Vfli dfc tiift nhflm bfnh chuyin khoa ttong dfl cfl rit nhiiu nhflm bfnh ic tftih giy inh hudng idn din chit lugmg cuflc sing ngirfli bfnh do Vifn iufln mong muin cung cip dugc mflt
Trang 1DANH GIA SITHAI LANO V£ CONB TAC CHAM sdc sunc KHOE cdn NGUlin ^_
Oliu TRI NOI TRO TAI V I ( N HUY£T HOC - T R U V I N MAU TRUNG UDNG N A M 2011
Bfti Nggc Dflng*, Tf Thj BIch Hi", Nguyin Khic Tuii*, Nguyin Mai Phugng*, Nguyin Hoa Vin*, Nguyin Thj Nhii*, Bfti Dftc Chiin*, Nguyin Thj Hvomg*, Nguyin Thj Minh Nguyft*, Dl Thj Huf'
T 6 M TAT:
t kiin cfla ngudi binh v i djch vu chim sflc
sfte khie (CSSK) cfl y nghia quan hgng gdp
phin glClp bfnh viin c i i tiin chit lugng djch vg
Nghiin cftu niy do ludng sg h i i idng cfla ngudi
binh diiu trj nfli tni tgi khoa l i m sing V l i n Huyit
hgc- Tnjyin m i u Tmng uong nhim tim hiiu
quan diim cfta ngudi binh v i nhftng mong dgi
c i a hg v i d|eh vu CSSK cfta Vifn Phuong phip:
D i y l i nghiin cftu mfl t i e i t ngang duge thgc tft
9/2011 d i n 12/2011 O i l tugng nghiin cftu g i m
390 nguflri binh diiu tr| nfli bft xuit viin ttong
thdi diim nghiin cftu Kit q u i nghiin cftu eho
thiy: T^ If h i i Idng chung cfta ngudi binh dgt
67,2% T ; l i hii ldng cOa y i u t i giao tiip, hrarng
t i c vflri nhin viin: 81,6% ( c i c h i u mgc ttong y i u
t i niy dao dflng tft 7 2 % d i n 98,2%), Ty l i h i i
hii Idng vdi k i t q u i diiu tri, chim sflc dgt 7 8 %
(74,6% d i n 95,1%), h i i Iflng v i thdi gian chd
Hip cfn djch vg CSSK l i 66,8% (71,5% d i n
89,2%) v i h i i Iflng v i diiu kifn vft chit/djeh vg
dgt 58,8% (62,2% d i n 79,2%) Nghiin cftu cDng
ehi ra m i i liin quan cfl y nghia thing k i gIfta s v
hii Iflng chung vdi tuii, hfln nhin, noi c u bft,
Mnh dfl hgc v i n cua ngudi bfnh
S U M M A R Y :
Background: Patients's opinion regarding
health care quality has acquired great
importance Patient's satisfaction play an
increasingly important role in quanlity oT care
reforms and health- care delivery The study
aimed to measure patient satisfaction at clinical
departments in order to know the patients'
* Vlin Huyit hpc - Tmyin miu Tmng uang
P h i n bifn khoa hgc: ThS Bach Q u i c K h i n h
perspectives and expectation of the senk»s and make appropriate improvements accordingly Methods: This was a cross-sectkmal study conducted at National Instlhite of Hematology and Blood Transfusion, fdr a period from September to December 2011 Sample size was
390 In-patients Results: Among die partrcipants, overall satlsfactxjn rate was equal to 67.2% Satisfaction rate of communication skill of health wori<ers was 81.6% (sub-categories ranging fram 72% to 98.2%), satisfied with care senrice was 78% (74.6% to 95.1%), satisfied with waiting time
to access health care servk:es was 66.8% (71.5% to 89.2%) and satisfied with facilities/services was 58.8% (62.2% to 79.2%) Age, marital stahjs, demographtes (urban/niral), educational level of patients was significantly associated with satisfaction level
I.OATvXNOf:
Qui trlnh phit tiiin djch vy y ti ttin thi giflri vi tfd Vift Nam cho tiiiy chit lugng CSSK li yiu to rit quan tt'gng, quyit #ih s\i tin t{u cfta bfnh vifn Cfl nhiiu phuong phip
di dinh gii chit lugng CSSK, nhung ngiy nay, sv hii ldng cfla ngudi bfnh li mflt nfi dung quan trgng efta chit lugng bfnh vifn [3] Dinh gii hii iflng cfta ngudi bfnh giiip^ bfnh vifn cd dugc nhftng thflng tin can tia&vE
mft m^tii, mft h ^ chi trong cflng tic CSSK,
tft dd diiu chuih, can tiiif p kjp tiidi di dip ftng nhu ciu ngiy cing cad efta ngudi bfnli
Trang 2Li mflt CO sd diiu trj chuyin khoa diu
nginh, hing nim Vifn Huyit hgc- Truyin
miu Trung uong tiip nhfn hing chye nghin
lugt ngudi bfnh diiu tii nfli tiii Vfli dfc tiift
nhflm bfnh chuyin khoa ttong dfl cfl rit
nhiiu nhflm bfnh ic tftih giy inh hudng idn
din chit lugmg cuflc sing ngirfli bfnh do
Vifn iufln mong muin cung cip dugc mflt
djch vv khim chila bfnh cfl chit lugng eao
dem Igi sv hii Iflng cho ngudi bfnh Tft
nhftng li do tt^n, chftng tfli tiin hinh nghiin
cftu niy vfli 2 myc tiiu: (1) Mfl ti sg hii iflng
cua binh nhin nfli trft vi chit lugng CSSK
tfi Vifn Huyet hgc- Truyin miu Trung
uong; (2) Xic dinh cic yiu ti liin quan din
sv hii Iflng cfta bfnh nhin ngi trft vi chit
lugng CSSK
II B 6 | TUI>N6 VA PHUDNG PHAP NGHIEN COU: 2.1 Dii tirgrng nghiin cftn: 390 bfnh nhin xuit vifn sau diiu tii tgi Vifn 2.2 Phvorne phip nghiin cftu
2.2.1 Thiit ki nghiin ciru: Mfl ti eit
ngang cfl phin tich
2.2.2 Thdi gian nghiin civ: tix tiling
9/2011 din tiling 12/2011
2.2.3 Bia diim nghiin cAu: Vifn Huyit
hgc- Truyin miu Trung uong
2.2.4 Phiromg phip chpn miu: chgn
mlu tiiufn tifn
2.2.5 Chlsi nghiin ciru vi bf cing c{i nghlln ciru: Cic chi si nghiin cftu dugc xiy
dvng dva ti^n tham khio mgt si nghiin cftu tgi cic bfnh vifn d Vift Nam vi trin flii gidi [1], [2], [4] Bg ciu hdi ed 04 yiu ti gim 20 tiiu myc hii Idng:
1
2
3
4
Yiu t i h i i Iflng/Chi s i dinh g l i
Thdi qian chd khi tiip c$n d|ch vg
Giao tiip, hronq tic vdi nhin viin
Co sd vit chit, djch vg
Kit qui diiu trj chim sflc
S i lugrng tiiu mgc
6
5
5
4
• Voi moi ngi dung hfli, sft dung thang danh gii Likert 5 mftc dfl tft rat khflng hii Iflng (1 diim) din rat hii Iflng (5 diim)
2.2.6 Thu thap so llfu: bing phil vin Ngudi bfnh tut diin vio phiiu khio sit 2.2.7 JOr If si lifu: phin mim SPSS 15.0
III KET QUA NGHIEN COU:
3.1 Thflng tin chung vi dii tirgrng nghiin cftn
Bang 3.1 Thflng tin chung vi doi tugng nghiin cftu
TT
1
2
3
4
Cic y i u t i die trung cfta NB
Tufli:
Gidi:
TInh trgng hfln nhin:
Noi cu ttfl:
Trin 60 S60 Niy Nam Banged qia dlnh' Bpc thin/chua lip qia dlnh NOnq thin/miin nil*
Thinh thi
N
63
272
203
187
259
103
230
151
Ty l i % 18,8 81,2 52.1 47,9 71,6 28,4 60,4 39,6
Trang 3TT
6
6
Cic yiu t i die tnmg cfta NB
Trlnh dfl hgc vin:
S i lin diiu trj binh:
i Truna dp'
iCioS Lin diu' Nhiiu lin
N
122
266
102
286
T * l i %
31.4 68,6 26.3 73,7
Kit qui cho tiiiy: df hiii chft yiu li < 60 tuii, Dii ttigng sing d vftng ndng tiifln/miir nfti chiim t^ If cao hom tiiinh tiij; nhflm cfl trinh df tft cip 3 trd xuing chiira tjr If cao hon sc vdi nhflm cfl ttinh df tft ttimg cip trd lin; dii tirgmg dang cd gia dinh cao hon nhflm dfc diin/chua Ifp gia dinh; di diiu tr) nhiiu dgt cao hon si din diiu trj lin diu
3.2 HU ling cfta ngirdi bfnh nfl trft vi chit luvng chim sic tin khie
3.2.L Hii ldng cia ngu&i bfnh vi Ih&tglm tiip cfn djch vif
Bing 3.2 Ti ij hii ldng cfta ngufli bfnh vi flifli gian tiip cfn djch vy
TT
1
2
3
4
5
6
Chl s i dinh oli
Thdi gian chd lim Ihu tgc ding k<; khim
Thdl gian chd khim tai khoa khim binh
Thflri gian ehd khim khi nhip khoa
Thdi gian chd lim xit nqhiim
Thdi gian ehd khi cin dugc glOp dd
Thflri qian lim thft hic ttianh toin ra vlin
Hii Ung (%)
71,5 79,2 89,2 80,0 86,9 72,8
ChlflHL|%) 28,5
20,8 10,8 20,0 13,1 27,2
Ngudi bfnh hii ldng cao nhit li thdi gian chd khim khi mdi nhfp khoa, thip nhit li hii Idng vfli thdi gian chd ding k^ t^i khu tiip ddn,
3.2.2 Hii ling cia nguiri bfnh vi tinh Ihin, thiidfphffc v{i nhin vllnyti
Bine 3.3 Ti if hii ldng efta ngufli bfnh vi tinh tiiin, thii dfl cfla nhiii viin
TT
1
2
3
4
6
Chl s i dinh gli
Thai do tiip dfln efta nhin vlin khoa khim bflnh
Thai dfl tiip dfln efta nhin viin ktioa diiu tri
TInh thin, thii dfl cfla bic si khi thim khim
Tinh thin, thii dfl cua diiu dudnq khi chim sdc
Tinh thin, thii dfl cfla nhin viin thu vlin phi
Mil Idng (%)
88.7 94.9 98.2
94,6
72,0
ChiraHLI%l
11.3
5,1 1.8 5,4
28,0
Ngudi bfnh hii Idng cao nhit Ii vfli tinh diin, tiiii df cfta bic sT khi thim khim, tiiap nhii
li hii iflng vfli tinh tiiin, tiiii df cfta nhin viin tiiu vifn phi
3.2.3 Hii ldng cia nguH bfnh vi ca s& vft chit, djch vp ciia Vifn
Bing 3.4 Ti If hii Iflng efta ngufli bfnh vi co sd vft chit, djch vy
TT
1
2
3
4
5
Chl s i dinh g l i
Tiin nqhi buflnq binh
V i sinh buflnq binh
V i sinh chung cua khoa, phflnq
Dich vu cua Viin: i n uflng, giit l i , bin hing
Cunq cio dfl dilng c i nhin: chin, qa, qii, dim
Hii Idng (%)
79,2 75,1 66.7 62,2 81,5
Ch»aHLI%)
20,8 24.9 33.3 37.8 18.5 J
Ty If ngudi bfnh hii ldng cao nhit vcH vifc eung cip di dftng cd nhin: chin ga, £
io, thip nhit li vi djch vy; gift li, in uflng, bin hing
Trang 43.2.4 HU ldng cia ngudi bfnh Oil vdi kit qui CSSK
Bing 3.5 Tl If hii ldng efta ngudi bfnh vi kit qui CSCK
Chl s i dinh ali
Hii Iflng vi kit qui diiu tri
2 Hii Iflng vJ chflm sflc diiu dudng
Hii ldng v i GDSK cia cin bfl y t i
Hil ldng 1%) 93,1 95,1
Chua HL (%1 6,9
11,0
Ty li ngufli bfnh hii Iflng eao nhit li chit lugng cflng tic chim sflc ciia diiu duSng, thip nhit li ty If hii Iflng vi giio dvc sftc khfle cfta nhin viin y ti
3.2.5 Tf If hil ldng theo tiing yiu ti:
Bing 3.6 Ti If hii long cua ngudi bfnh theo timg yiu ti
TT
1
2
3
4
Chl s i dinh gli
Thdi qian tiip cin dich vu
Tinh thin, thii dfl cin bfl v ti
Co sd vit chit, djch vg
Kit qui diiu hj, chflm sflc
Hil Idng (%) 66,8 81,6 58.8 78,0
Chua HL (%| 33,2 18,4 41,2 22,0 T^ If hii idng cao nhit li vi tinh tiiin, fliii dfl nhin viin y ti vi kit qui CSSK Thip nhat
li vi CO sd vft chit/djeh vg vi thdi gian ehd tiip cfn djch vy
3.2.6 Tf If hil ling chung cua ngu&i bfnh
'(J'' Bing 3.7 Ti If hii Idng chung efta ngudi bfnh
Ty If hil Iflng chung Hil Iflng I%1
67,2
Chua HL(%) 32,8 Theo kit qui nghiin cftu, ty if ngudi bfnh hii Idng chung d^t t^ if 67,2%, Kit qua niy dugc tmh dya trin ti hgp vi 4 yiu ti hii idng: Thfli gian tiip cfn dich vy, tiiii dfl nhin viin,
CO sd vit chit/djch vy vi kit qui CSSK
33 Mii lien quan giira sa hai ldng chung vdi cic yiu to nhan khiu hgc cfta ngudi bfnh Bing 3.8 Mii lien quan gifta hai idng chung vdi cic yiu ti nhin khiu hgc cfta ngudi bjnh
Cic yiu t i dfc trung cfta NB
Tuil:
Gidi:
Tinh trang
hfln nhin:
Noi eu ttii:
Trlnh dfl hgc
vin:
Sfl lin diiu tti
bjnh:
seo' Trin 60 NO' Nam Bic thin'
Cd gia dlnh Thinh thi' Ndng thdn
a Tmnq dp'
SCip3 Nhiiu tin' Lin diu
Hii Idng
171 Khflng
HL
101
65
63
101
100
OR (Cl= 95%) 2,51 (1,28-4,93) 1,18 (0,78-1,81) 1,17 (0,73-1,85)
(1,2-2,9) 1,84 (1,17-2,90) (0,90-2,47)
P < 0,05
P > 0,05
P > 0,05
P < 0,05
P < 0,05
P > 0,05
*Nhim dOng di so sdnh
Kit qui cho tiiiy khflng cfl moi lien quan giOa hii iflng chung vdi gidi tinh, tinh ttang hfln nhin, si lin nhfp vifn (p > 0,05) Nhung cfl mii liin quan vdi ttiii, noi cu ttii vi ttinh dfl hgc van (p< 0,05)
Trang 5IV, BAN LUiJiN: nlifn, gift, tri di vii cin sgch si, diy dft vi
- Sy hii Iflng cfla ngufli bfnh vi thdi nhanh chdng hon, Cfln dii vdi tifn nghi co gian tiip cfn djch vy: sd vft buing bfnh, eic di dftng ei nhin dugc 1^ If ngudi bfnh hii ldng vdi yiu ti niy cung cip (chin, ga, gii, dfm ) thi tf' If hii dgt tiiip (6S,8''/o), dfc bift liin quan din tiidi ldng cfta ngufli bfnh li khi cao
gian ding k^ chd khim (71,5%) thanh todn - Hii Idng cfta ngudi bfnh vflri kit qui vifn phi (72,8%) Di cii tiiifn tinh ttgng niy chim sflc sftc khfle:
cin phii hgp nhiiu giii phip cy tiii: ti chfte T^ If ngudi bfnh hii Iflng cfta yeu ti niy
tiidi gian lim vifc tgi khoa khim bfnh; sy iV 78% Trong dd ty hii Idng dii vfli kit qui
hudng din, giii tiiich cfta nhin viin vi cic diiu tii li khi cao (93,1%), T^ If hii Iflng vi
tiift tyc, quy trlnh; ti chfte tiip dfln, ding kf, chim sflc cfta diiu duflrng li cao nhit bong
ggi khim lin lugt dftng theo tiift ty; da dgng cic yiu ti niy (95,1%), T^ If hii Iflng cfta hon nfta cic phucmg tifn truyin thflng, giii ngudi bfnh vi giio dye sfte khde cfta nhin
bi tgi khu vyc chd, viin y ti dgt mftc thip hom (89%)
- Hii Idng cfta ngufli bfnh vi tinh thin - T^ If hii Idng chung:
thii df cua nhin viin y ti: Nghiin cftu cho thiy ty If hii Idng dning
Ty If chung dgt 81,6% Tong dd ty if hii cfta ngudi bfnh dgt 67,2% Kit qui niy dya Idng dii vfli tinh tiiin, diii df cfta nhin viin ti^ sy phin tich thing ki ti hgp cfta tit ci
bf phfn tiiu vifn phi chua cao (chl dgt 72%) cic tiiu myc hii Iflng
Dieu niy cin tiip tyc dugrc quin ttift vi cii - Liin quan giita hii Idng chung vdi yiu tiiifn hon nfta trong tiidi gian tdi Cdn Igi, ti xi hfi, nhin khiu cfta ngudi bfnh:
ngudi bfnh rit hii Iflng tiiii df cfta bic si khi Nghifn cftu cho diiy nhftng ngudi bin 60 tiiim khim (98,2%), thii dfl diiu dudng khi hiii hii Iflng cao hon so vdi nhflm < 60 hiii chim sflc (94.6%), tiiii dg dfln tiip efta khoa Dii tirgng siidi sing d khu vyc ndng diflnAniin diiu tii (94,6%), thii dfl dfln tiip cfta khoa nfti hii Iflng cao hon so vdi nhdm khu vyc khim bfnh (88,7%) tiiinh tiij, Nhdm cd tttah df hgc vin tir cip 3
- Hii Idng cfta ngufli bfnh vi co sd vft trd xuing hii Idng cao hon so vfli nhdm cfl chit, djch vy: tiinh df tii ttung cip ttflr Iin (P< 0,05)
Ty If hii ldng cfta yiu ti niy khi tiiip do Khi phin tich mii liin quan gifta nhu ciu inh huflmg cfta sy hii Iflng tiiip cfta ngudi vfli ttjii, tic gii Rob Sanson- Fisher cho
bfnh doi vfli tinh trgng vf sinh, djch vy gift diiu niy li kit qui cfta sy khic nhau vi tiiai
li, in uong cho dft sy hii iflng vi sy tifn nghi dfl bfc If quan diim vi nhu ciu cfta bin tiiln,
vi eo sd vft chit ii khi cao Tinh tt^g vf ngufli tri cfl xu huflmg di ding bfc If cam sinh khflng tit li do chit lugng cflng ty vf xfte, nhu ciu efta minh, cfln ngudi gii hom co
sinh ngiy cing kim cftng nhu i thftc gift gin xu huflmg tin ring bin tiifin cd khi ning dii
vf sinh efta ngufli bfnh vi ngudi nhi cftng mft, chju dyng dugc cic viri di, chhih vi vfy chua tot Dii vfli djch vy in uing ngufli bfnh hg si co gift khflng bgc If tiiii dg vi nhu cau mong muin dugc tu vin dinh dudng nhiiu niy[5] Cdn theo nghien cftu cfta Sook Yeon hon cflng nhu ning cao chit lugng phyc vy, Hwang, sy khic bift lien quan din ttinh df
da dgng hda eic mdn in di phu hgp hom vdi hgc vin, noi cu till ed tiii Ii do nhflm dii
khau vi Ngufli bfnh cflng mong muin vifc tugng cfl trinh dfl hgc vin/chuyin mon tiiip,
Trang 6sinh sing d khu vyc nflng thfln thudng cfl
diiu kifn kinh ti- xi hfli thip hon, hg it cfl eg
hfli thfla min cie nhu ciu djch vy cufc sing
cfl chit lugng tit, do vfy dl hii Idng vfli tinh
trgng hifn tgi hem Ii nhthig ngirdi cd trinh dfl
hgc vin/chuyin mfln, thu nhfp cao hon [6]
V KET LU$N:
Kit qui diiu tra cho thiy iing ti If hii
chung cfta ngudi bfnh li 67,4% T^ If hii
ling vi giao tiip, tucmg tic cfta nhin viin
j (81,6%); T^ If hii ldng vi kit qui CSSK dgt
78% Hii ldng vi thdi gian chd dgi nhfn djch
vy CSSK Ii 66,85%; Hii Idng vi eg sd vft
I chit/djch vy li fliip nhit 58,8%
T^ If hii Idng d nhdm tuii tt^n 60 cao
hon nhflm ttiii < 60; Nhflm sinh sing d vftng
nong thfln hii Iflng cao hon nhflm thinh thj;
{ Nhflm cfl trinh dg tti cip 3 trd xuing hii ldng
cao hon nhdm trinh dfl tir ttimg cip ttd lin
VI KHUYE'N NGHj:
Ti chfte tit quy trinh ding ky, khim tti
I kit qui sdm tgi khoa kham bfnh
Ti chiirc nhiiu phuong tiin truyin thong
Igi khu vyc chd cfta khoa khim bfnh: tivi, gii
lyng tii lifu, tranh inh tuyin truyin, giio
^ c sftc khoi
Cii tiiifn ky ning giao tiip vfli ngudi
bfnh dii vfli tit ei cin bg nhin viin, dfc biit
(i bfl phin thu vifn phi vi bg phin dfln tiep
tai khoa kham lif nh
Cii tiufn chit lugng djch vy: vf sinh,
dinh dudng, gift li do vii
Ning cao chit lugng hogt dflng tu vin, giio dye sfte khfle cho ngudi bfnh
TAI U | U THAM KH&O:
1 Nguyin Sftc Thinh vi cfng sy (2006),
Nghiin ciu stf hdl ldng ciia ngudi bfnh nfi Iri vi chit lupmg chdm sdc stic khde tpl cdc Bfnh vlfn tinh Hda Binh, Truflmg
Dgi hgc Y ti cflng cflng Hi Nfi
2 Nguyin Thu vi cfng sy (2011), Ddnh gii sp hil Idng vi chdt lupng chdm sdc sic khie cua bfnh nhdn nfi mi Ipi bfnh vifn Diiu dudng vi Phpc hii chic ning Binh Dinh ndm 2011, Lufn vin Thgc sjf Y
ti cflng cflng, Trudng Dgi hgc Y ti cflng cfng Hi Nfli
3 Trin Thu Thiy (2001), "Quin li cflng tic chuyin mfln bfnh vifn", Quin If bfnh vlfn,
Nhi Xuit bin Y hgc Hi Nfli, tt 149-164
4 Jorgen Nathorst Boos, Ingrid M E
Munck, Ingemar Eckerlund & Carolina
Ekfeldt Sandberg (2001), "An evaluation
of tiie QSP and the QPP: two metiiods for measuring patient satisfection"
International Journal for Quality in Health Care, 13(3), pp 257-264
5 Rob Sanson-Fisher, Afaf Girgis, Allison Boyes, Billie Bonevski, Louise Burton, Peter Cook & the Supportive Care Review Group (2000), "The Unmet Supportive Care Needs of Patients witii
Cancer", Cancer, 88(1), pp 226-237
6 Sook Yeon Hwang & Byeong- Woo Park
(2006), "The perceived care needs of
Breast cancer patients in Korea", Yonsei Medical Journal, 47(4), pp 524- 533
577