2354-0613S182015032.pdf

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V-NGHI NGHIEN CUU KHOA HOC

NGHIEN CUU THUC TRANG

CO CAU THUOC Sir DUNG TAI BENH V l l N A TiNH THAI NGUYEN NAM 2013

TOM TAT:

Nghien cuu phdn tich tten 106 benh nhan ndi tni va 560 ngoai tni. Co cdu thuoc su dung tai Benh vien A tinh Thdi Nguyen nam 2013 gdm 22 nhdm thudc vdi 226 boat chat, 5 nhdm thuoc c6 gid tri tieu thu nhieu la thudc chdng nhiem khudn, ky sinh trimg (39,5%i), thudc ngi tiet (15,7%i), dudng tieu boa (10,0%>), thudc tim mach (8,9%)) va thudc tdc dung ddi vdi mdu 7,1%.

Ty le thudc don thanh phdn 85,l%isd khoan, 82,7%. gid tri tieu thu. Thudc sdn xudt ttong nudc 48,5%i sd khodn va 28,1%) gid tri tieu thu. Thudc nhap khdu 51,5%. sd khoan, 71,9% gid tri tieu thu.

ABSTRACT:

The study were carried out and analyzed on 106 in- patients and 560 outpatients. The structure of drug use in Hospital A Thai Nguyen province in 2013. It's show that 22 of drug group in 226 active compound , 5 drug groups consumed much value as anti -bacteria, parasites (39.5 %) , hormone and endocrine drugs ( 15.7 % ) , gastiointestinal ( lO.O % ) , cardiovascular drugs ( 8.9 % ) and drug effects on the blood of 7.1 %.

Percentage of single- ingredient drugs account for 85.1

%) of all, and 82.7 % of economic value. Local drugs ac- counts for 48.5 % and 28.1 % of the value. There are 51.5

% of imported drugs account, 71.9 %> of economic value l.DATVANDE

Nghien ciiu sd lieu thdng ke sir dung thudc tai Khoa Dupc cua Benh vien Bach Mai cho thdy chi phi ve khang sinh ttong toan benh vien chiem hon 30% tong chi phi thudc dieu tri. Tai Benh vien C Thdi Nguyen nam 2011, chi phi khdng sinh ttong toan benh vien chiem tdi 34,4% tdng gia tri tieu thu thudc. Ty Ie chung tien thudc khdng sinh ttong

Trdn Thi Bidi Hop', Nguy4n Thi Thanh Huong' tdng sd tien sii dyng thuoc chiem 32,7%, mpt phan cho t b ^ md hinh benh tat tai Viet Nam cd ty 1^ cac b#nh Dbiem khudn cao, nhung mat khde cd the ddnh gid tinh trang lam daag khang sinh van cdn pbd bien. Ty Ie thudc nhap kbiu, thudc theo ten biet dupc ttong danh muc thuoc tai cdc benh vien chiem uu the. Viec su dung qud nhieu thudc thdnh phdm co Cling boat chdt hoac sii dung nhieu thuoc cd tac dung tuoi^

tu nhung vdi nhieu miic gid k h ^ nhau dang Id tinh trang phd bien hien nay tai cac benh vioL Tinh trsuig lam daag thudc, ddc biet Id thudc bo ttp. Vitamin, khdng dieo doi d ^ dii tdc dung phu cd hai ciia thudc ngdy cdng pho bien va cd xu hudng tang... Sii dung thuoc khdng hpp ly khdng chi dnh hudng tdi cdng tdc cham sdc kham chua benh ma cdn la nguyen nhan lam tang chi phi dang ke cho nguoi benh, tao ra gdnh ndng cho nen kinh te xa hpi.

Benh vien A tinh Thdi Nguyen sd luong benh nhdn den kham, dieu tri ngay cang dong, cdn Idm rd cdng tac sd dung thuoc. Vi vay, chiing tdi thuc hien de tdi "Phdn tich thuc trang co cdu thudc su dung tai Benh vien A tinh Thai Nguyen nam 2013".

2. DOI T L W G \A P H L O N G PHAP 2.1. Doi tirpnp, fhtri gian nghien cuu

- Toan bp thudc dd su dung ttong dieu tri ndi vd ngoai tru tai Benh vien A tinh Thdi Nguyen.

- Hd sa benh an tai khoa Ndi Tdng hpp, Benh vien A tinh Thai Nguyen.

- Don thudc ngoai tru tai Benh vien A tinh Thdi NguyoL Dia diem nghien ciiu: Benh vien A tmh Thai Nguyen quy md 420 GB.

Thdi gian nghien ciiu: Tu thang 8 2103 den thdng 57014.

2.2. Phinmg phdp nghien cuu

1. TruBTig DH Y Duwc Thai Nguyen 2. Tnfvng DH Duoc Ha Noi

» Ngay nhdn bai: 10/03/2015 j » Ngay phan bien: 08/04/2015 j » Ngay duy&l dang: 12/04/2015

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ISO I S - l h a i ^ 04/2015

I Website: yhoccongdong.vn

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Y H O C

JOURNAL OF COMMUNITY MEOICINE

CONGDONG2015

Thiet ke nglii£n cuu: Dieu tra mo ta cat ngang co phan tich MSU nghiSn cuu:

Ho so 106 benh dn noi tru

Cac benh nhan dupc chan doan xac dinh viem phe qudn phoi khdng xac dinh (ma ICD- 10 Id: J18) thdng qua k8t luan chan dodn liic ra vien duoc dieu tri npi tni tai khoa Npi Tong hprp BVATN ttong 06 thdng cudi nam 2013 (tii 01/7/2013 den31/12/20I3).

Ho sa 560 dan thuoc ngogi tru

Cdc don thudc ngoai tni cap phdt thuoc tir 01/12/2013 den 31/12/2013, ttong mpt n^ay, chpn don thudc dau tien, cac don thuoc tiep theo he so budc nhdy k=5 cho den khi het ngay.

Bdng 3.1. Co cdu danh muc thuoc bpnh viin theo nhdm tdc dung du^c ly Phirong phdp nghien cihi:

Sd li?u thu thap dupc nhap vd xu Iy bai phdn mem Microsoft Excel va phan mem SPSS 16.0 dephdn tich nhu sau:

Sap xep so lieu tuy theo muc dich phan tich. Tinh so lupng, tri gid vd ty 1? % cua timg bi6n. So sdnh, ve bieu do, nhan xet.

3. KET QUA NGHlfiN CUtJ VA BAN LUAN 3.1. Co cSu danh muc thuoc benh vifn theo nhom tac dung du^c ly

Sd lugmg boat chdt va so khoan thudc tiong danh mvc thudc b?nh vi^n nam 2013 dupc trinh bay bdng sau:

STT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Nhom thuoc Thuoc chong nhiem khuan, ky sinh ttung Thuoc tim mach

Thuoc duong tieu hoa Vitamin va khoang chat

Hocmon va cac thuoc tac dong vao he thong noi tiet Dung dich dieu chinh nuoc, dien giai, can bang acid-base va cac dung dich tiem truyen khac

Thuoc gay me, te Thu6c mat, tai miii hong Thuoc tac dung doi voi mau

Thu6c giam dau, ha s6t, ch6ng viem, thuoc dieu tri giit va benh ca xuong kh6p

Thuoc dieu tri benh da lieu Thu6c tac dung tren duong ho hap Thufic gian co va ire ch6 cholesterase

Thudc ch6ng di img va dung trong cac truong hop qua man Thu6c thiic de, cSm mau sau de & chong de non Thu6c giai doc va cac thuoc dung trong trucmg hop ngo doc Thudc dimg chan doan

Thu6c loi tieu Thuoc tSy triing, sat khuan Huy6t thanh va globulm mien dich Thu6c ch6ng roi loan tam thin Nhom thuoc khac

TONG SO

Hoat chat SL 39 33 27 19 15 15 14 13 11 11 8 7 6 6 4 3 3 2 2 2 2 6 248

Tyle

(%)

15,7 13,3 10,9 7,7 6,1 6,1 5,7 5,3 4,4 4,4 3,2 2,8 2,4 2,4 1,6 1,2 1,2 0,8 0,8 0,8 0,8 2,4 100

Thuoc SK 90 69 53 20 29 29 26 20 20 37 9 17 6 12 8 7 4 5 3 2 2 9 477

Tylf

(%)

18,9 14,4 11,1 4,2 6,1 6,1 5,4 4,2 4,2 7,8 1,9 3,6 1,3 2,5 1,7 1,5 0,8 1,0 0,6 0,4 0,4 1,9 100

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NGHIEN cuu KHOA HOC

Danh muc thuoc BVATN ndm 2013 dupc phdn thdnh 22 nhdm thuoc theo tac dyng dupc ly vdi 248 boat chat/477 sd khoan thudc. Nhdm thudc cd sd lugng, chiing loai ldn nhat la nhdm chdng nhiem khudn, ky sinh tning vdi tdng sd khodn thudc la 90/39 hoat chdt, chiem 18,9%> theo chiing loai.

Nhdm thudc chdng nhiem khudn, ky sinh tning, nhom khang sinh chiem sd luijng lan v£ boat chat (34/37) va khoan thudc (78/87), gia tti tieu thu tdng ti^n thuoc sir dung la 11.801.868 nghm ddng, chifira 39,3%» tong gid tii tieu flip thuoc todn benh vien.

• Thuoc chong nhiem khuSn, k^ sinh triing

• Thuoc tim mgch

• Thuoc duong tieu hoa

• Hocmon va cdc thu6c tac | dong vSo hp thong npi tiet

• Thuoc tac dyng dot vdi ,

mau I

• 17 nhdm khac Bieu do 3.1. Ty le gid tri tieu thu thuoc theo nhdm tdc dung duoc ly

Bang 3.2. Sd luang thudc trong DMTB V nhung khdng duoc su dung Npi dung

Khong sir dung Sudimg

TONG SO

Hoat chat So luong Ty ie (%)

22 8,9 226 1 91.1

248 100

Thu6c Sd khoan

35 442 477

Ty le (%) 7,3 92,7 10«

Nam 2013, khdng cd thudc sii dungngoai danh muc thuoc benh vien. Co 226/248 boat chdt dupc sii dung, chiem 91,1%.

Bdng 3.3. Co cdu thuoc don thdnh phdn vd da thdnh phdn

N$i dung Thuoc don thanh plian Thuoc da thanh plian

TONG S 6

Hoat chat SL 181 45 226

Tyle

(%)

80,1 19.9 100

Thuoc SK

376 66 442

Tyle 85.1

(%)

14,9 100

GTTT (l.OOOd) 24 840 703

5 182 354 30 023 057

Tyle

(%)

82,7 17,3 100

Nam 2013,100%i thudc su dung tai BVATN thudc danh muc thudc chii yiu cua Bp Y t6. Trong dd, cd 376 thudc don thanh phdn, chi&n 85,1 % so khoan thudc vd 82,7% gjd tri tieu thu.

;s>i34

(%)

24,4 73,8 1,8 100

Thudc dung dudng udng chiim 46,1% tdng sd boat chSt, chiim 48,2% sd khodn thudc tiong danh muc nhung chi chiim 24,4%. gia tri tieu thu. Ty le thudc dang tiem (bao gdm tiem bdp, tiem tinh mach, tiem dudi da vd tiem truyen) chiem 48,2%i so boat chdt, 40,5% s6 khoan thudc nhimg gid ti tieu thu chiim 73,8%, cao gap 3 ldn gid tii tieu thy thudc dung dudng udng.

Bdng 3.6. Ty li cff cau danh muc thuoc theo quy che chuyen mon N^i dung

Thuoc gay nghien Thuoc hucmg tam than

Thuoc thucmg

Thuoc noi Thuoc ngoai Thuoc npi Thuoc ngoai Thuoc noi Thuoc ngo^i Tong s6

SK 1 2 3 6 210 220 442

Ty le(%)

0,7

2,0

97,3 100

STT

1 2 3 4 5 6 7 S 9 10 11 12 13 14 15 16 17

Ten khoa

Hoi sue cap ciiu Noi long hop Ngoai long hop Ngoai chan thuong San No! 4- Tiro mach Nhi Than Nhan tao Gay me hoi sue Dongy Tmyen nhiem Tai miii hong MSt Da lieu Rang ham mat X-Quang Kham benh (Ngoai trii)

TONG SO

Hoat chat ( n = 226)

SL 132 167 140

T y l e

(%)

58,4 73.9 61.9 134 59.3 103 1 45,6 1 166 86 12 50 49 113 73 90 123 84 5 98

73,5 38,1 5,3 22,1 2 1 7 50 32,3 39,8 54,4 3 7 J 2,2 43,4

Thuoc

SK 221 264 240 217 170 268 140 18 77 57 172 125 121 184 136 8 167

T y l e

(%)

50.0 59,7 54.3 49,1 38,5 60,6 317 4,1 17,4 12,9 38,9 28,3 27.4 41,6 30.8 1.8 37,8

GTTT n OOOddngl

4 354 401 3 787 557 3 369 786 3 175 647 2 564 489 1 693 266 1362318 1 325 422

767 887 724 225 723 586 583 665 328 693 322 979 218229 37 906 4 683 001 j 30 023 057

T y l e

(%)

14,5 12,6 11.2 10,6 8,5 5.6 4,5 4,4 2,6 2.4 2.4 1.9 1,1 1.1 0 7 0,1 15.6 100

Cac khoa cd ty le gia tri tieu thy thudc nhieu: Khoa Hdi siic cap ciiu, Ndi Tong hgp, Ngoai Tdng hpp, Ngoai Chan thuong vd khoa Sdn. Khoa Hdi siic cap ciiu ludn dieu tri benh nhan nang, gid tri tieu thy thudc ciia khoa nay nhieu nhdt, chiem 14,5% tdng tien thuoc su dyng tiong todn benh vien.

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4. BAN L U ^

4.1. Cor cau danh muc thuoc su dung tai Bfnh vi£n A tinh Thai Nguyen nam 2013

Benh vien A tinh Thai Nguyen Id benh vien da khoa tuyen tinh, vdi bien che 420 giudng benh, sd giudng thuc ke cua la 590 GB. Trong nam 2013 Benh vien A tinh Thdi Nguyen da khdm b?nh cho 164.208 l u 0 benh nhan, tiep nhan 25.691 luot benh nhdn dieu tri npi tni; md hinh bfnh tat tai benh vi?n kha da dang, gom 21 nhdm benh, tiong do benh thai nghen, sinh sdn vd hdu san chiem ty 1? mac cao nhdt (16,7%), dieu nay phu hop vdi dinh hudng phat trien Benh vien A tinh Thai Nguyen thdnh Bpnh vien Phu sdn ciia Thdi Nguyen. Nam nhdm benh diing dau ve ty le mac cao nay da chiem 62,4% tdng sd benh nhan tiong benh vien.

Hpi ddng thudc vd dieu tri BVATN da xdy dung danh muc thudc benh vien nam 2013, dua tien ca sd Danh myc thudc thiet yeu Viet Nam ldn thii V, ban hanh theo Quyet dinh sd I7/2005/QD-BYT; danh myc thuoc chiia beoh chii yeu sir dung tai cac ca sd kham chua benh theo Thong tu sd 3I/20II/TT-BY; quy dinh vl td chiic vd boat ddng ciia Hdi ddng thudc vd dieu tri trong benh vien, theo Thdng tu sd 21/2013/TT-BYT; md hinh benh tat, nhu cau cua cac khoa, phdng vd diSu kien kinh phi cua benh vien. Danh myc thudc benh vien vdi 477 thudc tijong ling vdi 248 boat chat, dupc sap xep thdnh 22 nhdm tac dung dupc Iy. Tuy nhien trong nam 2013 cd 35 thudc khdng dugc sii dung. Tat ca cac thuoc kbdng dupc sii dyng deu thudc danh myc thudc chii yiu tan dugc theo Thdng tit 31/2011/TT-BYT.

Td chiic Y te the gidi khuyen cao khi lua chpn thudc la nen chgn thudc dupc bdo che d dang don chat. Thudc su dung tai Benh vien A tinh Thdi N^yen nam 2013 chii yeu la cdc thudc don thanh phan, chiem 80,1% tdng boat

chat, 85,1% tdng sd khoan thudc tieu thy va 82,7% tdng gia tri tieu thu. Day la mdt ty le thdp so vdi mdt sd benh vien khac, tai Benh vien C tinh Thai Nguyen, nam 2011, ty 1?

thudc don thanh phan Id 90,4% tdng boat chdt. Tai B?nh vien Trung uong Qudn dpi 108, nam 2012, ty le thudc don thdnh phan chiem 86,9% sd khoan va 89,6%gia tri tieu thu. Theo Td chiic Y te the gidi, thudc phdi hpp chi dugc lua chpn sir dyng khi chiing cd lgi the vugt tipi ve hieu qua, dp an toan hoac tien dyng so vdi thuoc d dang dan chat. Tuy nhien de dua ra quyet dinh lya chpn tdi im can cd san cac du lieu, thdng tin ve ddng tin cdy ve hieu qua cua cdc thudc nay. Hpi ddng thudc va dieu tn ciia Benh vien Thai Nguyen can cdn nhac, lua chpn cac thudc de gidm ehl phi, tang hieu qua dieu tri vd thuan tien trong sir dung vi cac thuoc da thanh phan, dac biet la cac che phdm phdi hgp Vitamin va khoang chdt thudng gia thanh cao ban dang don chdt.

5. KET LUAN

Danh myc thudc sir dung tai Benh vien A tinh Thai Nguyen nam 2013 gom 22 nhdm thuoc voi 226 hoat chat, 5 nhom thuoc co gid tri tieu thy nhieu la thudc chdng nhiem khuan, ky smh tning (39,5%), nhdm thudc hocmon va cac thudc tac ddng vao he thdng ndi tiet (15,7%), nhdm thudc dudng tieu boa (10,0%), nhdm thudc tim mach (8,9%) va nhdm thudc tdc dung ddi voi mau 7,1%.

Ty Ie khoan thuoc don thanh phan: 85,1% sd khoan vdi 82,7% gia tii tieu thy.

Thudc san xuat trong nudc chiem 48,5% sd khodn vd 28,1% gia tri tieu thy. Thudc nhap khau chiem 51,5%i sd khoan, chiem 71,9% gia ti tieu thu. Thudc diing dudng tiem chiem 38,7% sd khodn nhung chiem 73,8% gia tri tieu thu.

TAI LIEU THAM KHAO

1. Luong Thi Thanh Huyin (2012), Phan tich boat dpng su dung thudc tai Benh vien Tnmg uong Quan dpi 108, Luan van thac sy dupc hpc.

2. Duong Ngpc Ngd (2012), Phan tich mdt sd boat ddng cung ling thudc tai Benh vien C - tinh Thai Nguyen nam 2011, Luan van thac sy duoc hgc.

3. To chiic Y te the gidi (2004), Hpi ddng thudc va dieu trj- cam nang hudng ddn thyc hanh, Nhd xuat ban Giao thong van tai.

4. Td chiic Y tl thl gidi (2003), Hudng dan dieu tra sit dyng thudc tai cac ca sd kham chua benh.

5. Tnrdng Dai hpc Yte cdng cdng (2011), Quan ly duoc benh vien, Nha xuat ban Y hpc.

6. MSH (2011), "Managing Acces to Medicine and Other Health Techonologies".

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2354-0613S182015032.pdf

V-NGHI NGHIEN CUU KHOA HOC

NGHIEN CUU THUC TRANG

CO CAU THUOC Sir DUNG TAI BENH V l l N A TiNH THAI NGUYEN NAM 2013

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