bdnh vi?n (65.2%), 19,5% mua lai cdc nha thud'c dia phtfdng va 4,9% dtfdc mua lai cae bdc sy ttf Ty Id khach hang la nam gidi Id ngtfdi hdn 50 tudi hay ngtfdi khdng khuye't tdt ciia cdc trung tdm 44 Tap chi Y te Cdng cdng, 9.2013, Sd 29 (29) k b U t fn^slf Tlottt "Zl2U « 97.7 *" 9S.6 94.1 « J SI JS7 3IU1 41.3 49.4 TMcu,M)iftuXn 29.6 22,fi MJl 2S.7 M J 3JJ 26.1 T » M c ^ l » , < , „ h n » 46,9 46.4 43,0 KLO JJJ 49J 46,7 3J >J) IJ 3JI 06 95 " • ' 45J T o U c - u 1.2 'X i J T » l , 0.0 OJ 0,0 L.2 IJ OJI T«nbUv.»nl»,Ll>i(& 12 IJ 0,11 13 13 IJ U T ^ nEiKT, U i l c 49 2,4 l.< !S iD 0,0 3.6 T«cb3.l oU 49 !,4 W 47 SO 14 W 98.S lOOJ, 98.7 "^ M ,«« 99.4 72J S8J W I M.> 64;6 659 65.2 6,3 3* S.I 41 7jl 14 4.9 16,3 22.6 20J 186 24.1 1)3 19 l),8 IJJ II.J \1A li.2 141 146 S.X^*""""' T v i T r v i f iln T d l A ^ D H,=d,U,ir Cd 95,9% sdnhffng ngtfdi ed di khdm gap cdc vdn de hay bdnh vl mat da tham gia dieu tri, 4,1% edn lai khdng dilu tri - sdlidu (Bang 8) lirf^ll T » c t n M y , £ d KM»S 72.8 Cv « t u n t u !.< t £ - ^ , T Bdng Thifc hdnh diiu trj gap cdc vdn de/binh vi mdt cua cdng ddng I^IMI Bdng Tim kiim dich vp khdm ggp cdc vdn de/b^nh vi mdt cua cgng dong " • ™ - bdn thud'c cua cdc bdnh vidn cao hdn so vdi cac khach hdng khac Chieu htfdng ngtfdc lai dtfdc ghi nhdn ddi vdi nhffng khdeh hdng mua thud'c lai cac nha Ihudc dia phtfdng h f i t i i-Jtn 3.4 Slf tiip cqn cdc dich vif y ticham soc, khdm vd dieu tri cdc v£[n di va b$nh vi mdt cua cgng ddng Bang the hidn stf tidp can cua cgng ddng vdi cdc ngudn thdng lin ve cdc vd'n de hay benh ve mat tai dia phtfdng Sd' lieu thu thdp cho thay hdn 80% cdng ddng dtfde bid't dd'n edc vd'n dl vd bdnh mat thdng qua ede chtfdng trinh tivi, va khodng 67% cdc thdng lin ddn tff dai phdl vd loa truyin eua phtfdng Cac can bp y Id' mydn xd eung cd vai trd truyen thdng dang ke vdi ty Id dat 65,4% Ngodi cac cdn bd y td tuydn huyen va cdc bac sy cung la kdnh thdng tin dang ke, dat ty Id itfdng tfng Id 46,7% va 55,3% Thdng tin iff ban be vd nhffng ngtfdi thdn ed lam anh htfdng nhat dinh ddn nhffng kidn thtfe vl cdc vdn dl va benh mat ciia ngtfdi dan dia phtfdng (28,8% vd 36,2%), tham chi cao hdn so vdi ede y ta (21,4%) vd dtfdc sy (19,8%) Vai trd ciia Id rdi va dp phich edn khiem id'n, ehi chidm dtfdi 10% Mot sd' nhd cdc dd'i ttfdng phdng va'n tid'p edn thdng tin cdc bdnh vl mat thdng qua iiy ban nhan ddn, giao vien hoac edc thay lang (9 f j Ki 7a.: tS.1 U t a t T&,rf 1IMl ?' rô l i 7J JJ ãJJ 603 M < fc7 70.4 IJIWIJI^''"' rUBtl•^•4t % • « • • Ctv *^tir***"* *.^'iir"**'* t»db ^i^'ji^-i c* Bang 11 nid la cac yeu td kinh te cd anh htfdng idi kha nang cdng ddng liep can va stf dung dich \ u cham sdc kham va dieu tri cac van de va benh ve mat Bao hiem Y te dtfdc coi la mot nhffng hinh thtfc hd trd v l mat kinh te' giiip cpng ddng tang kha nang tiep can va stfdung cac dich vu y t d l i e n quan de'n cac van d l va cac benh ve mat Tuy nhien chi 66.4% s6'257 ngtfdi dtfdc hoi co mua bao hiem y te Ty le cao hdn d nhdm nam gidi nhom tren 50 tudi va nhdm khuyd'l lai Ly dtfdc dd cap nhieu hdn ca cho viec khdng mua bao hiem y le la gia qua dat (19.6%) va khdng cd diem ban (11,6%) Quan diem cho rdng mua bao hie'm y te'la khdng can thie't cung dtfdc de c a p tdi chi vdi ly le 3.5% Ty le ngtfdi khong khuyd'l tat cd quan die'm cao gan gap ddi so vdi d ngu'di cd khuydi tat Ket qua thu dtfdc qua phong van cho thd'y chi 15.2% cho rang chi phi de di tdi cd sd y id la re 4,7% cho rang qua dat va \ tfdr ngoai kha nang chi Tap chi V te Cong cdng, 9.2013, Sd 29 (29) 45 ITgHGaUM&NGHrENeirDI tra, 17,9% cho rSng dat nhien van cd the chi tra Doi vdi chi phi kham chffa benh ndu khdng cd stf hd trd cua bao hiem y td, hdn 50% ngtfdi dtfdc hdi ddnh gid la ddt bode qua dai, khodngl/3 sd dd khdng cd kha ndng chi tra TJ Id nhtfng ngtfdi ddnh gid chi phi ndy la re rd'i thap, chi chid'm 3,5% VI chi phi mua thude ndu khdng cd bao hiem y id, 31,9% tra Idi khdng ddt hoac re, sd ngtfdi tra Idi dat hode qua dat chidm 68,1% Ty le ddnh gid cdc loai chi phi Id qud dat the hidn cao hdn d nhdm ntf gidi, nhdm trdn 50 tudi va nhdm ngtfdi khuyd'l tdt, quan diem dat nhtfng van cd kha nang chi tra gdp d cac nhdm ngtfdc lai B^n lu^n Kdt qua dieu tra cho thd'y cac vdn de ve mdt dang xuat hidn ttfdng ddi nhieu tai tinh Nghd An, kid'n thtfc cda cpng ddng cung nhtf chdt Itfdng cdc dich vu cham sdc, khdm vd dilu tri vdn cdn nhieu ban chd' Cde bdnh mat thtfdng gdp tai dia phtfdng, theo J kidn ciia nhffng ngtfdi dtfdc phdng va'n, gdm cd dau m^t dd/nhiem trung mat, benh mdt hot va due thuy linh thd O dd'i ttfdng tre em, dau mat nhidm trtfng mat vd cdc tdt khdc xa cdn dtfdc chd 5^ hdn ea Cac bdnh ve mat tudi gia va mpng ihil cung dtfdc nhtfng ngtfdi tra Idi phdng van cho la nhffng benh mai mdi va ddng Itfu tdm Stf tid'p can vdi cdc ihdng tin lidn quan tdi cham sde, khdm va dieu tri cdc benh mdt the hidn khdc giffa nam vd nff, ngtfdi trdn va dtfdi 50 tudi cung nhtf giffa nhffng ngtfdi cd khuydt tall va khdng cd khuyd'l tat Phu nff, ngtfdi Idn luoi va ngudi cd khuydt tdt dtfdng nhtf cd it cd hdi hdn so vdi nhffng ngtfdi cdn lai Hau he't cdng ddng cd J thtfc vl vide bap vd mat thdng qua vide giff vd sinh sinh boat hdng nhtf stf dung ntfdc sach va diing ridng khdn mat Khoang 50% sd ngtfdi phdng vdn dl cdp dd'n cac kie'n thtfc khdc nhtf deo kinh bao hd lam vide, dpi mu vd deo kinh ram di nang, khdm mat dinh kJ hay an nhieu thtfc dn giau vitamin A Khi tre gap cdc vd'n dl ve mat, ngtfdi ddn dia phtfdng da phan eho rang ndn dtfa tre di khdm cang 46 Tap chi Y td Cdng cdng, 9.2013, Sd 29 (29) sdm cang td't Cdn bp y id tff edc trung lam y id tuydn xa, va bdc sy cdc bdnh vidn cdng dtfdc tin nhidm la nhffng ngudi cd the cung ca'p dich vu ttf vdn vd dilu tri td't nhd't chp tre Ra't it ngtfdi dan dia phtfdng tri thdi quen kidm tra mat dinh k^, ehu yd'u chi di kham mat ed vdn de Phan ddng thay cde bieu hidn bdnh cua mat thi l§p ttfe tim de'n cdc cd sd y td de khdm va dieu Iri, chi thidu so' tri hoan den hdn mot luan Nhdm phu nff, ngudi cao ludi va nhiftig ngtfdi cd khuyd't tdt cd khuynh htfdng tri hoan hdn cdc nhdm khac vide tim kie'm dich vu y td' cd benh Ly phd bidn nhdt cho stf tri hoan Id khdng coi vdn di dd la nghidm trpng bpdc dp ehi phi qud td'n kem, Trong sd'nhffng ngtfdi di khdm mat, pban ddng tie'p tuc Iham gia vdo qud trinh dilu tri Can bd y te' tuydn xa, vd bdc sy tff cdc benh vien cong vln la nhtfng tfu lien benh nhan Itfa chpn dich vu dieu iri Mdl sdrd't it bdnh nhdn tim dd'n cdc y td, dtfdc sy hode Iff dilu tri tai nha Trong qud trlnh dieu tri, trung tam thude cua bdnh vidn thu hdt dtfdc ddng dao bdnh nhdn tdi mua thud'c hdn so vdi cde nha thude ttf nhan lai dia phtfdng Rao can chinh han chd' viec tidp cdn vdi cdc cd s6 y id ve mat la chi phi kham, chffa benh va mua Ihudc dat, thdm chi nam ngodi kha ndng chi tra cua mpt bp phan ngtfdi dan, Tuy bao hiem y tdvan dtfdc coi la mdt bidn phdp hd trd vl chi phi, ly Id ngtfdi khdng mua bao hiem y id van cdn cao vdi mdl sd' nhffng I^ chinh la chi phi mua bao hiem qua dat Ye'u to'thdi gian va khodng cdch khdng phai Id mdt rdo can tai dia phtfdng bdi da phan ngtfdi dan sinh sdng gan cdc cd sd y td khdm, chffa mat Ngtfdi cd khuydt tdt phai do'i mdt vdi nhilu khd khdn hdn de tidp can vd stf dung cde dieh vu chdm sdc, kham va chtfa bdnh ve mat hi le thupc nhieu hdn vao gia dinh D^ giai quyd't nhffng khd khan, rdo can dang tdn tai va nang cao chdt Itfdng dich vu kham, chffa benh ve mat doi hdi stf phdi kd't hdp va can thiep loan didn khdng chi giffa cac cd'p quan 1^, cac cd sd y id' md ca irong cpng ddng, huy ddng stf ho trd ea ve kinh phi va chuydn mdn tff cac td chtfc phi Chinh phu va cac ban nganh, doan th^ ITdNGQUANK ^ Tdi li^u tham khio 2006Oct;13(5);309-20 Tidng Vi«t Leite C, Zin A.Health seeking behavior of the families of children with cataract attending an eye clinic in Rio de Janeiro, Brazil Arq Bras Oftalmol 2011 JnlAug;74C4):271-8 Kdboach qudc gia phdog cbdug tab 16a v^ cham soc mat oSm muc d£u thi giic 2020 cda Vi5t Nam - Giai ttoan nam 2009 - 2013 B^ab vi^a mdt tnmgtfcfng- Ban chi dao quoc gia ph6Dgchdng mO Ida - B$ Y td, editor, l - l l 8010 Tidng Anh Ammary-Risch N Kwon HT, Scaibrough W, Higgiubotham E Heath-Watson S.Minority primaiy care physicians' knowledge, attitudes, and practices on eye health and preferred sources of information J Natl Med Assoc 2009 E>ec;101(12):1247-53 du Toil R, Ramke J, Naduvilath T, Brian G Awareness and use of eye care services in Fiji Ophthalmic Epidemiol Muhit MA, Shahjahan M Hassan A, Wazed A, Ahmed N.Parental Knowledge, attitude and pracdcc related to blindness of children in some selected Upazilla of Bangladesh Mymensingh Med J 2011 Oct;20(4):671-9 Nirmalan PK, Sheeladevi S Tamilselvi V, Victor AC Vijayalakshmi P, RahmathuUah L Perceptions of eye diseases and eye care needs of children among parents in niral south lodia: the Kariapatd Pediatric Eye Evaluadon Project (KEEP) Indian J Ophthalmol 2004 Jun;52(2):163-7 Vietnam National Instimte of Ophthalmology Results of Rapid Assessment for Avoidable Blindness (RAAB) in 16 provmces of Vietnam 1-12-2007 Tap chi Y td C d n g cdng, 9.2013, Sd 29 (29) 47 ... cdn bp y te' tuydn xa vd cdc bdc sy bdnh vidn edng bdi nhdm ngtfdi tre tupi dat t ;y Id cac hdn lan so vdi nhdm ngtfdi tren 50 tudi Ty Id danh gid cao nhat cho dich vu Itf cdc can bd y td huydn dat... kham benh cua cac trung tam y te tuye'n xa, 45.3% stf dung dich vu cua cac bac sy bdnh vien cdng (Bang 7), So ngtfdi den kham tai cac cd sd y td' tuyen huyen chidm ty le thap hdn (27,3%) Chi mot... tai bac sy ttf (1.7%) Khdng trtfdng hdp nao dtfdc khdm bdi y ta thay lang, nhan vien nha thud'c, thay ciing, hay ban be ngtfdi than Giai thich cho viec khdng di kham cd vS'nde ve mat ly van 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