JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N°1/2014
Phan tich danh muc thu6c sir dung tai Benh vien Trung u-ffng Quan doi 108 nam 2012
An Analysis on the Drug list Used in tiie 108 Central Military Hospital in 2012
Ngu>en Sffn Nam, Nguyen Trung Ha Benh vien Trung uang Qudm ddi 108
Danh muc thuoc sd dung tai Benh vien Trung dong Quan ddi 108 nam 2012 phu hgp vdi nhu cau dieu tri tai benh vien. Cd 27 nhdm thude vdi 1.071 loai thude trong danh mue, tdng kmh phi sd dyng khoang gan 150 ty ddng. Trong dd, thudc ndi chiem 20,9%; thudc don thanh phan chiem 89,6%. Bdn nhdm thudc sd dung nhieu kinh phi gdm thude khang sinh, thudc chdng ung thU, thudc tim maeh va thudc dudng tieu hda. Ty le kinh phi sd dyng thudc nhdm khdng thiet yeu, kinh phi thap (nhdm III) chiem 1,51%.
Tdkhda:Danh muc thudc, Benh vien Trung uong Quan dpi 108 Summary
The drug list used In the 108 Central Military Hospital in 2012 was appropriate for its treatment requirements. There were 27 groups with 1,071 drugs on the list; the total budget were about 144 billion VND The domestic drugs accounted for 20.9%; single-elements were 88.7%. 4 drug groups, which used the highest funding, were antibiotics, anticancer drugs, cardiovascular drugs and gastrointestinal drugs.
The percentage of the non-essential, low funding drugs (group III) accounted for 1.51%.
Keyirords; Drug list, Central Military Hospital 108
I.Datvande Benh vien Trung Udng Quan ddi 108 la benh vien da khoa tuyen cudi, benh vien hang dac biet vdi Lua chpn thude tai benh vien la m d t ndi d u n g
quan t r p n g t r o n g cung dng thudc benh vien, ed anh hddng den ehat lUdng cham sdc y te t r o n g d d bao g d m 2 khau la xay d u n g va t h u c hien danh muc thudc [7]. Danh muc thudc benh vien can bao g d m cac thude an toan, cd hieu qua dieu tri cao, chi phi h g p ly va ludn s i n ed dap Ung dUde yeu cau dieu tri tai CO sd.
m d hinh benh tat rat da dang, chi phi dieu trj Idn t r o n g do chi phi danh cho thudc chiem ty le cao t r o n g t d n g ehi phi dieu trj. Trong n h d n g nam gan day, Benh vien da ed nhieu no luc t r o n g lua chon danh muc t h u d c dap dng viee sd d u n g thudc an toan, hieu qua, tiet kiem nang cao chat luong kham ehda benh tai Benh vien. Vdi mue dich dua ra nhdng kien nghj g d p phan nang cao hoat d d n g Ida chgn sii d u n g thude tai Benh vien, chung t d i tien hanh de tai
"Phan tich danh mue t h u d e sd d u n g tai benh vien I'han b,en khoa h^c: GS TS NGUYEN THANH BINH "^rung d d n g Quan ddi 108 nam 2012" vdi muc tieu:
Tip 9-S6 1/2014 Phan tich tinh hgp ly cua danh muc thuoc da sd
dung trong nam 2012 tai Benh vien Trung Udng Quan ddn08.
2. Doi taofng, phi/tfng phap nghien cuTu 2.1. Doi tuang nghien edu
Cac loai thudc da dugc sd dung de dieu tn eho ddi tugng b&nh nhan quan, bao hiem tai Benh vien trong nam 2012.
2.2. Phuang phap nghiin cthf
PhUdng phap md ti hdi edu. Tien hanh thu thap sd lieu lien quan den eae thudc da dUgc sd dung eho ddi tugng benh nhan quan, bao hiem dua vao eae bao cao sCfdung thudc cOa khoa Dugc Benh vien:
-Ten thudc, ham lugng, dang bao che.
Nhdm tac dung dugc ly - Ngudn goc/xuat sd.
-Sd lugng sddung.
SCf dung 1 sd chi sd danh gia ve mat sis dung va phan tich ABC/VEN phan tich tfnh hop ly cda danh muc thudc sd dung tai Benh vien nam 2012.
3. Ket qua nghien cuTu
3.1. Phan tich ea cau danh muc thuoc tai Benh vien nam 2012.
3.1.1. Ca cau danh muc thuoc theo nhdm tdc dung duacly
Sd lugng thudc theo nhdm va chi phi sd dung nam 2012 dugc trinh bay tai bang 3.1.
BSng 3.1. So lacrng va chi phi cac nhom thuoc siY dung nam 2012
STT
1 2 3 i 5
6 7 8
Nh6m thuoc
Thuoc dieu trj ung t h i / va dieu hoa mien djch Thuoc kh^ng sinh
Thu6c tim mach Thudc dadng tieu hda
Thuoc NSAIDS, thudc dieu trj gut va cac benh xuang khdp
Dung djch tiem truyen dieu chinh nUdc, dien gi^i Thudc tac dung vdi mau
Nhdm khac (20 nhdm) Tong
Thudc Sd
luong
105 197 181 108 7629 26 349 1.071
T^le
(%)
9,8 18,4 16,9 10,1 7,1
2,7 2,4 32,6 100
Chi phi (tridu ddng)
31.335 27.062 21.751 13.155 8.067
7.820 6.489 29.035 144.714
Tyle
(%)
21,7 18,7 15,0 9,1 5,6
5,4 4,5 20,1 100
Danh muc thuoc b§nh vien nam 2012 cd day du 18,7% theo kinh phi; thudc dieu trj ung thu, dieu hda Ctic nhdm thudc theo danh mue thude 31 cda Bd Y mien djeh 9,8% theo chCing loai, 21,7% theo kinh te vdi 27 nhdm thudc. Cac nhdm thudc sU dung cd phi; thuoc tim mach 16,9% theo chung loai, 15,0%
so lugng chOng loai va kinh phi Idn tai benh vien la theo kinh phi va thude dudng tieu hda 10,1% theo nhom thudc khang sinh 18,4% theo chung loai, chdng loai, 9,1% theo chi phi.
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JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
3.1.2. Co cdu danh muc theo thuoc dan thdnh phdn, da thdnh phdn
Bang 3 . 2 . C o c a u thudc ddn t h a n h p h a n , da thanh phan
Nhdm
Thudcdon thanh phan Thudc da thanh phan
Tdng Sd lupng
931
140
1.071 Tyle
{%) 86,9
13,1
100 Chi phi
(trieu dong) 129.694
15.047
144741 Tyle
(%)
89,6
10,4
100 Thudc d o n t h a n h phan chiem ty le Idn so vdi t h u d c da t h a n h p h a n t r o n g d a n h muc t h u d c b e n h vien nam 2012, t h u d c d o n t h a n h phan c h i e m 86,9% sd l u o n g c h u n g loai, 89,6% kinh p h i ; t h u d c da t h a n h phan chiem 1 3 , 1 % sd l u g n g c h u n g loai, 10,4% kinh p h i .
3.1.3. Co cau danh muc thuoc theo nguon gdc Ket qua so sanh ty le sd d u n g thude t r o n g ndde va nudc ngoai duac t r i n h bay tai bang 3.3.
Bang 3.3. Ty le thudc sii dung theo ngudn gdc
Ngudn gdc
Thudc ngoai nhap Thudc npi
Tong
Sd lupng
745 326 1 071
Ty le
(%)
69,5 30,5 100
Chi phi (trieu ddng) 114.463
30.251 144.714
Ty le
(%)
79,1 20,9 100 Thudc cd n g u d n gdc ngoai nhap chiem ty le Idn ve c h u n g loai va kinh p h i s d d u n g tai b e n h vien nam 2012 vdi 69,5% t h e o c h u n g loai, 7 9 , 1 % t h e o kmh phi. Thudc cd n g u d n gdc Viet Nam c d n g da ddac chu y vdi 30,5% t h e o ehung loai, 20,9% t h e o kmh p h i .
3.1.4. Co cdu danh muc thuoc theo khoi dieu tri Bang 3.4. Cd cau thuoc sii d u n g theo khoi dieu tri
Khdi dieu trj
Dieu tri npi tru Oieu trj ngoai tru
Tdng
Sd khoan
1.071 478
Ty
(%)
le 100 44,6Chi phi (trieu ddng) 110.587 34.127 144.714
Ty
(%)
le 76,4 23,6 100 Khdi ndi t r u sd d u n g day d u cac thudc theo danh muc thudc Benh vien nam 2012 vdi tdng so 1.071 biet duac, chung loai t h u d c ngoai tru sU dung chiem 44,63% d a n h muc thudc. Ve kinh phi khdi noi tru chiem 76,4% t d n g kinh p h i , khdi ngoai tru chiem 23,6% t d n g kinh phi.3.2. Phan tich danh muc thudc theo phin loai ABC, VEN
3.2.1. Co cdu danh muc thuoc theo phdn tich ABC Bang 3.5. Ket qua phan tich danh muc thudc
t h e o phan loai ABC
Nhdm Nhdm A Nhdm B Nhdm C Tdng
Sd Chung
loai 130 224 717 1.071
Tyle
(%)
12,1 20,9 67,0 100
Glatri (trieu ddng) 101.339 29.036 14339 144.714
Tyle
(%)
70,03 20,06 9,91 100 Thuoc n h o m A vdi 1 2 , 1 % chung loai chiem 70,03% t o n g kinh p h i sir d u n g , n h d m B vdi 20,9%
c h i i n g loai chiem 20,06% t o n g kinh phi, nhdm C vdi 67,0% c h i i n g loai chiem 9,91 % t o n g kinh phi.
3.2.2. Cd cdu danh muc thudc theo phdn loai VEN Bang 3.6. Ket qua phan tich danh muc thuoc
theo phan loai VEN
Nhdm N h o m V Nhdm E Nhdm N Tdng
Sd chiing loai 151 715 205 1.071
Tyle
(%)
14,1 66,8 19,1 100
Gia tri (trieu ddng)
33,12 96,38 15,21 144,71
TylS
(%)
22,9 66,6 10,5 100 118
Tap 9 - sa 1/2014
Ket quS p h a n tich VEN cho thay t h u o c n h o m V loai chiem kinh phf suf d i j n g nhieu n h a t 66,6% so cd 14,1% Chung loai, chiem 22,9% kinh p h i sir d u n g vdi t d n g chi phi. Nhdm N chiem kinh p h i sijr d u n g it so vdi t o n g chi p h i ; t h u o c n h d m E cd 66,8% chung nhat vdi 10,5%.
323. Ca cdu danh muc thuoc theo phdn nhdm I, II, III
Bang 3.7. Ket qua phan tich thuoc sur dung theo ma tran ABC/VEN
Nhdm
Nhdm 1 Nhdm II Nhdm III Tong
Sd chung loai
198 769 104 1.071
Tyle
(%)'
18,49 71,80 9,71
100
Gia tri (trieu ddng)
106.765 35.770 2.179 144.714
Tyle
(%)
73,78 24,72 1,51 100 Ket h g p phan t i c h ABC, VEN t h e o 03 phan
nhdm: n h d m I la n h d n g t h u d c sU d u n g kinh phi Idn, thiet yeu bao g d m AV, AE, AN, BV, CV; n h d m II it quan t r g n g h a n bao g d m BE, BN, CE v a n h d m 111 khdng thiet yeu, sd d u n g ft kinh p h i CN eho thay nhdm I vdi ty le n h d cac t h u d c t h e o c h d n g loai
(18,49%) chiem da phan kinh p h i sd d u n g (73,78%). N h d m II vdi so l u g n g chung loai Idn nhat (71,80%) chiem 24,72% kinh p h i . Nhdm III ehiem ty- le t h e o ehung loai va kinh p h i it nhat, tUdng d n g la 9 , 7 1 % va 1,51%.
3.2.4. Chi phi thuoc nhdm I, II, III theo tdc dung dugc ly
B a n g 3.8. Ket q u a p h a n t i c h n h o m I, II, III t h e o tac d u n g d u g c ly
sn
1 2 3 4 5
6 7 8 9 10
Nhdm Thudc gay te, me Thudc NSAIDS, gut Thudc khang sinh Thudc chdng u n g t h t r Dung dich dieu chinh nudc, diengiSI
Thudc tim mach Thuoc dudng tieu hda Thudc t i c dung vdi mau Khoang c h i t , vitamin Kh4c
Tdng
1 Chi phi
2.900 4.635 21.015 25.475 7.365
14.131 8.217 5.514 1.722 11.791 102.765
T y l e % 2,8 4,5 20,4 24,8 7,2
13,8 8,0 5,4 1,7 11,5 100
II Chi phi
525 3.255 6.047 5.860 455
7.406 4.318 888 1.693 5.023 35.470
Ty le % 1,5 9,2 17,0 16,5 1,3
20,9 12,2 2,5 4,8 14,2 100
III Chi phi
177
214 620 87 530 551 2179
Ty le %
8,12
- -
9,82 28,45
3,99 24,32 25,29 100
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N'='1/20li
Cac n h d m t h u o c ehiem t y le s d d u n g kinh p h i Idn tai Benh vien bao g o m t h u d c khang sinh, t h u d c ehdng u n g t h d , t h u d e t i m mach va t h u d c d u d n g t i e u hda deu ehiem t y le sd d u n g kinh phf cao t r o n g cac phan n h d m I va II, eu t h e vdi phan n h d m I n h d m chdng ung t h U chiem t y le kinh p h i sd d u n g cao nhat 24,8%; tiep t h e o la n h d m khang sinh 20,4%;
n h d m thudc t i m mach 13,8% va n h d m t h u o c dUdng tieu hda 8,0%.
Trong phan n h d m HI t y le sU d u n g nhieu kinh p h i t a p t r u n g vao n h d m t h u d c d u d n g t i e u hda (28,45%) va n h d m v i t a m i n , khoang chat (24,32%).
Phan n h d m III khdng cd cae n h d m t h u d c te, me;
khang sinh; chdng u n g thU; dieu ehinh nUdc, dien giai.
4. Ban luan
De dap Ung nhu cau kham va dieu tri tai Benh vien d d n g t h d i t h u c hien t d t cac qui d j n h eua Bd Y te, hang nam Benh vien Trung Udng Quan dpi 108 t d chUc dau thau mua thudc va xay d u n g danh muc thudc sd d u n g tai Benh vien. Danh muc t h u d c nam 2012 tai Benh vien dam bao day du cac n h d m t h u d c theo danh muc t h u d c sd d u n g tai eae c d sd kham ehda benh cua Bd Y te [3]. Do dac t h u la benh vien tuyen cudi cua Quan d p i , ddi t u g n g benh nhan chu yeu la benh nhan nang, benh nhan cao t u d i (ddi t u g n g Quan hUu) nen cac n h d m t h u d c sU d u n g kinh phi Idn tai benh vien t a p t r u n g vao cac n h d m t h u o c khang sinh, thudc t i m maeh va t h u d c dUdng tieu hda. rieng n h d m t h u d c chdng u n g t h u Bd Y t e m d rdng pham vi t h a n h t o a n bao hiem vdi nhieu loai thudc ed gia trj Idn, mat khac sd lugng benh nhan ung t h u tai Benh vien ngay cang t a n g len cung la n h d m thude chiem x^ le kinh p h i Idn nhat tai benh vien vdi 21,7% so vdi t d n g kinh phi thudc.
IVldt t r o n g so cae tieu chi dUde t d chUe y te t h e gidi khuyen cao khi lua chon thudc la nen chgn thudc dugc bao che d dang d a n chat [7]. Thudc sCf d u n g tai Benh vien nam 2012 chu yeu la eae t h u d c d o n thanh phan, chiem t d i 86,9% t h e o chung loai va 89,6% kinh phi, ehdng t d Benh vien da ed can n h i c
lua c h p n n h d n g san p h a m p h i j h g p vdi nhu cau dieu trj tai Benh vien. Ket qua nay c u n g t U o n g tU nghien c d u tai Benh vien Ngi t i e t T r u n g u a n g chiem 88,7%
t h e o chCing loai [5].
Can c d t h e o Quyet d j n h sd 4 8 2 4 / Q O - B r r ngiy 03/12/2012 cua Bp t r u d n g Bd Y te ve phe duy§tBe an "NgUdi Viet Nam Uu t i e n d u n g t h u d c Viet Nam"
quy d i n h ty' l e t a n g t r u n g b i n h t h u d c V i e t N a m dcac b e n h vien t u y e n t r u n g u a n g la 1-3% [4]. Benh vien da CO Ke hoach sd 803/KH-BVl 08 thUc hien de an tai Benh vien t r o n g d d p h a n dau kinh phf thudc Viet Nam sO d u n g tai Benh vien t d i t h i e u 2 2 % [2]. Vdi t j le sCf d u n g t h u d c Viet Nam tai Benh vien nam 2012 c h i e m 20,90% c h d n g t d b e n h vien da quan tam stjf d u n g t h u d c ndi cd chat l u g n g dam bao. Ket qui nSy c u n g p h u h g p vdi n g h i e n cdu cua Vu Thj Thu H u a n g , gia trj sd d u n g t h u d e ngi d cac benh vien t u y e n t r u n g u o n g t d 1 2 , 1 % den 27,9% [6]. Thudc c6 n g u d n gdc nude ngoai sd d u n g tai Benh vi^n chu yeu cd n g u d n gdc Chau A u , My, Nhat chiem tdi 49,54% t o n g kinh p h i sd d u n g cho thay benh vien Ida chgn t h u d c ed ehat l u g n g t d t , tU n h d n g nh^ sSn xuat uy t i n de dap d n g nhu eau dieu t n eCia Benh vien tuyen cudi.
Ket qua p h a n tich ABC tai Benh vien nam 2012 cho thay t y le t h e o chCing loai cac t h u d c nhdm A, B, C t u a n g dng la 12,1%; 20,9%; 67,0% phCi hgp vdi h u d n g dan cda To chdc Y te t h e gidi (A t d 10-20%; B t d 10-20%; C t d 60-80%) [7]. Ket qua nay tUOng tU cae n g h i e n cdu cua Devnani {A - 13,78; B - 21,85%;
C - 64,37%) [9], eua Gupta (A - 14,46%; B - 22,46%;
C - 67,53%) [10] va cao hdn n g h i e n cdu cda Huynh Hien T r u n g tai Benh vien nhan dan 115 (A - 9,2%;
B-16,9%; C-73,9%) [8].
Phan tfch ABC da phan d j n h dugc nhiJng thu6c nao s d d u n g nhieu kinh phi, de nhin nhan rd nhom sd d u n g nhieu kinh p h i tap t r u n g vao nhdng thu6c t h i e t yeu hay k h d n g t h i e t yeu can phdi h g p vdi phSn t i c h VEN. Ket qua phan tieh ma tran ABC/VEN da chi ra kinh p h i sd d u n g t h u d c t a p t r u n g chCi yeu vho n h d m I ( n h d m t h u d c sd d u n g nhieu kinh phi, thift yeu) vdi 73,78% kinh p h i , m a t khac n h d m thu6c sii d u n g it kinh p h i , k h d n g t h i e t yeu c h i e m t y le nh6
Tip 9 - S6 1/2014
1,51%. Oieu nay c h d n g t d c o cau sd d u n g thudc tai Benh vien la h g p ly. Ket qud neiy c u n g t u o n g tU nhU nghien cdu cua Huynh Hien Trung (nhdm 1 chiem 71,3%; n h d m II chiem 25,8% va n h d m III chiem 2,3%) [8], Kinh phi t h e o phan n h d m I, II, Hi t a p t r u n g vao cic thude khang sinh, cac t h u d c chdng ung thU, cac thude t i m mach va thudc d u d n g tieu hda phu hgp vdi ket qua ty le sd d u n g kinh phf tai being 3.1, eung nhu dac thu cua Benh vien.
5. Ket luan
Danh muc t h u d c Benh vien nam 2012 g o m 27 nhdm thude vdi 1.071 ehung loai thudc, 04 n h d m thudc sd d u n g kinh p h i Idn tai benh vien la thudc dieu tn ung t h u (21,7% kinh phO; thude khang sinh (18,7% kinh phO; t h u d e t i m mach (15,0% kinh phQ va thudc dudng tieu hda ( 9 , 1 % kinh phO. Thude don thanh phan, t h u d c da t h a n h phan chiem hy' le sd dung kinh phi l^n lugt la 89,6% va 10,4%. T^ le kinh phi thudc ndi chiem 20,9%. Cd cau thudc phu hgp vdi md hinh benh tat va dae t h u eCia Benh vien.
Benh vien da Ida chgn thudc sd d u n g hgp ly, dap Ung nhu cau dieu trj cua Benh vi0n, han che cac thudc bd t r g , vitamin. Vdi 18,49% theo chung loai thudc nhdm I chiem 73,78% kinh phi; 71,8% chung loai thudc nhdm II chiem 24,72% chi phf va 9,71%
chiing loai thude n h d m 111 ehiem 1,51% ehi phi.
Tai lieu tham khao
1. Benh vien Trung uang Quan ddi 108 (2012). Danh muc thudc Benh vien.
5.
Benh vien Tmng udng Quan €>di 108 (2013). Ke hoach so 803/KH-BV108 ngdy 08/5/2013 thUc hien de dn
"Ngudi ViitNam UU tien dung thuoc ViitNam'.
Bd Y te (2011). Thdng tU 31/2Qn/TT-BYT: Ve viic hudng ddn sd dung thudc trong cdc ca sd y te cd giudng benh.
Bp Y te (2012). Quyeif dinh sd 4824/QD-BYTngdy 03 thdng 12 nam 2012 phe duyet di dn "NgUdi Viit Nam Uu tien dung thuoc VietNam".
Nguyen Thj Song Ha, Le Thj Uyen (2013). Phdn tich mgt so hogt dgng sd dung thuoc tai Benh vien Ndi tiet TWndm 2012. Tap chi Dugc hgc sd 5/2013.445:
tr. 60.
6. Vu Thi Thu HUong (2012). Ddnh gid hogt ddng cua hgi ddng thudc vd dieu tri trong xdy dung danh vd thuc hien danh muc thuoc tai mdt so binh vien da khoa. Luan an tien sT Dugc hoe - Trudng Dai hpc Duge Ha Ndi.
7. Td chdc y te the gidi (WHO) (2004). Hdi dong thudc vd dieu tri - (^dm nang hUdng dan thUc hdnh. B^n djeh tieng viet do ehuang trinh DPCA eung d p . 8. Huynh Hien Trung (2012). Nghiin cdu mdt sd gidi
phdp ndng cao chat luang cung Ung thuoc tai binh vien nhdn ddn 115. Luan i n tien sT DUge hpc - Trudng Dai hge DUgc H i Npi,
9. Devnani et al (2010). ABC and VED analysis of the Pharmacy Store of a Tertiary Care Teaching, Research and Referral Healthcare Institute of India. J Young Pharm. 2(2): tr. 201-5.
10. Gupta, R., et al (2007). ABC and VED Analysis in Medical Stores Inventory Control. MJAFI: tr. 325-327.
