TCNCYH Phu tracing 80 (3C) - 2012
thu6c theo dan, ban hanh kern theo Quylt Nha xuat ban Y hpc, Ha Npi.
djnhs6l847/2003/QD-BYTngay 28/5/2003. 7 gayer I. Al-Azzam, Belal A. Al- 4. Katherine Fuentes Albarran, Lorenzo Husein, Firas Alzoubi, Majed M. Masadeh VillaZapata(2008).Analysis and quantification et al (2007). Self-medication with antibiotics of self-medication patterns of customers in in Jordanian population. International Journal community pharmacies in southern Chile. of Occupational Medicine and Environmental Pharm World Sci, 30: 863 - 868. Health, 20(4): 373 - 380.
5. Kondrad Zaman (2010). Tuberculosis: 8. Trjnh Ngpc Quang (2006). Ki6n thirc, a global health problem. J Health Popul Nutr, thai dp, thg-c hanh, SLP dgng thuoc khang sinh 28(2): 111-113. tgi cac ho gia dinh xa ViptDoan, Tien Du, B i c 6. Mai Tat To, Vu Thj Tram (2007). Du'vc ^inh. Luan van th?c sT Y te Cong cOng, Dgi Ly hoc: Sach dao tao du-gc sT dai hoc, Tap 2. ^^^ Y te Cong cpng. Ha Npi.
Summary
SITUATION AND SOME FACTORS INFLUENCING ANTIBIOTICS SELF-MEDICATION AMONG PEOPLE OF LA PHU COMMUNE, HOAI DUC DISTRICT, HANOI, 2011
Objectives of the study were to estimate the prevalence of antibiotics self medication among people in La Phu commune and to evaluate its influencing factors. The results indicated that the prevalence of antibiotics self medication was 66,8%. Commonly self-medicated antibiotics were ampicillin (39.8%) and amoxicillin ( 31.6%). 40,6% of antibiotics self medicated patients use antibiotics for less than 3 days. The common source for self-medicated antibiotics was private pharmacies (43.6%). Patients took self medication due to their belief of slight symptoms (33.8%) and confidence in own experience (27.1 %). Profession, private pharmacy, similar symptoms in the past and lack of counseling by health professionals were risk factors for antibiotics self medication. Management, strict monitoring of prescription, especially in private pharmacies, together with enhancing communication and education are measures to reduce antibiotics self medication.
Keywords: Antibiotics self medication
DANH GIA CUA BENH NHAN Vl^ C H A T L\J0HG K H A M CHU'A
BENH CUA BAC ST GIA OJNH VA BAG ST DA KHOA TAI Y T^
TUY^N CO S(y VA NHU CAU CHAM SOC SLPC K H 6 E
Nguyen Phirang Hoa, Ph^m Huy Tuan Ki?t Truung D$i hc?c Y Hii NQI
M6 hinh bac sTgia dinh ngay cang du^c phat thin rgng rai tren toan the giai vol vi$c chSm s6c SLK khoe ban diu, cung cap cic dich vij y te chit lir<?ng vdi mOc chi phi hqip ly' vii di tiSp c$n. Mi^c ti§u cCia nghien cuv nhSm so sanh si/ danh gia cua b$nh nhan ve chit lifqrng kham chira b$nh cCia bic sTgia dinh
TCNCYH Phy trudng 80 (3C) - 2012
va bite si da khoa t$i mQt so ccr sa y te tuyen huyen, xa va xac djnh nhu cau cham soc sCrc khoe cua ngtryi b$nh, nSm 2011. Kit qua nghien cCru cho thiy ty /? bac si gia dinh dove benh nhan danh gia la c6 thai dq tot cao hem so vdn cic bac sTda khoa (86,7% so vdi 77,0%; p < 0,01). 68.2% benh nhSn danh gia bac slgia dinh CO trinh do chuyen mon tot, ty le nay cao hem so vol nhom bac side khoa C53,5%, p < 0.001). Nguryi benh mong muon du^c dap Cmg mqt so nhu cau cham soc sue khoe nhw theo doi diiu tri lien t{ic (78%). tir van ve SLK khde (80,8%). Dong thai, cd mqt ty le tuvmg doi mong muon duvc quan ly sCrc khoe cho ca ho gia dinh (42,4%), du^c kham chCra benh t^i nha va theo doi SLK khoe cA khi khong bj 6m.
TIP khoa: bac sT gia dinh, cham soc si>c khoe I. DAT V A N Oe
Sy phattrien mgnh me cua n4n kinh te cung nhu' s\jf chuyin doi md hinh b^nh tgt tren toan c l u da dan den SI,F thay doi ve nhu cau chSm soc sice khoe cua cpng dong. Cl cac nu^c phat trien, vi^c cham soc cac b^nh mgn tinh nhu':
S&\ thdo du'd'ng, tang huy^t ap, b#nh phoi t i c nghen mgn tInh (CORD), hen p h i quan,... da chuyin tu' ph6ng b$nh nOi tm ra ph6ng kham ngogi tnj vdi cac phac do dieu trj du'pc xay dyng nhlm phan d p cac giai dogn dieu trj v6i SM" ph6i hpp cua cac chuyen khoa lien quan.
Trong b6i canh do, sy ra ddi cua cac chuofng trinh cham s6c sifc khoe ban d i u va chuyen khoa Y hpc gia dinh (YHGO) trong nhOng nam 1960 la mOt dap Cmg kjp thoi cua h$ thong y te d6i v6i sy thay d6i nhu c i u cham s6c sire kh6e cua ngu'6i dan tr§n toan t h i gidci [6].
Tgi ViQt Nam, cham soc su-c khoe nhan dan la mOt trong nhO-ng trpng tam uu tien trong chinh sach cua Ding va Nha nu'oc ta, da du-p'c t h I hi^n trong Lu^t Bao v$ va cham soc si>c khoe nhan dan v6i phuang cham uu tien dy phong, chu trpng cham soc SLPC khoe ban dau d t u y i n Off sd. Tuy nhien. do anh hirong cua qua trinh chuyin a6i n i n kinh t l , ho^t dpng cua mgng M\ y t l ca sa hi?n nay dang ggp nhilu kh6 khan va thach thCrc. Opi ngu can bp y t l ca sa v i n c6n thilu va y l u , chira dap irng di^gc yeu c l u cua nhipm vy. Ben c?nh do, nhu c l u Cham s6c SLPC khoe cua ngi/oi dan ngay
•cang tang; ngoai vi$c kham, d i l u tn cac b^nh thif6ng g$p ngi/d^i dan c6n c6 nhu c^u ti/ van
dy phong va nang cao sire khoe, quan ly theo doi cac b?nh mgn tinh t^l c$ng d6ng. Dong thai, tinh trgng qua tai ciia cac ca sa y te tuyen tren doi hoi phai c6 giai phap thich hpp de tang cu'ong kha nang phan logi, xCr tri va dieu trj cung nhu' dy ph6ng b$nh tat ngay lir tuyen ca sa. Khai ni$m YHGO m6i chi du-pc biet den trong v6ng 15 nam tra Igi day a Vi§t Nam. Vipc dao tgo bac sT chuyen khoa I (BSCKl) Y hpc gia dinh da du-pc triln khai tgi 6 trong 8 tn/drng dgi hpc y ciia ca nu-dc. Qua khao sat sa bO tgi mOt s6 ph6ng kham va trgm y t l c6 bac sT gia dinh (BSGO) lam vi$c, cho thIy nang lye cung cap djch vy cham soc y te da dupe nang cao han, phgm vi kham chOa b?nh cQng duvc ma rpng va mire dp hai I6ng cua b?nh nhan cOng c6 nhOng cai thi$n [1]. Tuy nhign, do khai ni^m v l y hpc gia dinh chu'a du'pc hilu dung va 6ky du; chua c6 quy djnh ve vai tro va vj tri cua BSGD trong he thong y te Viet Nam n6n chit lu'png va each trien khai hogt dpng van con r i t nhilu diem can nghi§n CLPU va hoan thipn.
Chung toi tien hanh nghien cCru vai myc tieu:
1. So sanh sy danh gia cua b^nh nhan ve chit lu'png kham chu'a bfenh cua bac sT gia dinh va bac sT da khoa tai cac ca sa y t l tuyen huyen,xa nam 2011.
2. xac dinh nhu cau cham s6c sire khoe cua benh nhan.
IL 0 6 l Tl/QfNG VA P H l / a N G PHAP Oja diem nghien cCru
Chpn 3 tinh, thanh pho Ha N^i, KhanfrHoa
375
TCNCYH Phu trUdng 80 (3C) - 2012
va Can tha vao dieu tra, 3 tinh thupc 3 khu vyc bIc, trung va nam ciia Vi^t Nam. De phyc vy myc dich nghien CLPU, chung toi lya chpn nhyng quan/huyen c6 mpt so cac BSGO, hien dang cong tac tai mpt so trgm y t l xa hogc phong kham cua b^nh vien huy^n. Tai m6i tinh chpn 2 qugn, huy^n; 4 xa/huypn, 2 phong kham BSGO. Phong van cac bpnh nhan d i n kham chOa bpnh tgi cac phong kham a moi tuyen, tong se c6 8 phong kham/ tinh.
BSGD: la cac bac sT da tot nghi^p chuyen khoa I YHGO.
Bac sT da khoa (BSDK): trong nghien CLPU nay la bac sT lam cong tac kham ch&a bpnh tgi trgm y t l xa, phong kham tuyen huypn. Qua thu th$p s6 lieu, p h l n Ian la bac sT da khoa, c6 mpt vai bac sT chuyen khoa I npi va rang ham mgt.
Doi tu'p'ng nghien ciru
Tat Cci cac bpnh nhan den kham chu'a bpnh tai cac ca sa y te tuyen quan/huypn va xa/phLPang da dLpp'c lya chpn vao m i u nghien CLPU.
Dy kiln phong v I n khoang 105 bpnh nhan/nhom bac sT/tinh (tuy thupc vao so lu'png
Bang 1. Phan bo b^nh nhan den
benh nhan d i n cac ca sa kham benh trong thai gian thu thgp so lipu).
Thiet ke nghien ciPU Nghien CLPU mo ta cat ngang Thu thap so lieu
Phong van doi tLPpng nghien CLPU bang bp cau hoi thilt k l s i n . Thu t h| p s6 lipu tgi thyc djatythang 5-12/2011
Phan tich so lieu
Nghien CLPU SLP dyng phan mem Epidata d l nhgp so lipu, phan tich so lipu blng phlln mem SPSS phien ban 10.0. Test Khi binh phyang (x2) dippc SLP dyng nhlm so sanh sy khac biet giu-a cac nhom. Nghien CLPU sCi dyng mLPC y nghTa a = 0,05.
III. K^T QUA
Dieu tra da phong van du-pc 691 bpnh nhan di kham chu'a bpnh tgi mpt so ca sd y t l huypn va xa thupc 3 tinh/thanh ph6 Ha Npi, Khanh Hoa va Can Tha. Trong so cac bpnh nhan, CO 44,6% b§nh nhan di kham tgi ca sa y t l CO BSGD. Trong do ty Ip bpnh nh§n a Khanh Hoa d i n kham BSGD la cao nhat (78,6%), (Bang 1).
kham theo chuyen khoa bac sT Chuyen
BSGD BSDK Tong
khoa Ha n 69 172 241
Npi
%
28,6 71,4 100,0Khanh Hoa n
165 45 210
%
78,6 21,4 100,0Can Tha
n % 74 30,8 166 69,2 240 100,0
Tong
n % 308 44,6 383 55,4 691 100,0
1. Si^ danh gia cua b^nh nhan ve mot so yeu to lien quan den chat lu'p'ng djch vu y te Thai dp cua bac sT
K i t qua nghi§n CLPU cho thIy ty Ip BSGD du'pc bpnh nhan danh gia la c6 thai dp tot cao han so vai cac BSDK(86,7% so v6i 77,0%; p < 0,01).
TCNCYH Phu trUdng 80 (3C) - 2012
Thai dp t6t
BSGD BSDK
P
Bang 2.
Ha Npi
n % 58 84,0 123 71,5
0,04
Danh gia bac sT Khanh Hoa
n % 141 85,5
18 40,0
< 0,001
CO thai do tot Can T h e
n % 68 91,9 154 92,8
0,81
Tong
n % 267 86,7 295 77,0
<0,01 Tuy nhi§n, khdng c6 sy khac bipt v l thai dp cua bac sT a cac chuyen khoa khac nhau tgi Cin tha, cac bpnh nhan a Clin Tha danh gia rat cao thai dp cua tat ca cac bac sT (Bang 2).
Trinh dp chuyen mon cua bac sT
Bang 3. Danh gia bac si c6 trinh dp chuyen mdn tot
Chuyen mon
tit
BSGD BSDK
Ting
P
n 35 63 98
hlaNpi
%
50,7 36,6 40,7 0,04
Khanh Hoa n
117 16 133
<
%
70,9 35,6 63,3 0,001
Can The n
58 126 184
%
78,4 75,9 76,7 0,67
Tong
n % 210 68,2 205 53,5 415 60,1
< 0,001 Bang 3 cho thiy BSGD dLPpc bSnh nhan danh gia c6 trinh dO chuyen mon tot cao han BSDK (68,2% so vdi 53,5%, p < 0,001).
Cham s6c lien tyc
Kit qu3 nghien cO'u cho thIy 63,6% bpnh nhan din kham bpnh tgi ca SCP C6 BSGD du'p'c hpn lich kham Igi. Ty 1^ nay cao han 6 nhlm din kham cac BSDK (63,6% so vai 53,3%, p < 0,01), (Hinh 1).
. BSYHGD I BS khjc
H?nKL KhonghenKL
Hinh 1. Hen benh nhan kham lai
377
TCNCYH PhM trUdng 80 (3C) - 2012
Bang 4. So sdnh mpt s6 y6u Ddnh gja
C6 th^i d$ t6t Chuy6n m6n t6t C6 hen khSm l^i
BSGO n {%) 267 (86,7) 210 (68,2) 196(63,6)
t6 llSn quan d^n BSOK
n (%) 296 (77,0) 206 (53,5) 204 (53,3)
ch&t lipp'ng khdm chu'a b^nh OR
1,94 1,86 1,64
95% CI
1,27-2,98 1,34-2,58 1,12-2,11 Bdng 4 cho th^y b$nh nhdn ddnh gid m$t s6 y4u t6 lidn quan d^n chit iLTQ-ng kham chu'a bSnh t^i cc s6 y t4 c6 BSGD d^u t6t hon cc s * kh6ng c6 BSGO,
2. Nhu cau Cham soc SLPC khde cua b^nh nhan
Trong s6 691 b$nh nhSn cCia di6u tra, nhu clu niu6n dug-c tu" v&n nhi^u han chiem ty I9 cao nhit (80,8%), ti6p theo li mong mu6n du'Q'c cSc bSc sT di^u tri va theo dfii si>c kh6e lien tyc (78%). 42,4% cd nhu clu du-tyc hu'dng djch vu chSm s6c sCrc kh6e cho cA gia dinh vA chl c6 29,8% mong mu6n duofc chSm s6c SLPC khde ca khi khdng dau 6m (Hinh 2).
Hinh 2. Nhu c l u ch3m soc su'c khoe cua benh nhan
V. BAN LUAN s6c SCHC kh6e lien tyc la c6 hen Ijch khSm lei Sv danh gii cue benh nhan v4 chit luwng "<>'' ''^"'^ "^^"- Ty I? nay la 63,6% o BSGD cuadlchvuyte (BSBK,» 53,3%).
V^ thai dO cOa c4c bSc sT, 86,7% b^nh *^'"'«° ^"*^ '^'^ '^^' ^ *^nh gia chat \uqing nhSn dSnh gia cSc BSGO c6 IhSi dp t6t. Ty \$ " " i * "» * P^'= '^"'^ " * i ^ " S'O'a <=*<= P*^°"9 nSy la 77% a c^c BSDK, si,f khSc bi§t niy c6 '^^*'" =* ^SGD va cac phdng kham khac, kit
^ nghTa thong k§ (p < 0,01). Benh nhSn dSnh 1 " ^ ^'^^ "'a '^° * ^ y ^enh nhSn dSnh gii chit gia cac BSGB c6 trinh dg chuy§n m6n t6t la '"'"'"9 >=*<= P*^°"9 kham BSGB tot han. Dieu 68,2% (BSDK \i 53,5%). " ^ 1 ' "=* * ^ ''° =*"= ^^GD da du'yc dao t?o thSm 2 nam chuyen khoa I YHGD, c6 thgm ' Mot trong Ccic thong tin danh giciviec Cham . , .^ ^^ , . , . . .
° cac kien thu'C va ky nang phSt hlgn, xii tri cac
TCNCYH Phy trUdng 80 (30} - 2012
v^n d^ SCPC khoe IhiPcvng g^p tgi cpng dong.
Kien thu'C da khoa cua cdc BSGD se tot hen cac bac sT chuyen khoa h?p khac hogc bac sT da khoa chu-a du-Q-c d^o tgo sau dgi hgc.
Kit qua nay cung tu-c^ng ti^ nhu' ket qua dieu tra cCia Ph?m Thj Ngpc BIch [1], Kit qua trong c^c nghi§n CCFU [3,4,7] t^i My, Litva, Estonia v^
mpt so quoc gia Trung va Dong Au.
Tuy du'g'c benh nhan danh gia mpt so diem li§n quan den chat lu'p'ng djch vg tu-ang doi t6t, nhu-ng ty 1? dgt du'g'c cua BSGD chu'a dugc nhu- mong 6(?\. Dieu nSy giOp cac nh^
l§nh dgo va cff so- d^o tgo can chu trgng hon vigc kiim tra chat lu'tp'ng thuo'ng xuyen cung nhu" cong tcic dao tgo l^i cho cSc cSn bg y te.
Nhu cau cham soc SLPC khoe cua bgnh nhan Nghien COPU cho thay nhu cau cua benh nhan mu6n du'gc theo doi dieu tn lien tuc la rit cao (78%). B0nh nhan mong du'g'c bac sT tu' van nhieu ho-n la 80,8%.
QuSn ly SLPC khoe cho ca gia dinh, kham si>c khoe tgi nha hay cham soc ca khi khong 6m cQng la nhijng ITnh vyc chinh trong thyc hanh y hgc gia dinh. Tat ca nhi/ng boat dgng nay dem l^i sy tin cay cua b#nh nhan doi vo-i b^c St, giup bac sT hieu du'gc moi tru-dng song cCia b^nh nhan va c6 ke ho^ch cham soc b?nh nh§n toan di$n va phu hp'p hon [2,5].
Trong dieu tra nay, nhu cau du'g'c quan \)/
SLFC khoe cho ca gia dinh chiem ty 1$ 42,4%, kham chiJa benh tai nha la 22%, du'g'c theo doi ch§m soc SCFC khoe ca khi khong 6m la 29,8%.
Co the do ngu-c^i dan c6 nhQ-ng e nggi v§ ca Che Chi tra chi phi va nhgn thCpc cua ngu'o'i daii trong cgng dong ve mu-c dp c^n thiet cua vi#c theo doi su-c khoe lien tyc ke ca khi khong 6m chu'a dung, nen mgt so nhu cau cua ngu'o'i
• dan con chu'a cao. Tuy nhien, & giai do^n hign nay - khi so lu'^ng cac BSGD du'ffc dao tgo du-^c c6n chu-a nhi^u - thi vi^c dap u-ng du-pc ' cSc nhu c^u tr§n cua cgng dong la c6 the kha •
thi. TO- hi^u qua trong thyc te tnen khai, cac nhu cau cua ngu'o'i dan se din tang len. Cung chinh nhOng phu'cng thi>c cham soc SCPC khde n^y se giOp lam giam so bgnh nhan vu-pl tuy§n v^ s6 b^nh nhan du'pc phat hi?n bgnh 6* giai dogn muOn cQng nhu' n§ng cao higu qua cua cong tac phdng benh, day chinh la Ipi ich cua mo hinh BSGD. IVlgt nghien ciiu ff Anh cho th^y c(y tang them mgt BSGD lam cong tac ch§m soc SLFC khoe ban dau cho 10.000 dan se giup giam ty suSt tip vong da hieu chinh vo'i cac bgnh mgn tinh va phan bo dan so chuan IS 5% [3].
Tgi Vigt Nam, hi?n nay, dang c6 hign tu'png qua tai a cac co so y te tuyen trung u'ong. Ngu'o'i benh thu'O'ng den cac co" sd kham chu'a benh tuyen tren ma khong su"
dung y te tuyen ca so', din den nhieu he luy xau khdng dang c6. Mpt h$ thong y t4 tuyen ca sa dam bao s6 lu'g'ng va ch&t lu'png cho phep giai quy§t khoang 90% nhu cau cham s6c SU'C khoe cua ngu-ai dan trong cgng dong.
Cac bgnh vien can danh tho-i gian dieu trj cho cSc ca bgnh nang dung vo'i vai tro cua ca sa y te chuyen sau.
VI.K^TLUAN
B^nh nhan danh gia lu'g'ng dich vu y te cua BSGD tu'cng doi t6t
BSGO CO thai do tot trong qua trinh kham ch&a bgnh cho benh nhan la 86,7%, ty Ig nay cao han so vai BSDK (77%, p<0,G1)
68,2% BSGO du-pc danh gia trinh dp chuyen mon a mCfc dp tot. Ty Ig nay cao ban khi so vai BSDK (53,5%).
Cac benh nhan c6 nhu cau Theo doi dieu trj lien tyc la 80,8%. Dong thai. CO mpt t^ le tu-ang d6i mong muon du'pc khSm chu'a bgnh tai nha, theo doi SLPC khoe ca khi khong 6m v& quan \^ SLFC khde cho ca gia dinh.
379
T C N C Y H P h y trUdng 8 0 (3C) - 2 0 1 2
Cdn cd th6m cdc nghien CCPU ti> phia cdc bdc sT vS nhS qudn l( y t4 dfi c6 th6m cAc th6ng tin yk nhu cSu vS dieu ki$n cdn t h i l t cho vi$c t r i l n khai hi$u qud m 6 hinh B S G D t^i Vi§t Nam.
T A I L I E U T H A M K H A O 1. Ph^m T h j N g g c B i c h (2008). So sdnh m i j c dO hSi Idng cua b$nh nhSn vd'i bSc sT CK I Y hpc gia dinh vd bdc sT da khoa t^i m$t 56 trgm y t6 xa 6 HS Ngi; Tgp chl nghifin c i j u y hgc, 67(2): 1 9 8 - 2 0 3 .
2. Freeman G, H j o r t d a h l P (1997). What future for continuity of care in general pratice?
British Medical Journal. 314(7098): 1870 - 1 8 7 3 . 3. M a l n o u s A G (2001). Continuity of care and trust in one's physician: evidence
from primary care in the U S and UK. Family medicine, 33(1): 2 2 - 2 7 .
4. S t o c k K e i s t e r (2004). What people want from their family physician? Am Fam Physician; 69(10): 2 3 - 3 0 .
5. T a h e p o l d H (2006). Patient expectations from consultation with family physician; Croat Med J; 47(1): 1 4 8 - 1 5 4 .
6. W O N C A ( 1 9 9 1 ) . T h e role of the General Practitioner/Family Physician in health care systems: A statement from Wonca; WONCA.
7. Z e b l e n e (2008). Agreement in patient- physician communication in pnmary care:
a study from Central and Eastern Europe;
Patient Educ Couns; 73(2): 246 - 250.
S u m m a r y
Q U A L I T Y OF H E A L T H SERVICE AT G R A S S R O O T H E A L T H C A R E L E V E L O F GENERAL PHYSICIANS A N D FAMILY PHYSICIANS FROM PATIENT'S PERSPECTIVES A N D
PATIENT'S H E A L T H C A R E NEED
Family physician model has been more and more developing and expanding in all over the world to provide good health services, reasonable cost and better access. The study was to compare quality of health services provided by family physicians with general physicians at district and communal levels from patient's perspectives and to identify healthcare need from patients, in 2011. The results indicated that family physicians had good attitude than that In others (86.7% versus 77.0%; p < 0.01). 68.2% of the patients reported that family physicians were good professional, the rate was higher than general physicians (53.5%, p < 0.001). Patient's healthcare needs were continuous care (78%) and consultancy (80.8%). In addition, there were relative rates of health care services for whole family (42.4%)', home services and health services in healthy period.
K e y w o r d s : f a m i l y p h y s i c i a n s , h e a l t h care
