TAP CHi Y DL/OC LAM SANG 108 Tap 10 - So 4/2015
Mot s6 nhan xet vg tinh hinh kham benh va dihu tri tai Khoa Rang mieng Benh vien Trung u-ang Quan doi 108 (2010 - 2014)
Comments on examination and treatment at the Dental Therapy Department of 108 Military Central Hospital from 2010 to 2014
Chu Thi Thu Phiromg Khoa Rdng mieng - Benh vien Tl/QD 108 Le Thi Thu Ha
Muc tiiu: Oanh gia, nhan xet ve cac chi tieu kham, dieu tri phuc hlnh rang gi^ cho cac ddi tUgng benh nhan den kham va dieu trj tai khoa Rang mieng va kien nghj mgt so van de de nang cao chat luong kham benh va dieu tri tai khoa. Do/tucrngvdp/n/ong.p/idp: Chung tdi tien hanh thu thap so lieu cac ddi tugng den kham va dieu trj rang mieng trong thdi gian 5 nam t d 2010 - 2014, gom: Quan tai ngu, BHYT Quan (BH hUu), bao hiem quan dgi, b i o hiem y te khac, bao hiem than nhan, ban, chinh sach, tr^ em< 5 tudi, djch vu y t e va doi tUOng khac. (10 ddi tuong). Kit qua va kit lugn: Trong 5 nam (2010 - 2014) Khoa Rang mieng - Benh vien TLfOD 108 da kham 80.015 benh nhan vdi tong sd lan dieu trj 99.103 lan, dieu trj khdi 99,82%, sd benh nhan dUgc dieu tn bao ton la 75.622 trirdng hgp chiem t y le 76,3% so lan dieu trj, sd benh nhan nho rang la 9.880 trudng hgp chiem ty le 12,35%. Doi tugng Quan c o t y lecao nhat la 34,28%, t h d 2 la Bao hiem y t e HUu chiem 19-16 26,57%. Ooi tugng Bio hiem y te hUu la doi tUOng benh l i r a n g mieng phdc tap nhat va t y l e bao ton thap nhat (66,06%) va lam ham g i i cao nhat chiem t ^ l e 15,91%.
Tdkhda: Khoa Rang mieng, Benh vien TUQB 108.
Summary
Objective: To assess and comment on the examination criteria and pfosthetic treatment for patients who diagnosed and treated the Dental Therapy Department, and propose some measures to improve the quality of examination and treatment at the department. Subject and method: Ali patients who undenA/ent prosthetic treatment during the period of 2010-2014 were selected, and classified into the following groups, based on types of insurance: Military officer, military health insurance, retired health insurance, military insurance, health insurance, officer family insurance, children below 5 years, people, foreign, policy and other subjects (10 groups). Result and conclusion: in 5 years (2010-2014), 80 015 patients were examined at the Department, there were 99 103 times of treatment with 99.82% of success; 7566 patients were preserved (76.3%) and 9880 cases were extracted (12.35%). The military officer subjects had the highest percentage o f t h e patients (37.28%), and followed by the retired health insurance (26.57%). Oral diseases o f t h e retired health insurance patients were the most complex with the lowest chance of preservation (66 06%); 15.91% of them were treated with prosthesis.
Keywords: Dental Therapy Department, 108 Military Central Hospital.
PhaD bien khoa h9C: PGS.TS. TRUONG UYEN THAI
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol. lO-NM/2015
1 . Oat van de
Khoa Rang mieng - Benh vien TL/QD 108 la khoa dau nganh tuyen eudi cOa quan ddi, ed ehde nang ehinh la kham va dieu trj eho tat ca cae ddi tUdng duoc chuyen den t d cac Benh vien, cac cd sd Quan y tuyen trUdc. Ben canh nhiem vu ehinh tren khoa edn cd nhiem vu tiep nhan benh nhan ban Lao theo sU phan edng eua Nha nUdc. Khoa dUde bien che 26 ngUdi, cd 11 Bac sy, trong d d 03 Tien sT, 01 BS CK 11, 02 BS CKI. Oieu dddng OH: 03, Oieu dUdng t r u n g hge: 11; h o l y : 0 1 .
Khoa dugc trang bj: 11 ghe rang, 01 La bd rang g i i hien dai, 03 chiec may XQ (1 XQ KTS Panorama, 1 XQ KTS can chdp, 1 XQ can chdp).
De g d p phan danh gia k h i nang hoat d d n g chuyen m d n eCia khoa trong pham vi 05 nam t d 2010-2014, chung tdi tien hanh nghien edu danh gia va nhan xet ve t l n h hinh kham benh va dieu trj tai khoa vdi muc tieu:
Ddnh gid, nhdn xet ve cdc chi tieu khdm, dieu tri, Idm hdm gid cho cdc doi tdgng tai khoa Rang miing.
Kiin nghi mgt so vdn de di ndng cao han nda chdt Idgng kham binh vd dieu tri benh thugc khoa Rdng mieng.
3. Ket q u i
3.1. Sdbenh nhdn mdi din khdm benh
2. D o i tUdng va phifcmg phap 2.1. Doi tugng
Cac doi t u g n g den kham va dieu trj tai khoa Rang Mieng t r o n g t h d i gian 5 nam tU nam 2010 - 2014, bao g d m : Cae Quan tai ngu (Q), BHYT Quan huu (BHH), bao hiem Quan ddi (BHQO), bao hiem y te khac (BH#), b i o hiem than nhan (BHTN), ban (B), chfnh sach(CS), tr^ em < 6 t u d i (TE), djeh v u y te (DV) va doi t u o n g khac (10 ddi tugng).
Cae doi t u o n g den kham va dieu trj dUde tien hanh nghien cUu theo cac chl sd: Sd benh nhan mdi, so lan dieu tri, sd dieu tri b i o t d n , sd duge lam ham g;a, so benh nhan n h o rang, so benh nhan sd dung ky t h u a t cao, sd benh nhan khdi.
2.2. Phucmg phdp
PhUdng phap nghien cUu: PhUdng phap hoi edu, phan tfch sd lieu.
Ndi d u n g nghien edu: Sd benh nhan mdi, sd lan dieu trj, dieu trj b i o t o n , sd benh nhan nhd rang, so benh nhan lam ham g i i , sd benh nhan sU dung ky thuat eao va sd b&nh nhan khdi.
7000 • 6000 • 5000 • 4000 3000 2000 1000
L l l i l l . 1 I I I
1 J 1 J 1 J
1 J
1
r i « i i i B 111 J
2010 2011 2012 2013 2014
• Q
• BHH
• BHQD
• B^n
• TE
• CS
• DV
• BHK .BHTN
• Khic
Bieu do 1 . So benh nhan mdi den i<h9m benh,
Nhdn xet: Nam 2010: 14.532 benh nhan, nam 2011: 15.397 benh nhan, nam 2012: 15.733 benh nhan, nam 2013:17.227 benh nhan, nam 2014:17.126benh nhan.
T A P C H I Y D ^ J C L A M S A N G I O S Tapl0-S64/2015
3.2. So luat benh nhdn tiiu tri
Nam 2010 2011 2012 2013 2014 Tong
B a n g 1 . So l i / o t b e n h n h a n d i e u t r O o i tiTcmg ( S o lUdt b e n h n h a n d i e u t r i ] Q
6560 6575 6181 6816 6830 32.962
BHH 5370 6045 5713 5887 5143 28.158
BHQO 45 146 88 83 65 427
Ban 49 61 70 177 121 478
TE 33 33 35 50 22 173
CS 963 267 2 6 1 1.239
DV 1577 2058 2357 2398 1948 10.338
BH khac 1877 2633 3734 4364 5163 17.771
BHTN 1269 1055 1145 1336 1158 5.963
KHAC 720 570 258 28 18 1.594
Cong 18.463 19.443 19.583 21.145 20.469 99.103 Nhdn xet
Trong so 80.015 benh nhan den kham tai khoa vdi sd luot dieu tri la 99.103 luot ngUdi. NhU vay t r u n g binh eU 1 b e n h nhan kham se ed 1,24 lan dieu trj.
Trong 99.013 lUdt ^ e u trj t y le benh nhan Quan ehiem tdi 33,26%, BHH: 28,4%, eae doi t u g n g khac t y le it hgn nhieu so vdi 2 doi t u g n g nay.
3.3. So benb nhdn dUdc dieu tri bao ton
Bang 2 . S d b e n h n h a n d u g c d i e u t r j b a o t o n
Nam
2010 2011 2012 2013 2014 Tdng
Doi tUtfng (So b e n h n h a n dieu trj bao ton) Q
5637 5635 5262 6043 6096 28.673
BHH 3251 3673 3395 3670 3190
BHCiO ! Ban ! TE 30
105 66
38 48 52 48 , 167
27 32 33 49 43 1 109 ! 19 17.179 1 292 414 760
CS 951 265 2 0 1 1J19
DV 1131 1558 1733 1573 1310 7.305
BHkhac 1580 2196 3105 3661 4170 M . 7 I 2
BHTN 940 737 Til 931 844 4.249
Khac 577 476 155 11 0 1.219
Cong 14.162 14.725 14.600 16.153 15.782 75.422 Nhdn xet Sd lan dieu tri b i o t d n t r o n g 5 nam ehiem ty le 7 6 , 1 % (75.422)
(99.103). So b e n h nhan la ddi t u g n g BH HUU cd sd lan dieu trj bao tdn thap nhat nhan BH Hdu ehiem ty le 61,1 %, ty le cao nhat la d tre e m : 92,5%.
3.4. So benh nhdn nho rdng
Bang 3. So lUcmg Benh n h a n n h o r a n g
so vdi t d n g sd lan dieu trj 17.179 so vdi t o n g so benh
Nam 2010 2011 2012 1 2013
2014 Ton^
Q 309 353 3 6 ; 322
BHH 764 809 799^
^95 756 1.929
BHQD 1 ' 6 19 10 59
£}6i t u o n g (Benh nhan n h o rang) Ban
5 5 6 5 6 2 7
TE 6 1 0 1 3 I I
CS 8 2 2 3 0 IS
DV 211 268 320 392 328 U I 9
BHkhac 145 238 310 402 578 1.673
BHTN 195 175 195 229 197 911
Khac 9 4 6 0 0 19
Cong 1.653 1.873 2,012 2.168 2.174 9.880
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoLlO-N" 4/2015
Nhdn xet: Trong 80.015 benh nhan den l<hani va dieu tri co 9.880 benh nhan nho rang chiem ty le 12,35%.
Trong do doi Wong bao hiem huu chiem ty ie cao nhat la 3.929 tttlimg hop chiem ty le cao nhat (39,75%).
3.5. So benh nhdn duac Idm ham gia
B a n g 4 . S o b e n h n h a n d i / o c l a m h a m gia
Nam
2010 2011 2012 2013 2014 Tdng
Doi t u o n g (Benh nhan iam ham gia)
Q 584 562 564 452 418 2580
BHH 1.365 1.549 1.541 1.392 1.197 7044
BHQD 11 23 11 22 23 90
Ban 6 8 12 4 7 37
TE 0 0 0 0 0 0
CS 4 2 0 4 0 10
DV 222 228 307 422 316 1495
BH Ichac 329 202 335 307 422 7595
BHTN 132 145 155 162 119 713
Khac 137 95 97 17 18 364
Cong
2.790 2.814 3.022 2.782 2.520 73.928 Nhdn xet Oa lam ham gia eho 13.928 trUdng h o p ehiem t ^ le 17,4% t d n g sd benh nhan den kham benh va dieu tri. Trong d d ddi t u g n g BHYT HUu lam rang g i i 7.044 benh nhan cung chiem t J le eao nhat 50,57%
trong t o n g sd benh nhan den phuc hinh rang, sau do den eae ddi tUdng: Quan: 18,52%, cac ddi t u g n g edn lai t y l e khdng dang ke.
3.6. Sdbenh nhdn sddung ky thudt cao
Bang 5. So b e n h n h a n sii d u n g k y t h u a t cao
Nam
2010 2011 2012 2013 2014 Tong cong
Cac ky t h u a t cao Cau chup suT
Kim loai thUcmg 452 449 443 380 474 2198
Cau chup sijr Titan, Cercon
0 30 57 62 71 210
Ham k h u n g + Nhua deo
54 70 95 69 55 343
Ham nan 12 25 20 25 8 90 Nhdn xet NhU vay trong 5 nam da thuc hien 2198 t r u d n g h g p eau chup sU t h u d n g , 210 t r u d n g hop cau chup sU Titan, eereon, 314 trudng h g p ham khung, ham nhUa deo va 90 t n / d n g h g p n l n ehlnh rang.
TAP CHlYjjcJC LAM SANG 108 Tap 10-564/2015
3.7. So binh nhdn Suae dieu tri khoi
6000 -
5000 '
4000 :
3000 -
2000 •
1000 '
1 1 • I I I
J 1 J 1 i
1 J
•
rnviiiiiii J
2010 2011 2012 2013 2014
• Q
• BHH
• BHQO
• B^n
• TE
• CS
• DV
• BHK
• BKTN
• Khac
Bleu d o 2 . So benh nhan dieu tri khoi.
Nhgn xet: Trong t o n g so 80.015 benh nhan d u o c dieu t n tai khoa t r o n g 5 nam, da dieu trj khoi cho 79.871 benh nhan chiem t y le 99,8%.
4. Ban l u a n
4.1. So benh nhan mcfi
Trong 5 nam co t d i 80.015 b e n h nhan den kham, t r u n g b i n h 1 nam kham cho 16.003 n g u d i , tnjng binh 1 t h a n g co 1.334 n g u d i , t r u n g b i n h 1 ngay 63 - 64 n g u d i (tinh theo so ngay lam viec/ nam 252 ngay). So luong b e n h nhan den kham co xu hudng tang, nam 2010 la 14.532, nam 2014 la 17.126 Ooi t u p n g Quan chiem ty le cao nhat, chiem ty le 34,28%, sau d o la cac doi t u o n g BHH: 26,57%, bao hiem khac: 19,4%, dich v u y te: 9,62%, bSo hiem than nhan: 5,7%, ban: 0,53%, doi t u o n g khac: 1,81%, chinh sach: 1,53%, tre e m : 0,15%.
Rieng cac doi t u o n g nghien ciJU khoa hoc, quan he doi ngoai, chinh sach ngay cang giam do cac quy djnh ve cac doi t u g n g nay cua Benh vien ngay m p t chat che, cung do m o t so doi tupng tn/cic day la chinh sach, quan he r i ngoai nay da co Bao hiem y te.
Cac doi t u o n g la dich vp y te va bao hiem y te khac c o x u huPng tang, nam 2010 la 1593: nam 2014 la 4419 ngi;.- ' ' = ' ' ° ' ' ^ ^ " 9 ™ " ' ' ' ^ ^ '^^^'^ "^'"
g i U a c a c r . ' n g d a n g k e .
4.2. So sdnh sdbenh nhdn mdi vd solugt dieu tri Qua bieu do 1 va bang 1 ed ket q u i 4 ddi tUdng ed su khac biet rd ret ve t y le so lugt benh nhan dieu trj va sd lUdng benh nhan m d i .
Vdi benh nhan Quan ty le nay la 1.2, benh nhan HUU t y le nay la 1,33, benh nhan BH Y te khac t y le nay la 1,15, benh nhan Djch vu Y te t y le nay la 1,34
Oieu nay cung hoan toan d u n g thUc te vi b e n h nhan BH H QD phan Idn la ngudi cd tudi, t i n h trang benh rang mieng nang hon nen sd lan den dieu trj nhieu hgn eae ddi t u g n g khae. Rieng vdi Djeh vu y te eung Idn do khi dau nhieu mdi den kham cho nen t i n h trang benh Rang mieng nang hgn va phUe t a p h o n , chi'nh vi vay sd lugt dieu tri eao nhat (1,34)
4.3. Sdbenh nhdn dieu tri bdo ton Nghien eUu cua chung tdi cd ket q u i : Trong 5 nam ehiem t y le 76,01% (74.422) so vdi t d n g sd lan dieu tri (99.103). Sd benh nhan la ddi t u g n g BH Huu cd so lan dieu tri bao t d n thap nhat so vdi t o n g sd benh nhan BH HUu, ehiem t y le 66,01%, sau d d den cac ddi t u g n g sau: b i o hiem quan ddi 68,38%, dich
101
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY VoLlO-NM/IOlS
vu y te: 70,66%; b i o hiem than nhan: 71,23%, Bao hiem y te khae: 82,79%, ban: 86,61%, quan: 86,99%, tr^ e m : 92,29%. Dieu nay hoan toan phu hop vdi benh ly ve rang mieng cua tUng loal doi tUdng. Doi t u g n g BH HUu la ddi t u g n g cd ty le dieu tri bao tdn thap nhat 66,01%, trong khi d d d t r e em la 92,29%.
4.4. Sdbenh nhdn nho rdng
Trong t d n g sd 80.015 benh nhan den kham va dieu trj ed 9.880 benh nhan dugc nho rang chiem ty le 12,35%. So lugng nhd rang cd sU bieu hien khac nhau rat rd ret gida eae ddi t u o n g dddc den kham va dieu trj tai khoa rang mieng trong t h d i gian 5 nam qua, cu the: Doi tugng b i o hiem hUu quan dgi chiem t^ le cao nhat tdi 39,71% sd benh nhan dUdc nho rang, sau dd den bao hiem khac: 17,86%, quan nhan: 16,63%, dieh vu y te: 15,37%, b i o hiem than nhan: 10,03%, eae doi tugng cdn lai: 9,82%.
Neu xem xet giUa benh nhan den kham benh va dieu t n tai khoa vdi sd dUOc nho rang cua t d n g loai ddi t u g n g thi doi tugng BH Than nhan chiem ty le cao nhat la 21,72%, doi tugng Quan cd ty le nho rang thap nhat la 5,99%, dieu tren hoan toan phu hdp vdi t i n h hinh benh ly rang mieng cCia t d n g loai ddi t u g n g . Odi tugng BHTN ty le nho rang nhieu do day la sd nhan nhan si quan chu yeu la ngUdi gia va tr§ em, cdn ty le nho rang cua Quan thap vl day la Ida tudi sung sdc, rang cdn tot.
4.5. Sd benh nhdn dugc Idm hdm gia Trong 5 nam, Khoa Rang mieng da lam ham g i i eho 13.928 benh nhan chiem ty le 17,61% t d n g so benh nhan den kham benh va dieu t n . Trong d d doi tuong BHYT Huu Quan dgi chiem t;^ le cao nhat 50,36%, sau do den cac doi tUOng: Quan: 18,52%, BHYT khac: 11,65%, djch vu y te: 10,73%, BHYT than nhan: 5,12%, eae ddi tugng cdn lai khdng dang ke.
Neu so sanh gida benh nhan den kham benh va dieu trj vdi benh nhan duoc lam ham g i i cung cd su khac nhau kha rd ret: Odi tUdng BH HUu ehiem ty le 25,91 % va ddl tugng Quan chiem t^ le it nhat la 7,83%.
4.6. So benh nhdn su" dung ky thugt cao: Ky thuat cao eCia khoa chung tdi bao g d m : Cau chup sU kim loai, eau ehup sU Ti tan, Cercon; ham khung, ham nhua deo, ham nan.
Sd luong benh nhan dugc lam eau ehup sd ti t a n , cercon t r o n g 5 nam chl cd 210 t r u d n g hgp, so lugng nay ft la do ehi p h i eung ehi t r i ky thuat nay kha dat tien, chfnh vi vay benh nhan phai can nhac khi lUa chgn ky t h u a t nay.
So lUdng benh nhan lam cau ehup sU kim loai t h u d n g t r o n g 5 nam la 2198 t r u d n g hgp, eao gap 10 lan so vdi sU kim loai Titan. Su chenh nhau nay la do chi p h i ky thuat thap, benh nhan khdng dUdc bao hiem ehi t r i nhUng dUde benh vien quan tam nen so benh nhan lam ky t h u a t nay chi phai chi t r i phan nguyen lieu sU d u n g cho ky thuat nay. Cd 343 t r u d n g h o p lam ham khung va ham nhUa d^o, so lUdng nay it la do chl d i n h dieu trj cCia benh nhan va chi phi cho loai ky t h u a t nay cao. Cdn t r o n g 5 nam chi cd 90 trUdng h g p sU d u n g ky thuat ham n i n . Day la m g t ky thuat khd, benh nhan p h i i chi chi Idn khi sd d u n g ky t h u a t nay. D o i tUdng sd dung ky thuat ham nan ehCi yeu la ddi tUOng djch vu (chiem 95,6%) Sd benh nhan ddqc dieu tri khdi: Ty le khdi cao do khoa Rang mieng nhieu nam gan day dugc su quan tam cua Oang Ciy Benh vien da duoc trang bj nhieu trang thiet bj may mde n h u may X-quang, ghe may r a n g . . . m d i giup phan cho viec chan doan va dieu trj benh nhan, cung vdi dd 1^ trinh do cua cic Bac sT ludn ludn dugc cap nhat nang eao trinh do chuyen m d n , chinh vi vay t y le dieu tri thanh cdng benh nhan eao hon rat nhieu. Benh nhan tin tUdng vao chat lUdng dieu trj nen den kham ehda benh tai khoa ngay cang d d n g .
5. Ket l u a n
Trong 5 nam xd nam 2010 den nam 2014 Khoa Rang mieng - Benh vien T l j Q D 108 da kham eho 80.015 benh nhan/2.036.452 benh nhan chiem ty le gan 4 % t o n g so benh nhan den kham va dieu trj cua toan Benh vien. Vdi t o n g so lan dieu trj la 99.103, dieu tri khdi 99,82%, so cdn lai chuyen sang nam 2015. So benh nhan ddac dieu tri b i o t o n la 75.622 t r u d n g hgp, ehiem ty- le 76,01% so lan dieu tri, so benh nhan nhd rang la 9880 t r u d n g hgp, chiem t^ le 12,35% sd benh nhan den kham va dieu tri, tUdng tU sd dUdc lam ham g i i la 13.928 t r u d n g hgp, ehiem ty 102
TAPCHIYL_-CLAMSANG108 Tap 10-564/2015
le 17,65%, so d u g c fam cau chup cac loai va nan ham la 1759 t r u d n g h o p , chiem ty le 2,20%.
D d i t u o n g quan cd t y le cao nhat 36,28%, t h d 2 la BH HUU c h i e m t y le 26,57%, thU 3 la b i o hiem y t e khae chiem t y le 19,60%, t h d 4 la doi t u g n g djch vu y te chiem t y le 9,62%, cdn lai la cae ddi tUong k h a c
Odi t U d n g BH Huu la ddi t u g n g cd benh ly rang mieng phUc t a p n h a t Ty le dugc dieu trj bao t o n thap nhat (66,06%) so vdi tat ca cae ddi t u g n g ; lam ham gia eao nhat ehiem t y le 15,91%; n h o rang la 18,46%; lam cac loai cau c h u p la 2,60% so vdi t o n g so benh nhan t h u d e cac ddi tUdng nay.
M g t sd t h u t h u a t n h u lam cau chup cae loai, nan ham sd lUdng chua phai ldn nhUng da d e m lai hieu qua cua viee nang cao chat luong edng t i e dieu tri benh rang m i e n g .
Cdng tac dieu tri bao d i m an t o a n t u y e t ddi ve moi m a t duge nhieu b e n h nhan khen nggi.
Kien n g h j : Tang cUdng cdng t i e giao due truyen thdng ve ve sinh rang mieng de Bd dgi ed y ttiUe tU giae b i o ve de phong benh rang mieng 6dgc t d t han.
Tai l i e u t h a m k h a o
1. Vd The Quang va CS (1995) Diiu tra ca bdn sdc khoe rdng mieng d Viet Nam. Tdm t3t bao eao khoa hgc tai Dai hgi Rang ham mat va Hgi Rang ham mat Viet Nam.
2. WHO {1990; Oral heath Suroeys - basic method & 4 th Edition - Geneva - 1997.
3. WHO(1994)Ora/he(it/iftw/)eath[/7y/ffe-Ger)ew7-?994.
4. Nguyen Khang (2004) Dieu tra ca bdn sUc khde rdng mieng trong Qudn dgi. Tap chi Y hge Viet Nam tr. 158-162.
5. Bui Duy Sau (2004) Nhdn xit tinh hinh benh rdng mieng d mgt sd dan vl phia Bdc. Tap chi Y hgc Viet Nam,tr 89-95.
