Y HOC VIET NAM THANG 5 • SO 2 0 0 1 4
- Ty le mac benh tai huyen An Thi cao hdn thanh ph6 HiTng Yen ( 3 , 6 % so vdi 3,4%), khong CO sir khac biet co y nghTa (P>0,05);
- GiOS cac nhom tuoi co SLT khac biet co y nghTa ve ty le mac benh,tudi cang cao ty le mac benh cang tang (p<0,05);
- Nam gidi co nguy cd mac benh cao hdn so vdi nu" (P<0,05)
- Nhffng ngu'di hut thuoc cd ty le mac benh cao hdn 1,6 lan so vdi nhffng ngu'di khong hut t h u o c ( 0 R = 1,62, P<0,05);
- Chtfa tlm tjiay yeu to nguy cd do tiep xuc vdl khdi bep vdi BPTNMT ( O R = 0 , 4 , P>0,05).
Tk\ Ll|U THAM KHAO
1. Lg Van Anh (2006), Nghien cuU dich tehgc benh phdi tac nghen man tinh trong dSn cU thanh phd BSC Giang, Lu$n van Bac sT chuyen khoa I I , Trirdng 0?i hoc Y Ha Noi.
2. Ngo Qu^ Chau va cs [2002), 'Vnh hinh dian doan ra dieu tri benh phdl tic ngh&i man b'nh tai
lOioa Hd hip Benh vien Bach Mai trong 5 nim 1996-2000', Thong tin Y hoc lam sang, Nha xuat ban Y hoc, tr. 50-58.
Phan Thu Phu'dng (2010), Nghien cdU dich tS hgc benh phoi tac nghSn man tinh trong^ dan ai ngoai thanh thanh pho Hi iidi va tinh Bac Giang, Luari an Tien sy y hgc, Tru'dng Dai hpc Y Ha N6i.
Binh Ngpc Sy va cs (2009), Nghiin culi djdi U hoc tienh phdl tic nghen man tinh d Viet Nam t l dfc- t^en phap dUphdng, didu tri, Bao cao k a q i ^ nghien cuu khoa hoc de tai cap nha n\itz, Ha Ngf Trevor T, Hansel, Peter J (2004), 'Definitiont burden and causation". An Atlas of chronic od^rucbi^ pulmanary disease COPD, p. 2-12.
Ran PX, Wang C, Mannino D et al (2006]^
"Epidemiology and cos^ of Chront obstniOive pulmonary disease, linking outcomes and pathobiology of disease modlhaOorl', Eur Re^
J, 27, p. 188-207.
Ramiez-Venegas A, Sansores Raul H, Perez*
Pandilla R et al (2006), "Survival of patients m Chronic obstructive pulmonary disease due to biomass smoke and tobacco. Am J Re^'r Ott Care Med, 173, p. 393-397.
MUC DO H A I L O N G COA B E N H N H A N V E C H A T LU'O'NG K H A M CHfrA BENH COA B A C SY 6" TUYEN Y TE CO* Sfr
TAI T H A I NGUYEN VA TP HO CHI MINH
T6MTAT
MMC tiSu: Danh gia mffc dp hai long cua b$nh nhSn ve chat lu'dng kham chffa benh cua bac s? d tuyen y te cd sd tai Thai Nguyen va thanh pho Ho Chi Minh. Doi tu'ang va phu'dng phdp nghien cOti:
Nghien culi mo ta cat ngang. Ket qud: 480 benh nhan du'dc phdng v3n. Benh nh§n cho rSng thdi gian chd (301 kham d tuy^n y te co sd nhanh (59%). Benh nhan chu^ hai long vdi co sd h^ lang va trang t h i i t bj y te t^i cdc CO sd y t§ (mffc d$ hdi long ISn Iffdt la 43,4%
vi 27,8%). B^nh nhan hai I6ng khi dffpc bde s9 thcio lu$n ve phudng phdp dieu tit vh hu'dng d i n each dieu trj ngoai tru (mffc dp hai long lan Iffdt la 62,2% va 80,3%). Ket lu$n: B^nh nhan hai long hdn khi kham tai cac CO sd y t^ c6 bac s? gia dinh.
Td' ichda: Chat Iffdng Wiam chQa benh, Y te co sd, Bac sy gia dinh.
* Tru'dng Dal hgc YHa Npi
Phan b^n khoa bgc: PGS.TS Nguyen Thj Kim Chuc
Ph^m Thi Ngpc Bich*, Nguyin Phirong Hoa*
S U M M A R Y
PATIENT S A T I S F A C n O N W I T H QUALmT OF MEDICAL CARE P R O V I D E D BY DOCTORS
AT THE GRASSROOT LEVEL I N T H A I N G U Y E N A N D H O C H I M I N H CITY Objective: To assess of pattent satisfaction with tiie quality of medical care provided by doctors at grassroot level in Thainguyen province and Ho Chl Minh a t y . Methods: A cross-sectional study was done. Results: A total of 480 patients were interviewed. 59% patients agreed with waiting time In examination were fast. Patients were not satisfied with the infrastiucture and medical equipment at the grassroot level (43.4% and 27.8%, respectively).
Patients were satisfied when receiving treatment discussions and Instructions (62.2% and 80.3%r respectively). Conclusion: Patients' satisfaction vritti medical care provided by family physicians is higher than those given by other doctors.
Keywords: Quality of medical care, grassroot level, family physician
Y HOC V l ^ NAM T H A N G 5 • S 6 2I20U I.BATVANOI
M6 hinh benh tat d Viet nam hien nay dang 6 giai doan chuyen tiep. Cac nhom bSnh lay nhilm van d mile cao, trong lihi do cac binli lihong lay nhiem va tai nan thuHng tich tang nhanh, mot so benh lay nhiem mdi noi co xu hu'dng tang ro ret nhu': Oian-tay-mieng, quai b|, thiiy dau, sdi...l.
Nhu rau l(ham chijs benh (K:CB) cua ngua dan ngay c^ng tSng rao, cung vdi viec tap trung phat trien ky thuat mcli, y te chuyen sau, doi hoi can phai tSng aUSng c6ng tac cham soc su'c khoe ban dSu (CSSKBO) t^l cong dong.
Tru'dc kia, cac bac sy tham gia KCB tai cac cd sd y te nay bao gom chii yiu la bac sy da khoa (BSBK), y sy, bac sy chuyen khoa (BSCK) nhu':
BSCK npi, nhi, rSng ham mat, truyen nhiem.... Tir nim 2002, xuat phat tii ttiifc tien neu tren, ket hdp vi€c v$n dung va hoc tap kinh nghiem tif cac nildc CO nBn y te phat trien, Bp y te da cho phep dao tao loai hinh BSCK cap I ve Y hpc gia dinh (YHGO). Khao sat so bo tai mpt so phong kham va tr?m y tS cd BSCK cap I YHGO lam viec cho thay nang lire cung cap djch vu cham sdc y te du'dc nang cao hdn, ph?m vl KCB du'dc md rdng va mu'c do hai ldng ciia benh nhSn cung cd nhu'ng cai thi^n dang ke 2.
Tai Thai Nguyen (TN) va thanh pho HS Chi l>1lnh (TP HCM), cdng tac CSSKBO trien khai tai YTCS cung du'^c quan tam va phat trien. Hoat
dong bac sy gia dinh (BSGO) da budc dBu trien khai dudi nhieu md hinh khac nhau nhU: Phdng kham YHGD, ttam y te cd BSGO, phdng kham (PK) BSGB tai cac BV... Bao cao cho thay 80%
ngu'di benh kham tai PK BSGB duHc giai quyet van de sii'c khde tai cho ma khong phai chuyen tuyen, gdp phan giam tai cho BV tuyen tren 3.
Tuy nhien, van con thieu rac khao sat, nghien cifu danh gia ve chat lUdng dich vu KCB tai tuyen YTCS it 2 tinh nay qua thu'dc do la stf hai long cua benh nhan. Xuat phat tif nhifng van de tren, chiing toi tien hanh nghien cifu nay vdi muc tieu:
Oinh gii mdc d$ hii long ciia b$nh nhan ve chat iddng khim chiha b$nh cua bic sf t^i tuyin yte cdsd tai Thii Nguyen vi thinh pho Ho Chi Minh
II. B 6 | TirpNG VA PHITONG PHAP NGHIEN CUTJ 2.1. Doi tu'dng nghiSn cu'u
Tai moi tinh se chpn 02 BV qu$n/huyen, 04 Tram y te xa/phu'dng tai 2 quan/huy^n tu'dng iimg, 01 PK BSGO cong va 01 PK BSGO Uf nhan.
Binh nhan den kham, dieu trj ngoai tru tai cac cd sd y te dUdc lifa chpn trong thdi gian tif 3/2012 den 9/2012.
2.2. Phu'dng phap nghien cu'u Nghien culi md ta cat ngang. Phdng van 480 benh nhan bang bp cau hdi thiet ke s§n. Phan tich so lieu: siJ dung phan mem STATA 12.0.
iii.KfrQuA
3.1. Thv'c tr^ng sij' dMng dkh vu KCB t^i tuyen YTCS ol TN v i TP HCM 3.1.1. TSn suit aSh cd sd y telihim chda bfnh
Hinh i;Tan suit kham dnOa b?nh tai Thai Nguyen va TP HCM, 2012
T h i n h tho.niK ' l I u r t r n K x u y e
STP HCM ' T h . t i NK»v£-n
Y HOC Vl|T NAM THANG S - SO 2/2014 Tan suat benh nhan den kham benh thudng
xuyen tai TT) la 37,9% va 33% tai TP HCM. Cac benh nhan den kham tai cac cd sd y te d TN rao hdn CD y nghia thong ke vdi TP HCM (p<0,001) (Hinh 1). Benh nhan di kham thu'dng xuyen hdn
tai PK YHGD d TN (56,7% so vdi 31,7%). Ty IS binh nhan den kham tai PK BSGD d TP HCI^ li 20%. Ty le benh nhan den kham benh tai PK YHGD tai TN rao hdn CD y nghTa so vdl TP HCM.
(p<0,05) (Hinh 2).
Hinh Z-Tan suat benh nhan den KCB tai Thai Nguyen va TP HCM, 6 0 (
2012
3.1.2. Binh gii cda b$nh nhan vS chit Iddng dich v^ khim chtfa binh Bing 1: Mifc do hai Idnq ciia benh nhan ve chat lu'dnq dich vu KCB
e i n h gii hai long Thdi gian chd
kham
Thii tuc KCB
Cd sd ha tang
Trang thiet bj y t i
Liu Vifa Nhanh Phien ha, rac roi
Binh thu'dng Gon nhe, thuan tien
CD ky Binh thu'dnq
Tot Ngheo nan Binh thu'dnq Hiin dai
BSGD n 0 77 71 1 62 86 0 68 81 0 101 48
%
0 52 48 0,7 41,6 57,7 0 45,6 54,4 0 67,8 32,2Khong phai BSGD n
12 108 213 9 100 224 24 181 128 33 214 86
%
3,6 32,4 64 2,7 30 67,37,2 54,4 38,4 10 64,2 25,8
TSng n 12 185 284 10 162 310 24 249 209 33 315 134
%
2(5 38,5 59,0 2,1 33,6 64,3 5,0 51,6 43,4 6,8 65,4 27,8P 0,0005
0,021
0,0005
0,0736
• I Hien oai | 41i | iZ,i | 86 | 2S,» | 1J4 | 2/,B I Benh nhin hii long vdi thdi gian chd khim ti 59%, thu tuc gpn nhe (64,3%). Danh gia cua benli nhan ve cd sd ha Sng va ttang thiS bl yted tuyen y teed sd chu yeu van d mdc 2 la binh thuing (Bn Iddt la 51,6% va 65,4%).
3.2. Bcinh gii cCia b$nh nhan t% chSt lu'dng KCB c&a bac sy
Trong nghien cifu nay, benh nhan danh gia ve chat ludng KCB cua bac sy qua cac khi'a canh:
Thai dp phuc vu, trinh dp chuyin mon va ky nang KCB ciia bac sy. Trong dd ky nang tu' van, KCB du'dc danh gia: Trifc tiep qua viic bac sy lang nghe benh nhan ke benh, glai thich tinh trang benh cho benh nhan, thao lu$n va tham
khao y kien ciia binh nhan tru'dc khi dua ra quyet djnh dieu tr! va hu'dng dan ngu'di b$nli vl phu'dng phap diiu tri.
3.2.1. Binh gii cda benh nhin vS thilli phuc vu vi trinh d^ chuyen mdn cua Ific^
Benh nhan hai long vdi thai dp phuc v^i <«
nhan vien y te (73,4%) va trinh do chuyin n * ciia bac sy KCB (60,2%).
Y HQC V l g T NAM THANG 5 - SO 2/2014
Bang 2; Mifc do hai long ciia benh nhan ve thai do phuc vu va trinh do chuyen mdn aia
bac sy KCB ' Oanh g i i hai long
Thai d o phuc v u Trinh d d chuven m o n
Khong t o t n 1 11
o/o 0,2 2,3
Binh thu'dng n 127 181
26,4
%
37,5 To*
354 290
73,4
%
60,2 Tong
482 482
o/o 100 100
„ -., , khac: Thai dd phuc vu tot hdn (87,5% so vdi VM cua BSGO tan hnh hdn (81,9% so vdi 70,1%) 69%) va trinh dd chuyen mon cua BSGO duBc va tnnh dp chuyen mdn ciia BSGO tot hdn danh gia cao hdn (750/0 so vdi 47,8%). Song sif (82,7% so vdi 56,1%). Hai SU khac biet nay deu khac biet nay khong co y nghTa thong k i CO y nghTa thong ke (p<0,05) (Hinh 3). {p>0,05) (Hinh 3).
_+ T?l TP HCM: Mifc dp hai Idng cua benh nhan kham BSGO rao hdn so vdi nhdm bac sy
Hinh 3; Mifc dp hai Idng ciia benh nhan ve thai dd phuc vu va trinh dd chuyen mdn cua bac sy tai TNva TPHCM
JKhong BSGEJ K h o n s f^.SGi) K h n n H BSGO K h n n s HSGi;
p h . i i ph.-ii ph.-ii phcil BSG!> BSGf) BSGD BSGD Th.U d o p h u c T r i n h d o ' r h . i i ili) Phiu- T r i n h d o
VII c h i i y t ' i i i n o i i v u L h i i y o n im'ui
Thai Nguyen
• K h i i n m o t S H i n h thuiViif.
• T O I
TP Ho Chi Minh
3.22. Oinh gii ciia bfnh nhin ve ky ning KCB cua bic sy Bang 3: Danh gia ciia benh nlian ve ky nang KCB cua bac sy
H i i ldng k ; n i n g KCB Linq nqhe binh nhan ke benh Giai thich cho binh nhan ve benh
Thao luSn v i dieu tri vdi BN Hu^dnq d i n dieu tri cho BN
Khong n 4 10 86 11
»/o 0,8 2,1 17,9 2,3
SO sal n 126 103 96 84
»/o 26,2 21,3 19,9 17,4
T y my n 351 369 300 387
0/0 73,0 76,6 62,2 80,3
Tfing n 481 482 482 482
Vo 100 100 100 100 Ky nSng KCB ciia cic bac sy dudc danh gia
trong nghiin dfu niy la ky ning ciia cac bac sy qua v i ^ thu thip cic thong tin ve trieu chulig aia bpnh, bl3 ling nghe, tao cho binh nhin dim glic thoil mil trong c i qiii trinh khim chOa b|nh, tdn trpng cic quyit dinh cua benh nhan, glil thfch i5 v i b$nh va kien lihSn vdl b^nh nhan, chim sdc v i quan t i m tdl b|nh nhin trong suot
a
ui trinh khim chOS bfnh. Ty lp b|nh nhan hai ing vS vl$c thio luin vdi bic sy trudc khi ra quyit d{nh dieu tri l i 62,2%. Sau khi kham chii^benh co 80,3% benh nhan hai Idng v i viic hifdng dan diiu tn; ciia bac sy.
IV. BAN LU$N
Tim ly cua binh nhan khi dm dau l i cin du'dc quan tam kjp thdi, bdi vay thdi gian chd ddi la mpt yeu td ma cac nha quin ly cSn quan tam de cil thiin chat lu'dng dfch vu. Theo Laurence Salomon viec xie djnh va thiit lap thdi gian chd ddi hdp ly ddi vdi da sd binh nhan l i khau quan
Y HOC VIET NAM THANG 5 - s 6 2/2014 trong trong cdng tac quin ly, nham iam cho
benh nhan va gia dinh hp hai Idng hdn khi den kiiam chCte benh, gdp phan nang rao chat lu'dng cong tac cham sdc su'c khde cpng dong 4.
Nghien cifu cua Roger T Andeson va cpng sif cung chi ra rang thdi gian chd kham nhanh la yiu td gdp phan cai thien sif hai Idng ciia benh nhan vdi bac sy kham chifa benh 5. Trong nghien cu'u nay, 59% benh nhan danh gia thdi gian chd kham tai YTCS la nhanh va 64,3% benh nhan thay rang cac thii tuc kham tai tuyen YTCS la gpn nhe, thuan tien (Bang 1). Kit qua nay cung pliii hdp vdl mpt khio sat gan day cua Bd y te d tram y t i xa 6. Trong nghiin ciJu cda Ngo Thj Ngoan ve sif hai Idng ciia binh nhan kham tai phdng kham d 5 binh vien: BV Bach Mai, BV Viin Nhi, BV Oong da, BV Hal Du'dng va BV Yen Bai (2002) cho thiy thdi gian chd dpi ciia binh nhin trung binh la 64,5 phiit, trong dd thdi gian chd dpi ciia binh nhan tai BV Bach Mai la lau nhat (77,4 phut) va du'dc cho la do lu'dng binh nhan ddng. Tuy nhiin, trong nghien cifu nay tie gia khdng danh gii mifc dp hai long ciia binh nhan dol vdl thdi gian chd ddi tiep nhan cac djch vu y t i 7. Tuy phu'dng phap dinh gii khac nhau nhu'ng nghien ciili nay da chi ra rang thdi gian chd kham binh tai cac BV tuyin tinh v i trung Udng la tu'dng ddi lau. Trong nghien cifu ciia Pham Nhat Yin ve sif hai Idng ciia benh nhan den KCB tai khoa kham binh theo yiu cau benh vien Bach Mai chi ra rang mifc dp hai Idng ciia benh nhan ve thdi gian chd kham thap (30,1%)
Nhin chung danh gia ciia benh nhan ve chat lifdng djch vu y t i tai tuyen YTCS d 2 tinh nay la kha tot. Tuy nhiin, ty l i tdi khim binh thu'dng xuyin tai cac cd sd y te nay khdng cao (33,1%
tai TP HCM va 37,9o/o tai TN) (Hinh 1), chifng td ngu'di din chu^ cd thdi quen kham hay kiem tra sii'c khde djnh ky, hp chi den cd sd y te khi cd benh. Hanh vl khim hay kiem tra sifc khde djnh ky ciia ngu'di dan vifa the hiin nhan thifc ciia ngu^i dan v i sifc khde ndi chung va cdng tac dif phong noi riing, vifa the hiin thai dp va thifc hanh ciia hp vdl cham sdc sifc khde.
Benh nhan hai Idng vdl thai dp phuc vu ciia bac sy (73,4%) va trinh dp chuyen mdn ciia bac sy KCB (60,2%). Khi so sinli vdi kit qua nghiin ciHi tai mpt so binh viin tuyen b'nh va trung udng, kit qui cung cho thay binh nhan danh ^a nhan vien y t i od thii dp hda nha va hu'dng dan nhiet tinh cho ngu'di benh. Kit qua nay cung phu hdp vdi mpt sd ket qua ciia cac nghiin cii\j tru'dc 7
Benh nhan danh gia nhdm BSGD cd thai do phuc vu tot hdn, trinh do chuyen mon cao haii cac nhdm bac sy khac: Tai TN, benh nhan danli gia cac BSGO co thai do phyc vu tdt hdn bac sy khac (81,9% so vdi 70,1%), trinh dp chuyin mon rao hdn (82,7% so vdi 56,1%) so vdi cac BSGO tai TPHCM.
V. KET LUiiN
Ngu'di benh hai Idng ve thai dp phuc vu va trinh dp chuyin mdn ciia bac sy KCB tai cac ctf sd y te d 2 tinh (73,4% va 60,2%). Oanh gia ola binh nhan ve ky nang kham chCfa binh d nghien cifu nay la thu'dc do mifc dp hai Idng ciia b^nh nhan ve cac ky nang KCB nhu': biet ling nghe binh nhan ke benh, glal thich ro ve binh clio benh nhan, thao luan vdl benh nhan ve cac phu'dng phap dieu tri cung nhu' hu'dng dan dio benh nhan each dieu trj tai nhi. Mifc dp hai long ciia binh nhan ve cac liy nang KCB cua bac sy 8 nghiin cifu nay tu'dng dol rao (tren 60%). Benh nhan hai Idng hdn khi kham cic cd sd y te c6 BSGB. Tuy nhiin tan suat benh nhan din kham benh tai cac cd sd y te d 2 tinh khdng cao (37,9% tai TN va 33% tai TP HCM). Binh nhan di kham thu'dng xuyin hdn tai PK BSGB d TH (56,7% so vdl 31,7%).
TAI Lif U THAM KHAO ^
1. B9yte(2012). BaocaoT6ngquannganhyte2011.
2. Pham Thi Ngpc Bich (2008). So sanh mut d$
hai long cua benh nhan vdi bac sT chuySn khoa mdt Y hpc gia dinh vi bac si da khoa tai m$t s9 tram y te xa d Ha Ndi, Viet Nam, Tap chi NghlSn cifu Y hoc, Phu truang 67 (2) - 2010.
3. 56 Y te thinh pho Hd Chi Minh (2013). Bao cao ve hoat dpng bac sy gia dinh 2012.
4. Laurence Salomon (1999). Construction of a scale measuring inpatients' opinion on quality oi care. International lournal for Quality in Hearth Care 1999, 11(6), p. 507-516.
5. Nguyen HOu Cau, Nguyen Van Hien, Pll#
Bich Di|p, Nguyen Thu Hu'dng (2006). C&l|l nSng giao tiep trong y khoa, Tru'dng dai hpc Y KB Noi du' an Vet Nam - Ha l^n
6. B$ Y te (2012). Hpl thao danh gii 1 nSm thin khai thi diim md hinh thanh toan theo djnh suSl taitramytexa, BoYte.
7. Nga Thj Ngoan (2002). Ket qua nghiin oiu S) hai long cua ngu'di benh tai cic khoa khim b^""
ciia 5 benh vien khu vifc Hi Npi va cic tinh. | yeu cac de tii nghiin cutJ khoa hpc di§u duf Hoi nghi khoa hoc dieu du^ng toan quoc lan II niiat, p. 20-22.
