Nghien ciru - Ky thuat
\/ Tim hiiu thyc trang hieu biet va su tuan thu sir dung thuoc cua benh nhan dieu tri ngoai trii tai Benh vien Noi tiet Trung uong nam 2014
Nguyen Thi Song Ha', Le Th[ Uyln^', Nguyen M a n h Tuan' ' Trudng Dgi hgc Dugc Hd Ngi
^Binh viin Npi tiit Trung uang ' E-maii- [email protected]
Summary
To prove ttie importance of the patient's adfierence to medication for successful managing chronic diseases, this study was performed at National Hospital of Endocrinology by interviewing 400 randomly selected out-patients using a questionare to assess the l<nowledge and adfierence of out-patients. Of them, 66 % fcneiv the reason for their medications; more than 70 % aware of the way to use their drugs, but only 10.8 % apprehended the side effects of aii the prescribed drugs; about 40% neglected tiie condition of insulin storage. Neariy one-half of the patients were heedless of regularly tailing the drugs.
These Endings suggest some interventions should be done to improve the patient's knowledge of and adherence to the medicine use.
Keywords: Patient's l<nowiedge, adherence, out-patient, National hospital of Endocrinology.
Dat van de
B$nh vi^n N$i ti^t Trung u o n g Ici b^nh vi^n chuyen khoa tuyen cu6i ve dieu tn cac b$nh ngi tiet - roi logn chuyen hda Nam 2014, cd hern 224.000 l u ^ benh nhdn den kham va dieu In tai b$nh vi$n, trong dd 92,05% \k benh nhan ^ e u trj ngo^i tnJ. Cdc b^nh v4 nOi ti^t Id benh man tinh, thuang phdi d\ku trj Idu dai, kM hap nhieu loai thuoc, chi phf t6n k6m, cSn phdi tudn thu dieu trj tot d ^ hgn ch4, phdng ngCra cdc bi^n chu-ng cua b^nh. Do dd, hiSu biet dung v^ SCF dung thuoc, nh?ln thuc du'Q'c t^m quan trpng cOa viec su- dung thu6c dung cdch, deu d^n cung nhu tuan thu dieu trj Id mOt p h i n v6 cung quan trpng, quyet d|nh td-i thdnh cdng cua vi$c dieu tri '*'. Nham danh gia si^ hieu b i l t va tudn thu sCr dgng thuoc cua bpnh nhdn dieu trj ngo?i tni tgi b0nh vi$n, nghien citu
"Tim hieu thyc tr^ng hiiu biet va tuan thu su- d^ng thuoc ciia b^nh nhan dieu trj ngoai tru t$i B$nh vifn N^i tiet Trung uvng nam 2014"
da dyp'C thyc hipn. Cdc ket qud dat du'p'c se lam c a s d d l B^nh vipn cd nhOng bi#n phdp thuc day
si> dyng thu6c h p p ly, an toan, hieu qua, ndng cao ch^t lu'png chdm sdc benh nhan.
Phirang phap nghien ciru Phipo'ng phdp m d ta cdt ngang Khao sat s y hieu b i l t vd tuan thu dieu trj cua bpnh nhan BHYT dieu trj ngoai t m tai Benh vien Noi t i l t TW nam 2014 thong qua phdng v^n tnrc tiep bpnh nhan nhdn nhan thuoc tai qu^y phdt thu6c BHYT d y a trfen bp cau hdi xay dyng san.
Co* m i u va phu'O'ng phap c h p n mau Camau: S6 lu'p'ng m§u d u a c tinh theo cdng thuc 1^1:
, P(1-P) N=Z='{1-a/2)x-^
d^
Trong 66- N Id s6 bpnh nh$n c^n phdng van, P Id tyl$u^ tinh so b$nh nhan c6 kien th&c day dii v^ si>
dgng thuSc va tuSn thu sd" dgng thuoc. Do chira c6 s6 li$u nghiSn c&u Uvdc n§n chpn P= 0,5. Z la h0 s6 tin c$y d mOc x&c suk 95%. 2= 1,96. did khoang sai l$ch cho ph6p giOa t} 1$ thu dui^ tir miu va ty 1^ cita quin th4, chgn d = 0,05
T^P CHi DirgfC HQC - 9/2015 (SO 473 NAM 55)
• Nghien CLFU - Ky thuat
Tinh du'yc so bpnh nhan c^n phdng van la N = 384, t h y c t l i l y 400 mdu.
Phirong phap c/ipn mau
Phong van ngau nhien 400 benh nhan nhgn t h u l c tai q u i y phdt thuoc BHYT vdo cdc ngdy tCr thCr 2 d i n thir 6 trong khodng thai gian tCr thdng 10/2014 d i n thdng 12/2014 den khi du s6 l u p n g ; loai trCr cac tru'd'ng hpp nhgn ho thuoc cho
ngyai nha, khdng t y su" dyng t h u l c va m&\ dieu trj thdng dau.
K i t q u a n g h i e n CLPU
Thong tin chung cua bpnh nhan tham gia phong van
Thdng tin chung ve 400 benh nhan tham gia tra Id-i phong v i n d u g c trinh bay trong bang 1.
Bang 1 : Thdng tin chung v l benh nhan tra ien phong Vcin STT
2
3
4
5
D^tua
.
B$nh mic chlnh
Noi dung 18-59
>60 Nam N»
Khonq di hpc Chira TN THPT THPT dmii BH BH.sauBH
DTB TuY^n qiap
Kh4c
< 1 nam 1 - 5 nam 5-10nam
>10 nam
So/uong 162 238 133 267 2 144 160 94 337 65 4 107 193 20 80
TvK%(n=4a»
40,5 69,5 33,3 66,7 0,5 36 40 23,5 84,3 16,3 1,0 26,8 48,2 5 20 Hieu b i l t cua ngiro*! b f n h ve SIP d^ng va Ket qua khao sat s y h i l u biet cua b$nh nhdn bdo qudn t h u l c v l cac thdng tin ca ban lien quan <5en sCr dyng
Hiiu biit ctia b$nh nhan ve su- d^ng thuoc t h u l c du-pc trinh bdy d bdng 2.
Bang 2: Hieu biit cua b$nh nhan vd su' dgng thudc
Biii vSt^d^ng diiu trj chinh CUE
Blit vi liiu dung
Blit vi Ihdi diim dOng thuoc
Biit t6c dung phu cOa thuie c^tn 1 thuie
ingddn Nii duna
Khdnq biet Biet khong diy dO Biltdaydu Khdng nho
Nhd khdng diy du/chinh xac Nhd diy du Khdng nhd
Nhd khdng diy diV chinh xac Nhd diy du
Khdnq rd Bill mdt veii thudc Nim ro tit ca cac thuoc
S6 luvm (n = 400) 32 104 264 26 81 293 26 86 288 218 139 43
TiliV.
8,0 26,0 66,0 6,5 20,3 73,2 6,5 21,5 72,0 54,5 34.8 10,8 Ngung diing thuoc. hoi lai bac sy
Van si> dgng thuoc, dpi den dot kh^m sau hoi lai X(> III khi g$p tic dvng phg cOa thuoc Vin diing Idiflng hoi lgi
T^f di^u trj tri$u chimg Khdng bi4t y ki4n kh^c
Bd qua lieu d6, khong uong bii xatrikhiquSnlliki
Uong khi nho ra U6ng hii \k\ sau Khong bi^t each xi> tri Y kien kh^c TAP CHi DirqC HQC - 9/2015 (SO 473 NAM 55)
Nghien ciru - Ky thuat
K i t qua tip bang 2 cho thay ty 16 benh nhan biet tdc dung dieu trt t ^ i n h cua tat ca cac thuoc minh dang sir dyng la kha cao (66,0%). Ty le benh nhan biet ro v l l i i u dCing vd thai diem dung cua t h u l c tu-ang doi cao, lan luyt la 73,2 % va 72%. Tuy nhien chi c6 10,8% b&nh nhan nam du'yc th6ng tin v l cdc tac dyng phy ca ban va co den 54,5 % so bpnh nhdn khdng b i l t v l bat cu- tdc dyng phg ndo cua thuoc ma minh su' dyng.
Khi gap tdc dyng khong mong m u l n cua thulc, xu huang p h i b i l n n h i t Id benh nhan se trao doi
Bdng 3; Hiiu biit cua benh
lai vai bdc sy c h i l m ty le cao nhat (30,3%); tuy nhien ty lp kh6ng b i l t hu'dng XLP tri v§n con kha lan (23%). Khi quen 1 l i i u thuoc, benh nhan bo qua lieu d6 va khong uong bii c h i l m ty le cao nhdt (65,5%), mOt s l benh nhan u6ng vao bat cip thai d i l m nao trong ngay khi nha ra (10%), chi co mpt s l it la u i n g bu ( u i n g g i p d6i lieu) vao ngay hom sau (2%), tuy nhi&n ty le khong biet each xii ly Id kha cao (22%).
Hiiu biet cua b^nh nhan ve bao quan thuoc nhan ve bao quan thudc
STT Bao quan . Bad qudn cdc dang thu6c thdng ttiiKmg
(n = 400)
Bio quSn cdc dang thudc dac t)idt (insulin) (n = 214)
thuie
Khdng biet Bill each Bao quan dOng Bao quan diua ddng
S6 luvng 103 297 126 88
Tyl6%
25,8 74,2 58,9 41,1 K i t qua nghidn ciru cho t h i y vai cac thuoc
thong thu-dng df dgng vidn ndn hay vien nang, ty 1$ b^nh nhdn b i l t cdch bdo qudn chiem 74,2%
(Bdng 3).
Trong s l cdc b^nh nhdn phdi dung t h u l c tiem insulin thi c6 58,9% b^nh nhdn biet cdc bao quan dung, tuy nhidn v i n c6n 4 1 , 1 % bpnh nhan khong biet cdch bdo qudn dung thuoc tiem insulin.
S y tuan thCi s i r d y n g t h u o c cua benh nhan Nghien ciju lya chpn hinh thii-c "ty bao cao" (self report) d l ddnh gid s y tuan thu cua
Bang 4: S y tuSn thd su-
benh nhan. D^ tdng tinh chinh xdc, nhom nghien CCPU sap x l p cdc cau hoi nay a cac vj tri khac nhau trong bO cdu hdi. Ngu'6'i phong van cung tien hanh h i i du'l'i hinh thiPC khac d l danh gid tinh t h i n g n h i t trong cdu trd \ce\ cua benh nhan.
K i t qua cho thay ty lp bpnh nhan tirng quen uong thuoc la khd cao, c h i l m 46% (bang 4). Phin Idn bpnh nhdn khong bao gia t y y ngirng sir dung t h u l c (95,5%). G i n nhu- todn bo bdnh nhan du-pc phong v i n se di kham Igi sau khi sir dung h i t thulc, chi 6 bpnh nhdn t y y mua thulc theo dan cu ma khong tdi kham.
dung thudc cua b$nh nhiin
Qu^ udng thuoc Ti/y ngimg thu6c Xir tri sau khi ss dgng hit i
N^i dung
fhuSctheoAm
Da timg quen u6ng thuoc Chua timg quen u6ng thuoc Ty y ngimg thu6c Khong bao gio Dl kham lai
Ty y mua thu6c theo don cQ
S6ltrgng(n-- 184 216 18 382 394 6
--400} Tyle%
46,0 54,0 4,5 95,5 98,5 1,S
Ban luan
T u van, hu'dng dan de bpnh nhdn hieu, nam d u ^ c each si> dyng t h u l c vd tuan thu trong dieu trj Id mpt d i l u vd cOng can t h i l t d l dam bao du'ac hi^u qua cua vipc d i l u trj. Ket qud phong van 400 b f n h nhdn nh|ln t h u l c tpi quay phdt thuoc BMYT a Bpnh vipn Npi t i l t Trung irang tir thdng 10 d i n thdng 12 nam 2014 cho t h i y ty le bpnh nhan
b i l t du'yc tdc dyng dieu trj chinh, l i i u diing va thai diem diing cua t i t cd cdc thuoc trong don la tu'ang d l i cao (66,0%; 73,2% va 72,0% tirong iJng). Tuy nhidn, s l lirpng bdnh nhan hieu biet v l tdc dyng khong mong muon cua tat ca cdc t h u l c trong dan cdn kha thap, chi chilm 10,8%
vd da so nhirng ngu'd'i nay tm-dc khi nghi hu'u da ti>ng lam trong ngdnh y t l . Van cdn han 50%
TAP CHi DlTijK: HQC - 9/2015 ( S 6 473 NAM 55)
Nghien CIFU - Ky thuat
bpnh nhan khdng b i l t ve tac dyng phu cCia bat cu"
thuoc nao minh du-yc ke, 23% khong b i l t each XLP trl khi g§p cdc tdc dung phu va 2 2 % khong b i l t cdch xir tri khi qudn 1 l i i u t h u l c . Odi khi cac tac dyng khdng mong m u l n gpp phai luc b i t d i u dieu trj se chi thodng qua trong vai ngay nhu'ng neu bpnh nhan khdng d u a c thdng bdo se rat c6 t h i gay tdm ly hoang mang, lo s p d i n tai t y y ngyng sii' dgng t h u l c vd anh hudng d i n k i t qua dieu trj. Ben canh dd, cung cd nhQ'ng tdc dyng khdng mong muon nguy hiem can phai thdng bao s a m , kjp thd'i cho bdc s7 h o | c can bd y t l khdc khi ggp cac dau hipu dau tien (vi dy nhu mdi c a . yeu c a khdng rd nguyen nhdn khi sir dyng cdc t h u l c ha lipid mau nhdm statin ...) thi bdnh nhdn cung can d u y c hudng dan cy the d l trdnh d i n d i n h§u qua nghidm trpng han.
Bdo qudn thuoc dung each giup duy trl chat l u y n g t h u l c , gdp p h i n vdo hi^u qud d i l u tn ciia bdnh nhan. Tuy nhien, van cdn khoang 1/4 benh nhan khdng b i l t each bao quan t h u l c vien, ehu y l u Id d l thuoc I l n Idn vdi cdc do dung khdc, d l thuoc d nai tiiy y vd ea bipt con cd trudng hyp bdc t h u l c ra khdi vl vd cho vao Ip d l "tipn sir dyng".
Ooi vdi cac thuoc tiem insulin, cd tdi 4 1 , 1 % benh nhdn khdng b i l t edeh bao quan dung. Oieu nay cd t h i dnh hudng den c h i t luyng cCia insulin vd k i l m soat d u d n g huyet cua bpnh nhan.
Trong qud trinh phdng van benh nhdn de danh gia hieu b i l t v l su- dung thuoc, nhdm nghien ciru cung tim h i l u v l viec cung d p cdc thdng tin lidn quan d i n si> dung t h u i e va bao quan thuoc cho b^nh nhan cua cdc can bd y t l . K i t qua eho t h i y chi mdt ty 1$ khidm t i n bpnh nhan tra Idi d u y c n g u d l cap phat t h u l c hudng dan each sir dyng (4,5%) vd cdch bdo quan thuoc (4,8%). VI vay, trong thdi gian tdi, benh vidn nen c6 nhirng bien phap d l tang cudng hogt dpng t u van cho benh nhan trong qua trinh d p phat t h u l c , gliip bpnh nhdn hieu b i l t han v l sir dyng thuoc vd bdo quan diing cac thuoc, d§c bidt Id insulin.
Bpnh nhdn thudng cd xu hudng t y y ngung si> dyng t h u l c khi t h i y cac tripu chung d d hope khi t h i y tinh trgng bpnh khdng cai thien, khi gpp cdc tdc dyng khdng mong m u l n . Tuy nhidn, k i t qua nghien ciru cho t h i y chl cd 4,5% bdnh nhdn t y y ngung sir dyng t h u l c , t h i p han so vdi nghien ciru tpi Bpnh vidn Oa khoa Ninh Binh (11,7%) '^'
vd Bdnh vldn Nhdn dan Gia Ojnh (31,7%) '^'. Mac dii da s l bpnh nhdn deu khdng t y ^ ngirng s u dung t h u l c nhung cung d n phai luu y de khae phyc thdi quen x i u trong s u dyng t h u l c cho bdnh nhdn de khdng anh hudng tdi hipu qua dieu trj.
Sd bpnh nhan tra Idi dd tirng quen dung t h u l c la kha Idn, c h i l m 46%, cao han so vdl d Bpnh vipn Da khoa Ninh Binh (12,5%) i^' vd Bpnh vidn Nhan dan Gia Ojnh (36,6%) '='. Nguyen nhan chu yeu Id do cdng vide bdn bju, mpt so Id do tinh dang trf eua ngudi gia. Khi quen t h u l c , da so bpnh nhan se bo qua vd khdng uong g i p doi lieu d l bii. Tuy nhidn, vdn cd 8% bdnh nhan u i n g tang gap ddi lieu de bii l i i u qudn. O i l u nay cung d n phai luu y, n h i t la vdi cac t h u l c ma vi^c t y y tang gap ddi lieu cd the khiln bpnh nhan gap cdc tdc dung khdng mong m u l n cua t h u l c , vf dy, hp d u d n g huyet. Trong qua trinh t u v i n cho bdnh nhan, cung d n n h I c nhd bdnh nhdn khdng d u y c uong g i p ddi l i i u de bii lieu da qudn.
K e t l u a n
Khdo sdt thyc trang h i l u b i l t ve sir dyng t h u l c cua bpnh nhan BHYT didu trj ngopi tru tpi Bdnh vidn Npi t i l t Trung uang cho thay p h i n Idn benh nhan biet v l tdc dyng d i l u trj chfnh (66%), lieu diing (73,2%) va thdi diem diing (72,0%) cda cdc t h u l c hp duae ke. Tuy nhien, van con 54,4%
bpnh nhan khdng biet v l b i t cCr tdc dgng phy ciia t h u l c ndo trong dan, 23% bpnh nhan khdng b i l t cdch x u tri khi gap cdc tae dyng phy cua t h u l c , Sd luang bpnh nhan khdng biet cdch bdo qudn t h u l c thdng thudng c h i l m 1/4 va han 40% bpnh nhan khdng biet each bdo qudn diing t h u l c tiem insulin. V l tuan thCi sir dyng t h u l c , chT c6 4,5 % benh nhan tra Idi da tirng t y y ngirng su* dyng t h u l c nhung ed tdi 46% bpnh nhan da tung quen sir dyng t h u l c . Phan Idn khi qudn t h u l c se bd qua l i i u , khdng u i n g bii (65,5%) nhung van con 22% bpnh nhan khdng b i l t cdch x u tri.
T a i l i e u t h a m k h a o 1. Bp Y te (2007), Dich te dwQK hgc. Nha xuit bdn Yhpc.
2. Nguyin Thj Thu Thao, Nguyin Thanh Minh (2009), "Danh gia dnh hudng truyin thdng gido dye v l kien thuc, thdi do thuc hdnh vd cdc chf s l kilm sodt tren b^nh nhdn dai thao duong typ 11", Tap chl Y hgc Tp. H6 Chi Minh, 13(6), pp. 71-78.
3. Vti Phong Tuc, Le Chfnh Chuygn (2012).
T^P CHI DUgiC HOC - 9/2015 (SO 473 NAM 55)
