Khó khăn trong thực hành kê đơn thuốc và nhu cầu đào tạo về sử dụng thuốc hợp lý an toàn của cán bộ y tế thuộc một số bệnh viện ở miền bắc, việt nam

TCNCYH 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 80.0% (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 2020" 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 TOAN CUA CAN BO Y TE THUOC MOT SO BENH VIEN 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 khd khan qua tnnh ke dan ciia cin bd d cic tuyen dieu trj khic Muc tieu: md ti nhdng khd khan chinh 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 tuyen d mien Bac Ket qua: khd khan chinh cua cic can bg tuyen huyen 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 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 DAT VAN DF 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 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 tdn ddng khdng chl cdng ddng ma 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 [ , 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 96 TCNCYH 65(6) - 2009 Ket-noi.com kho tai lieu mien phi ph den tlnh trang sfl dung thudc khdng hpp ly - an mdi d i n hdi trfldng de d i i n p h i i u t r i Idi difdi sfl t o l n tai cac co sd y t l , vf du nhfl cac can bd d i i u hfldng d i n cua cac nghien cflu vien 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 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 xfl ly v l phan tfch sd lieu khd khan q u i trinh ke ddn cua c l n bd d cac III KETQuA tuyin d i i u trj k h l c VI cae ly tren, chung tdi tie'n hanh d l tai nghien cflu vdi muc tieu: 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 tuyin trung fldng (32.1%), 58 trinh c l n bd tuye'n tinh (42,3%) va 35 c l n bd tuye'n kboa/dan huyen (25,5%) Cd 56 can bd nam (40.9%) v l 81 vi Ngi, Nhi va Lay d mgt sd benh vien cac tuyen c l n bd nfl (59,1%) Chu yeu c i c c l n bd difpc d i i u Mo ta nhifng khd khan chinh qua ke dan cua can bg y te thugc mgt sd d mien Bac Viet Nam, nam 2008 va xac dinb nbu cau dao tao ciia cac can bg duac dieu ve cac van de co lien quan den sif dung tra thudc 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: 5,9% v l help ly an toan phd g i l o sfl: 4,6%) T"/ le c l n bd cd trinh dp sau dai II DOI TUONG vA PHUONG PHAP hpc d tuyen tlnh cung dat gan 50% (chu ye'u la , chuyen khoa 1) va tuyen huyen la 14.3% (tit c l NGHIEN CL/U deu I I chuyen khoa 1) Tai tuyin huyen, 34,3% sd Bdi tuang nghien cdu: C I c can bd dieu trj mdt sd khoa/ddn vj Npi, Nhi, Lay d mdt sd' benh vien eac tuye^n d mien B i c Thief ke nghien cii'u: Nghien cflu md t l c i t 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 tuyin trung flpng, Xy le can bd cd tren 30 nam cdng t i c la tfldng dd'i cao (36,4%) Tai tuyin tlnh va tuye'n huyen, p h l n Idn c i c c l n bd ngang Bia diem nghien c l n bd difdc dieu tra cd trinh dp y sy Hp dflpc Ifla ciifu: dflpc d i i u tra cd dfldi 10 nam cdng t i c (55,2% d tuyen tinh va 50% d tuyen huyen) - Tuyen trung fldng: benh vien Bach Mai - Tuye'n tinh: benh vien (benh vien tinh Ha B l n g trinh bay nhflng khd khan chfnh m l Nam - vung Ddng bang sdng Hong, benh vien c i c c l n bd d i i u trj thfldng gap qua trinh ke tinh Viet Tri - vung Ddng Bac, benh vien tinh Hoa don 8,3 % c l n bp dfldc d i i u tra cho r i n g hp Binh - vung Tay Bac) 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 - T u y i n huyen: Tai mdi tlnh difpc Ifla chpn, benh vien huyen dfldc d i i u tra 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 C6 miu va chgn mau: t i t ca c l n bd d i i u trj thdng tin ve thud'c qua trinh ke ddn Ty le (bic sy, y sy) thudc cac khoa/ddn vj ndi, nhi, lay can bd dflpc d i i u tra cho rang hp thieu k i l n thflc tai c i c benh vien nghien cflu dflpc d i i u tra v l dflpc lam sang la 40,9% Ty le n l y cao d c l Ky tbuat va cong cu tbu thap thong tin: sfl tuye'n, dac biet d t u y i n tuyen huyen (45,7%) Cd dung be cau hdi tfl dien Cae can be d i i u tri dflpc 19% can bd dflpc d i i u tra cho rang hp cd khd 97 TCNCYH 65 (6) - 2009 khan qua trinh ke ddn benh-.vien t h i i u tuyen huyen (60%) so vdi tuyen tlnh (29,3%) va thud'c Ty huyen tuyen trung fldng (25%) Mdt sd khd khaQ khac (28,6%), tiep theo I I d tuye'n tinh (17,2%) va q u i trinh ke ddn lien quan dfldc cac can le nly cao nhit d tuye'n cud'i cung la t u y i n trung fldng (10,7%) C a n % bd dfldc d i i u tra ke d i n bao gdm sfl tuan thu cua c l n bd difpc d i i u tra cho rang hp cd khd khan benh nhan kem (ty le chung la 50,4%) va viec q u i trinh ke ddn benh vien thieu cac b i o hiem y te khdng che tran toan (Trung xet nghiem hd trp Ty le dac biet cao d fldng: 29,5%, tlnh: , % ; va huyen: 54,3%) Bang Kho khan cbinb qua trinh ke dan cua cac can bg dugc dieu tra Trung ffdng Tfnh Huyen Chung n (%) n (%) n (%) n(%) Thieu kie'n thfle c h i n d o l n , d i i u trj (18,2) 5(10,3) 11 (31,4) 25(18,3) Thie'u thdng tin v l thud'c 8(18,2) 13 (22,4) 24 (68,5) 45 (32,9) Thie'u k i l n thflc dflpc l l m sang 19 (43,2) 21 (36,2) 16(45,7) 55 (40,9) Benh vien thie'u thud'c 6(13,5) 10(17,2) 10(28,5) 26(19,0) Benh vien thie^u xet nghiem hd tro 11 (25,0) 17(29,3) 21 (50,0) 49 (35,8) Benh nhan tuan thu kem 22 (50,0) 28 (48,3) 19 (54,3) 69 (50,4) Bao hiem khdng c h l tran toan 13 (29,5) 24 (41,4) 19 (54,3) 55 (40,9) Tdng sd 44 (100) 58(100) 35 (100) 137 (100) Cac kho khan B l n g 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 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 Cac khda dao tao lien quan den ke dan ma cac ddi tUgng dieu tra da tbam gia nam trd lai day Cac khoa dao tao Trung ffdng (%) Tinh (%) Huyen(%) Sfl dung thud'c hpp ly, an toan 80 50 50 Dflpc l l m s i n g 70 30 40 D i i u tri viem phe quan 40 30 10 Dieu trj viem loet da day - t l trang 60 30 20 D i i u trj ly trflc trung 40 10 10 D i i u trj benh viem phdi tre em 30 30 20 D i i u trj tieu c h l y tre em 30 30 50 B i i u dd 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 98 TCNCYH 65 (6)-2009 Ket-noi.com kho tai lieu mien phi ph dao 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 , % (trung fldng: 80%, 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 % (trung fldng: 74,0%, tlnh: 82,4%) 95,2% Q Trung udng B Tinh D Huyen '• 92,4% 80,0% ^^ 90,1% 88,3% 86,2% 82,4% 79,7% 74,0< a ! •