JOURNAL OF COMMUNin MEDICINE
Y MUU
CONGDONG 2018
THUC TRANG MOT SO HOAT DONG CUNG UfNG THUOC TAI TRUNG TAM Y TE THANH PHO THAI NGUYEN NAM 2016
Iran Thj Bich Help', DUdng Ngpc Nga'
T O M TAT
Cung img thudc dong vai tro quan trpng trong hoat dpng khdm, chua bpnh t^i cdc benh vien, Vi vay, nghien ciiu m6t sd ho^t d^ng cung ung thuoc tai Trung tdm Y te TP Thai Nguyan dupe thuc hien dua tren hoi ciiu s6 lieu. Ket qua nghian cdu cho thdy, nam 2016 cd 9 hogt chat dupe bo sung vdo danh myc thuoc. Danh mye thuoc benh vipn co 145 hoat chdt phdn thdnh 19 nhom tac dung dupe ly trong do chu yau Id thuoc dan thdnh phdn vdi 81,9% vd thudc generic chiem 93,4%. Ty le thuoc thiet yau trong danh muc thu6c Id 51,6%, ty le thu6c san xuat trong nude chiem 54,6%. Nam 2016, tdng gid tri tian thuoc sir dung cua Trung tam la 7893,1 triau ddng, ty la gid tri tien thuoc biet dupe g l c vd thuoc sdn xudt d nude ngoai sii dyng Idn lupt la 6,6% va 52,7%.. Thudc tiem sii dyng vdi ty le nho ve s6 luong 4,5% nhung gid tn Idn 27,5%. Phdn tich ea cdu t h u l c su dyng theo ABCA/^EN cho thdy cd ii,u6c A chiem ty Ip nho 10,3% va s l lupng vd chiam ty le Idn 76,3%. v l gid tri su dyng. Thudc tdi c^n(nh6m V) chiem 31,5% v a s i lupng vd 63,3% v l gid trj su dyng. Cac thudc quan trpng nhdm I (AV, BV, CV, AE, AN) chilm 35,2%. v l s l lupng va 80,8%. v l gid trj sii dyng.
Tir kh6a: Cung ung thuoc, phdn tich A B C A ^ N , thuoc sit dyng
ABSTRACT
THE REALITY O F MEDICINE SUPPLIES AT HEALTH CENTER O F THAI NGUYEN CITY IN 2016
Drug supply plays an important role in medical examination and treatment at hospitals. Therefore, drug supply activities research at Thai Nguyen Health Center was conducted based on retrospective data. The study resuhs showed that 9 substances were added to the list of drugs in 2016. The list of hospital drugs has 145 substances were classified into 19 groups
1. Trudng Daii hpc Y Dup-c Thai Nguyen.
Tdc gid chinh Tr^n Thi Bich H p p , SDT: 01292629149
of pharmacological effects in which mostly single component drugs with 81.9%. and gene.ic drugs accounted for 93.4%.. The rate of essential drugs in the list was 51.6%., the proportion of domestically manufactured medicines accounted for 54.6%. In 2016, the total value of used drugs in the Center was 7893.1 million V N D , the rate of value of original brand-name and foreign manufactured medicines were 6.6% and 52.7%. The quantity of injection medicines accounted for small percentage but the used value was high accounted for 27.5%). ABC/VEN analysis showed that the quantity rate of A drugs was small accounted for 10.3% but the used value rate was large accounted for 76,3%. Drugs in group V were 31.5 % in quantity and 6 3 . 3 % in used value. Drugs in group I (AV, BV, CV, AE, AN) were 35.2% in quantity and 80.8% in used value.
Keywords: Dmg supply, ABCA'EN analysis, used drug, I. DAT VAN DE
Mpt trong nhimg nhipm vu quan trpng dnh hudng den chat lupng khdm chua b?nh ciia benh vien la vdn dl cung ting thuoc ddy du, kip thdi, eo chdt lupng. Trong nhimg nam gdn ddy, thi trudng dupe phdm thi gidi va trong nuac ngdy cang dupe md rpng vdi sy da d^ing phong phii ca vl chung loai vd sd luong. Vi vdy cung ling thuoc trong b^nh vien vira c6 them nhilu thudn Ipi vira phdi dli mat vdi nhtrng thach thuc mdi. Su phong phii cua thi trudng dirpc pham giiip cdc banh vien cd co hpi tiep can vdi nhiing thuoc an todn, chat lupng, cd hieu qud vd kinh tl. Dong thdi su da dang ndy ciing gay nan nhiing lung tiing va cd tiau eye trong cdc hoat ddng lya chpn, mua va sd dung thudc tai cdc benh vipn. De ndng cao chat lupng ciia hoat d§ng ndy, cdc ca quan qudn ly da ban hanh nhilu quy djnh va lua chpn, mua, cap phdt vd quan ly sii dung thulc t^i cdc ca sd khdm, chira bpnh.
» Ngay nhan bai: 04/12/2017
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VJLBHIENCOU KHOA HOC
Trung tam Y tl TP Thai Nguyen la md hinh ling ghep quan ly 2 phdn tuyen chuyen mdn ky thudt (tuyln 3 vd tuyan 4) tuong duong benh vien h^ing III vdi quy m6 170 giudng benh. Trung tam vua cd ehdc nang dy phong vira c6 ehde nang khdm, chira benh ban dau cho ngudi cd ttie bao hiem y ta vd cac d6i tupng khdc. Vdi mong muln tim hiau tinh hinh cung ling fliuoc t^ii Trung tdm, chung t6i tiln hdnh dl tdi nghian cdu vdi muc tieu phdn tich thuc trang mpt sl hogt d^ng cung ung thulc tai Trung tam Y tl TP Thai Nguyen nam 2016.
U. PHU'ONG PHAP NGHlfeN ClTU Sd dyng phuong phap md td cdt ngang tren eo sd su dung so lipu hoi cim trong cdc bdo cao, s6 sach, hda dan chimg tir lien quan dan ho£it d^ng cung dng thudc tai Trung tam Y tl TP Thdi Nguyen nam 2016.
III. Ktv QUA NGHIEN CtTU
3.1. Kit qua 1 ^ chon thuoc vdo danh muc thuoc b^nh vien
Bdng 3.1. So luffng hoat chAt m&i bo sung ndm 2016 STT
1 2 3 4 5 6
Nhom Thuoc didu tri ky sinh trung, chong nhilm khu^n Hocmon va cac thuoc tac dpng vao he thdng npi tidt Thuoc ducmg tieu hoa
Thuoc ch6ng roi loan tam than Khoang chat va vitamin Thuoc tac dung tren dudng ho hap
Tdng
So lin^l'g 2 1 1 2 1 2 9 Bdng 3,2. Co cdu danh mifc thudc theo tdc dung dupe if STT
1 2 3 4 5 6 7 8 9 10 11 12 13
Nhom Thudc didu tii Icy sinh trung, chong nhiem khuan Thudc tim mach
Hocmon va cac thuoc tac dpng vao he thong npi tiet Thudc giam dau, ha sot; chong viem khong steroid Thudc du6ng tieu hoa
Dung dich didu chinh nuac, dien giai, can bang acid - base va cac dung dich tiem truyen khac
Thuoc chong roi loan tam than Khoang chat va vitamin Thudc diSu tri dau nira dau Thudc chdng co giat, chdng dpng kinh Thudc tac dung tren dudng ho hap
Thudc chdng di ling va dung trong cac trudng hpp qua man Thuoc khdc
Tdng
So Iirpug 35 19 12 12 14 8 5 11 1 3 4 5 10 14S
Tylf(%) 30,9 15,9 8,6 8,6 7.3 6,0 3,0 5,6 0,4 1,7 3,4 2,6 6,0 100
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37
JOURNAL OF COMMUNITY MEDICINE
Y H O C
O0NGE)ONG 2018
Bdng 3.3. Ty IS thuoc thikyiu STT
1 2
Npi dung Thuoc thiet yeu
Thuoc khong phai la thuoc thiet yeu Tong so
sd l i r ^ g 175 164 339
T y l f ( % ) 51,6 48,4 100 Bdng 3.4. Ty le thudc dffn thdnh phdn, da thdnh phan
STT 1
Npi dung Thudc don thanh phan 2 Thuoc da thdnh phan
Tdng sd
S d l i T ^ g 308
31 339
T y l f ( % ) 90,9
9,1 100,0 Thu6c dcfn thanh phiui gom 308 khoan muc chiem ty le 90,9%.
Bdng 3.5. Ty le thuoc sdn xuat trong nu&c STT
1 2
N^i dung Thuoc san xuiit trong nude Thuoc san xuat d nude ngoai
Tdng sd
S d l i r ^ g 185 154 339
T y l e % 54,6 45,4 100 Thuoc san xuiit trong nude co 185 khoan muc chidm 54,6%.
Bdng 3.6. Ty l^ thudc biet duac goc STT
1 2
N$i dung Thuoc biet dupe gdc Thuoc generic
Tdng sd
So Ivpng 37 302 339
Tyle(%) 10,9 89,1 100 Thuoc generic chiam s6 lupng Idn trong danh myc glc chilm 10,9%.
vdi 302 khoan myc, chilm 89,1%. Co 37 thulc biat dupe 3.2. Phan tich hoat d§ng sur dijing thuoc Bdng 3.7. Gid tri tieu thu mpt sd nhdm thudc tdn dupe ndm 2016
STT
1 2 3 4 5 6
Nhom
Thuoc dieu tri ky sinh tning, chdng nhilm khudn Hocmon va cac thudc tac dpng vao he thdng npi tidt Thuoc tim mach
Thudc giam dau, h? sdt; chdng viem khdng steroid Thuoc dudng heu hoa
Thudc Idiac
Tdng
Kho^n So khoan
58 14 27 18 15 56 188
miic T y l j
r/c)
30,9 7,4 14,4 9,6 8,0 29,7 100
Gid tri tiSu thv GW tri (Trieu dong)
2.353,4 1.963,6 1.777,6 732,7 114,5 416,3 7358,1
Tyl? 32,0 26,6 24,1 10,0 1,6 5,7
looH
B
O Q I S 6 2 (43) - Thing 03-04/2018 I Website yhoccongdong vn\M\ HIEN CUfU KHOA HOC
Nhdm thudc su dyng nhilu nhdt la thudc dilu tri hormon vd cac thudc tac dpng vdo he thong npi tiet 26,1%
ky sinh tning, chdng nhiem khuan (32%). Tiap theo la vathude tim m^ch (24,1%).
STT
1 2
Bdng 3.S. Gid tri su dung thudc
Ca cdu thudc
Thudc bidt daQC goc Thuoc generic
Tong so
STT
1 2
Bdng 3.9. Gid
Co can thudc
Thudc san xuat trong nude Thudc sdn xuat d nude ngoai
Tdng sd
'lift dupe s d l u ^ g thudc sir dyng (Tinh theo DV dong got nho nhdt)
Solinrng 168 470 3 594 359 3 762 829
T y l f ( % ) 4,5 95,5 100
tri ^i^ dung thuoc sdn xuat & nu&c ngodi s d ludng thuoc sir dung (Tinh theo BVdonggoi nho nhdt)
s d liri^g 2 515 467 1 247 362 3 762 829
Ty le (%) 66,9 33,1 100
Gia tri sir dyng (Trteu dong) SL 518,9 7 374,2 7 893,1
TL(%) 6,6 93,4 100
Old tri sir dung (Trieu dong) Sdlirdng
3 732,7 4 160,4 7 893,1
Ty 1| (%) 47,3 52,7 100 Thudc san xudt trong nude dupe su dung vdi sd vdi s6 lupng thu6c sdn xudt d nude ngoai nhung gid tri sd lupng (tinh theo dan vi ddng goi nhd nhdt) cao gap ddi so dung chi chiem 47,3%..
STT
1 2 3
Bdng 3.10 Gid tri sir difng thuoc tiSm
Cd cau thu3c
Thudc udng Thudc tiSm Thudc khac
Tdng sd
sd lirpng thudc sir dung (Tinh theo DV dong goi nho nhat)
s d lirdng 3 586 334 170 201
6 294 3 762 829
TJ1?(%) 95,3
4,5 0,2 100
Gid tri sir dung (Tri4u ddng) Sdlirprng
5 667,2 2 170,1 55,8 7 893,1
T y l e ( % ) 71,8 27,5 0,7 100 Thulc dung dudng uing duac sd dung vdi sd luong sir dung 4,5% sl dan vi dong goi nho nhat nhimg gia tn rdt Idn chilm 95,3% nhung gid tii sd dyng chi chiem su dung chiem 27,5%.
71,8%i. Trong khi do thuoc tiem- tiem truyen mac dii chi
Bdng 3.11. Cff c&u thuoc su dung theo phdn hpng ABC
Hang A B C Tdng
Khoan s d khoan muc
25 30 158 213
aiuc Ty le (%)
10,3 14,1 74,2 100
Chi phi Gia tri (Ineu dong)
6 019,1 1 155,2 718,8 7 893,1
l y le W 7 6 , 3 1 4 , 6 9,1 100
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JOURNAL QF GOMiVlUNITY MEDICINE
YHOC
CONGDONG 2018
] ~ '.—^
Ting sl 213 thulc dupe phdn tich ABC. Thulc hang A muc chilm 14,1% vl sd lupng mat hang va chilm 14,6% i^ , cd 25 khodn muc chilm 10,3% vlsl lupng khoan mye nhung gidtiisirdung. 158thu6changCchichiem9,l%vlgiatritiiD I chilm din 76,3% vl gia tri tiau thy. Thulc hang B co 30 khodn thu nhung chiira 74,2% ve s6 hipng khoan muc. I
Bdng 3.12. Cff cau thudc su dung qua VEN
Lo^i V E N Tdng
Khodn muc sd khodn muc
67 103 43 213
Tylsf%;
31,5 48,4 20,1 100
Chi phi Gid t r i (Trieu dong)
4 992,9 1 870,8 1 029,2 7 893,1
Tyi?(5«
63,3 23,7 13,0 lOO Nhdm thudc thilt ylu (nhdm E) cd sd loai thudc cao sd lupng. Nhom thudc N Id thudc khong can thilt troi^
nhdt vdi 103 thulc chilm 48,4% vl sd lupng va 23,7% dilu tri, sl loai thu6c co 43 khodn muc ehilm 20,1%, va gid tri. Nh6m thulc cd gid trj sd dyng cao nhat la vdi gia tri su dyng nhd nhdt chiem 13%. ting gia tri su thudc tdi cdn (nhdm V), 63,3%. vl gia tri va 31,5% ve dung thuoc.
Bdng 3.13. Phdn tich ma trdn ABC/VEN
Loai A B C Tong so
V Kdthpp
AV BV CV
Sdlirtrng 17 17 33 67
E Kdthfrp
AE BE CE
Sdlirprng 6 11 86 103
N Kdthdp
AN BN CN
SdltrQUg 2 2 39 43 LoalI:AV-^-BV+CV+AE^-AN=75sanphdmchilm BN= 99 sdn phdm chilm 46,5yo ve sl lupng msit ha:
ty le 35,2%i vl s6 lupng khodn muc. Loai 11: BE+ CE+ Cde thulc loai III: CN = 39 san phdm chilm 18,3%.
Bdng 3.14. Gid trf su dung cdc loai thudc theo ma trdn ABC/VEN
Lo^i Loai I L o a i n Loai III Tong sd
So lirong mat hang sd lirgng
75 99 39 213
TylfW
35,2 46,5 18,3 100
C b i p U Gid tri (J>-ieu ddng)
6 378,4 950,7
567 7893,1
TJ IS (%) 80,8 12,0 7,2 100
Cac thuoc loai I chilm 35,2% vl sl lupng vd 80,8% tiianh phi Thai Nguyan da bl sung 9 boat chdt vao danli ve gia tii su dyng. Cac thulc lo?ii II chilm ty le cao nhit muc, thupc 6 nhdm tdc dyng duoc ly. Danh muc thuoc vl s6 lupng su dyng (46,5%) vd dung tiiu hai vl gid hi su nam 2016 gom 145 boat chdt chia tiidnh 19 nh6m tdc dM dung vdi 12,0%..
IV. BAN LUAN
Ve kit qud lua ch^n thuoc vao danh muc thulc b^nh vifn
Ket qud phan tich cho thdy nam 2016, Trung tam Y tl
dupe ly. Trong dd, nh6m thulc co sl lupng boat chat Mm nhdt la nhom thulc dilu tri k^ sinh tiling, chIng nhiem khudn vdi 30,9%.. Danh muc thuoc ciia trung tam nam 2016 chu ylu la tiiulc don thdnh phdn vdi ty le 90,9%.
Cdc tiiude da tiianh phdn chilm t^ le nho vd hdu hit deu la cac thulc dupe chiing minh lai thi vl hieu qua dieu tri
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\\\ HIEN CUfU KHOA HOC
vd thudn tien trong su dung. Ty Ip thulc generic chilm ty Ip Idn trong danh muc 81,9% cho thdy tnmg tam da thuc hien tot quy dinh ciia Bd Y tl nhdm gidm chi phi dilu tri- Tuy nhien, vdi dac trung ve md hinh benh tdt va tuyen dieu tri cua trung tam chu ylu cham soc sue khde ban ddu vd cdc benh nhe thi ty Ip thudc thiet yen vd thudc sdn xudt hong nude chua cao, chi d^t 51,6 % vd 54,6%..
v l hbat d$ng sir dung thuoc
T6ng kmh phi sd dung thulc t^i trung tam nam 2016 la 7893,1 trieu ddng, trong dd kinh phi sir dung thudc tdn dupe Id 7358,1 trieu ddng. 58 khoan muc thupc nhom thu6c dieu tri ky sinh trung, chdng nhiem khudn dupe sd dyng vdi gid hi sir dung Idn nhdt chiem 32,0%. Vdn dl cua trung tam la can ddnh gia lai boat dpng ke don va sd dyng khdng sinh nhdm ngan ngua nguy co lam dyng khdng sinh va tinh trang vi khuan khang khang sinh trong benh vien va trong cpng ddng. Ban canh do, nhdm thudc hocmon, thudc tdc ddng vdo hp thdng npi tiet, thu6c tim mach vd thulc giam dau ha sit chIng viem khdng steroid Cling dupe su dyng vdi so lupng vd gid tri Idn do tinng tdm CO nhiem vu khdm chua bpnh cho phan Idn benh nhdn cao huylt ap, tiln dudng co the bdo hiem y te tren dia ban thdnh pho. Cdc ihudc biet dupe goc da cd day du cac sd lieu vl chdt lupng, an todn vd hipu qua dupe Bp Y te ban hdnh trong "danh myc thudc biet dupe glc" cd vai trd nhdt dinh trong dilu tri. Md hinh benh tat ciia trung tdm chu ylu Id cdc benh uhp nhung trong mpt sd trudng hpp cdn bp y tl vin co the can nhdc su dung thulc biet dupe glc dl ddm bdo hifu qua dilu tri. Vi v^y, ty le thulc bipt dupe glc dupe sd dung chilm ty Ip nho 6,6%. Song song vdi viec uu tien su dyng thuoc generic, trung tdm ciing su dung phEin Idn thulc sdn xudt trong nude nham gidm chi phi dilu til. Tuy nhien do cdc thulc sdn xuit ti-ong nude c6 gia thdnh thdp nen mdc du s6 lupng su dung Idn nhung gia
tri thuoc san xuat trong nude su dyng chi d^t 47,3%.. MOt v ^ dl ddng quan tdm nua la dang thulc tiam-tiem truyen dupe khuyen cao chi su dung trong cac trudng hpp cdn thiat, tai trung tdm chi su dyng vdi so lupng nhd nhung gid tri rdt Idn ehilm 27,5%. Phdn tich ABCA^N cho tbay cde thuoc tdi cdn vd thu6c thiet yeu chiem ty IS Idn ve sd lupng mat hang ciing nhu vl gia tri su dyng nhung cdc thulc kh6ng thilt ylu ciing cd gid tri sir dyng tuong ddi cao tdi 13,0%.. Cac thulc nhdm A chilm ty I| Idn ve kinh phi (gan 76,3%) nhung chi chiam ban 10,3% vl so lupng. Trong sl 25 thudc nh6m A, chu yeu Id thudc t6i cdn (V), CO 6 thulc thilt ylu (E) vd co 2 thulc khdng thiet ylu (N). Cdc tiiule loai I - AV+AEH-AN-HBV-HCV chilm ban 80% ve gia tri su dung. Tuy nhien, gid tri sd dyng thu6c lo^i III (CN) tai Trung tam kha cao, chiem 7,2%, Thulc AN CO gid tii su dyng cao nhat la Katripsin 4,2mg vdi 4,5%. vd Dpc ho?t tang ky sinh chilm 2%. tdng gia tri su dyng. Trung tam can nghian cira l^i vipe su dung cdc thulc khong thilt ylu (N) dl loai khdi danh myc, giaro chi phi dilu tii cho benh nhdn.
V. KET L U ^
Danh muc thulc benh vien eo 145 boat chat vdi 19 nhom tac dyng dupe ly, thulc don thdnh phan 81,9%., thuoc generic chiem 93,4%. Ty le thudc thiet yau 51,6%, thudc sdn xudt tirong nude chiem 54,6%.. Tong gia tii tiln thudc nam 2016 Id 7893,1 triau ding, thuoc biet dupe goc vd thuoc san xudt d nude ngodi Id 6,6% va 52,7%, thudc tiem 27,5%. Phan tich ca cdu thudc sd dyng theo ABC/
VEN cho tiidy cdc thulc Aehilm ty le 10,3%. vl sd lupng vd ehilm ty le 16,3% vl gia tri su dyng. Thuoc tdi cdn (nhdm V) chilm 31,5%. vl sd lupng va 63,3%. ve gid tri su dung. Cac thulc quan trpng nhdm I (AV, B V, CV, AE, AN) cliiem 35,2% vl sd lirong vd 80,8%. ve gid tri su dung.
K ^ I LIEU THAM KHAO|
1. Bp Y tl, (2013), Thdng hi 21 /2013/TT-BYT quy dinh tl ehdc va boat dpng cua Hpi ding tiiudc vd dilu tin ti-ong benh vien.
2. Vii Thi Thu Huong, Nguyen Thanh Bmh(2011), Ddnh gia boat dpng xdy dyng danh muc tiiudc cua Banh vian E nam 2009, T^p chi Dupe hpc 12/20II.
3. Ha Van Thuy, Nguyen Anh Phuong, La Thu Thuy (2017) Phdn tich co cdu thulc su dung tai Banh vipn Phu sdn Ha Npi nam 2014, Tap chi Dupe hpc sl 7/2017.
4. Jonathan-D.Quick, James.R-Rankin and others authors, Managing drug suply, Kumarian press, (2010).
5. WHO (2007) Drug anh therapeutics commitee training course.
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