TCNCYH Phy trUOng 80 (3B) - 2012
NANG LUC THUC HIEN THO THUAT CAP CUU, CHbNG DOC, Npi KHOA VA NHI KHOA GIUA TRAM Y Jt
XA/ PHUONG Cb VA KHbNG Cb BAC SlTbT NGHIEP CHUYEN KHOA 1 - Y HOC GIA DINH
Phgm Huy Tuan Kiet, Nguyin Phuang Hoa Tru&ng D^i hpc Y Hd NQI
M(ic tleu cua nghidn cOn Id so sdnh ndng /yc thuc hidn thu thuat hoi sue cip ciiv, ching dpc. ndi khoa vd nhi khoa theo Quyet dinh 23/2005/QD-BYT cua Bi Y ti giua tram y ti xa/phu&ng ci vd khong cd bdc sT tot nghiep CK1-YHCD. Phucmg phdp nghien cuv la khdo sdt md ta, cit ngang tai 20 tram y ti xa/phu&ng a Ha Ngi. mdu tuang tw tir nghidn ciru cdc thu thuat ngoai khoa, (hyc hi$n v&i khoa Y hoc Gia dinh/ Dai hoc ting hqp h^anila/ Phillipine. Kit qud nghidn cuv cho thiy ty Id cac tram y ti xa/phu&ng c6 bdc sJ CK1-YHGD CO ndng luc thijc hi$n dupe cdc thii thu$t theo muc tieu cOa nghien ciru la 100%i trong khi ty le nay & nhdm chimg ch! tif 10 - 50%. Dao tao CK1-YHGD cd kiin thuc va ky nang toan dien ve cdc chuyen nganh khii ngi, la phii hpp giup ndng cao chat lupng bdc sTtuyin ca s&, Idm vide t^i cdc tram y te xa/phu&ng & Ha Nqi.
Tip khoa: Y hpc gia dinh, trgm y te xa I. DATVAND^
Hpc tap kinh nghi0m y hpe dy phbng eua cae nude Xa hgi chii nghTa, ngay sau khi hod binh lap Igi vao nam 1954, Viet Nam xay dung hp thbng cde trgm y t l xa, giup dua cbng tde cham sbc sue khoe, mgt dich vy md trudc day chi danh eho ngudi Phdp ehilm dbng va mot nhbm nhb ngudi Vipt cb tien, din vdi mgi ngudi dan. Mac dii chlen tranh keo dai, nen kinh t l nbng nghipp cbn Igc hgu, cdc chi so y t l ciia ngudi Vi0t Nam trong nhieu thgp ky ngang bdng vdi cdc quoc gia cb thu nhdp binh quan dlu ngudi d muc trung binh. H0 thbng trgm y t l xa cOa Viet Nam tdng duyc vinh danh la mbt mlu hinh tieu bilu eua eham sbc siic khoe ban dau [3,4,6].
Tuy nhien, khi Vipt Nam xay dyng nen kinh t l th] trudng, cac trgm y t l xa khbng cbn duyc bao cap nhu trude kia. Hgn che v l ca sd vgt chat cung nhu thieu y bae sT cb trinh dp
chuyen mbn cao da lay di long tin ciia ngudi b0nh doi vdi trgm y t l xa. Hp len thing ea sd y t l tuyln tren khi eb b0nh, gay nen tinh trang qua tai d day Xay dyng chuyen nganh va mb hinh Y hgc gia dinh eho eae tram y t l xa duyc xem xet la mpt giai phap khbi phyc lai chdl luyng he thing cham sbc sdc khoe ban dlu d Viet Nam [6].
Tu' nam 2002, trudng Dgi hpc Y Ha Npi dao tao Chuyen khoa 1 - Y hpe gia dinh (CK1- YHGD). Trong nam 2010, trong khuon kho hyp tae vdi Khoa Y hpc gia dinh/ Dgi hgc Tong hyp Manila/ Phillipine. Nguyin Van Khuang va dbng nghi0p da tiln hdnh mgt khao sdt ve ndng luc thyc hien thu thugt ngoai khoa, phy san vd y hpc co truyen giO'a trgm y t l xa/
phudng eb vd khbng cb bdc sTtot nghiep CK1- YHGD [5]. Dy an Ho try phdt triln Y hpc gia dinh d Vi0t Nam tiep tuc nghien edu nay vdi nghien cuu khao sdt nang lye thye hien cdc thii thugt chuyen nganh thupc khoi npi.
TCNCYH Phy trUdng 80 (3B) - 2012 Myc tleu: So sdnh thye trgng ndng lye thyc hi0n thii thudt hli sue elp cdu. chlng dpe, ngi khoa vd nhi khoa Iheo Quyll djnh 23/2005/QD-BYT cua Bb Y l l giua trgm y t l xa phudng cb vd khbng cb bdc sT i l l nghi0p CK1-YHGD.
II. D 6 I T U g N G VA P H U a N G P H A P -Thiet ke nghien cu'u: Nghien cu'U khdo sdt mb Id, e l l ngang Irong ndm 2010
Dia dilm nghidn edu: Chpn Igl 20 trgm y l l xd/ phudng d Hd Nbi, nguydn mlu td nghidn cdu cua Nguyin Vdn Khuang vd ding nghi0p. Trong db, 10 cb vd 10 khbng eb bdc sT tot nghl0p CK1-YHGD Idm vi0c.
Doi tuyng nghien euu: Bdc sT phy trdch ciia 20 trgm y t l xa/ phudng
Cbng cy, chi so vd biln so nghien cdu, Ty 10 cb khd nang thyc hi0n cdc thu thugt hoi sdc cap euu, ehong dbc, ngi khoa vd nhi khoa theo danh myc duyc Bg Y t l che phep trong Quylt djnh 23/2005/QD-BYT [2].
Phuang phap thu thgp d d lipu: Tien hdnh phbng van va khao sdt nang lye ciia cdc bde sT Idm vi0c tgi trgm y t l xa/ phudng dya tren bb cdu hbi va quy trinh quan sdt.
Nhgp va XCP ly so Ilpu: S6 Ii0u djnh luyng
duyc nhdp bdng phin mlm Epi Data 6 vd xu"
ly bing phin mlm SPSS 16.0. Thong ke mo td tinh todn ty 10 %. Kilm djnh Fisher Yates duyc su dyng trong thing ke phdn tich, so sdnh hai ty 10 cb cd mlu nhb. Sy khdc bi0t c6 5^ nghTa thing kS khi gid trj p < 0,05 vd rlt c6 y nghTa thing kb khi p < 0,001.
Dgo due nghien ciiru: Nghien cdu dupe tiln hdnh Irong khubn khi hggt dbng ciia Di;
dn H 5 try phdt triln Y hgc Gia dinh d Vipt Nam. Mpi thbng tin mang tinh cd nhdn du-pc giu bl m0t.
IM. KtT QUA
1. Thbng tin chung ve doi tuyng nghien cdu
Cd 20 trgm y te xa/ phudng d Hd Npi deu duyc ebng nh0n dgt chuin y t l quIc gia. Khac bi0l ve ca sd hg tang cung nhu trang thiet bi y te gida nhbm trgm eb vd khbng eb bac sT CK1- YHGD khbng cb J nghia thong ke (p > 0,05).
2. Thii thugt hoi sue cap cuu va chong dye
Bang 1 mb ta ty 10 eb ndng lye thyc hi0n cdc thu thudt hoi su'c cap cdu va chlng dpc theo Quyet dinh 23/2005/QD-BYT gida nhom tr$m y t l xd/ phudng eb vd khbng cb bac sT CK1-YHGDIamvi0c.
Bang 1- Ty 10 co nang lyc thyc hlpn thu thugt h&i sCfc cap ciru va chong dpc Stt.
1.
2.
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6.
7.
ThiJ thugt
Thii nggt
Bop bong Ambu qua mdt ng
£p tim nggai long ngyc
ThO thugt Hgimlleh (lly dj vdt duang tho) Rua dg day
Bdng bo v l t thuong
C6 djnh tgm thd'l b$nh nhdn gdy xtrong
Trgm co BSYHGD 10(100%) 10(100%) 10(100%) 10(100%) 10(100%) 10(100%) 10(100%)
Trgm khong CO BSYHGD
4 (40%) 4 (40%) 5 (50%) 3 (30%) 2 (20%) 1 (10%) 1 (10%)
Gia trj p
0,011 0,011 0,033 0,003 0,001
< 0,001
< 0,001
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TCNCYH Phy trUOng 80 (3B) - 2012
Thu thugt Trgm co
BSYHGD
Trgm khong Gia tri p CO BSYHGD 8. Cam mdu (vet thuong chay mdu) 10(100%) 3 (30%) 9. Van Chuyen bgnh nhdn an todn 10(100%) 2 (20%)
10. Dat ong thong da day 10(100%) 2 (20%)
11. Thong bang quang 10(100%) 0 (0%) < 0,001
100% trgm y t l xa/ phuong o6 bdc si CK1-YHGD dlu co nang lye thyc hign dugc tit cd cdc thu thugt hll SU'C edp cij-u vd chlng dgc theo Quylt d|nh 23/2005/QD-BYX trong khi nhom eae trgm y t l xa/ phu-ong khong co bdc sT CK1-YHGD chi cO ndng lyc thyc hign dugc tir 10 - 50%
danh myc. Sy khdc biet giu'a hai nhom 6 tat cd cde thu thugt deu co y nghTa thong ke cao.
3. Thu thugt ngi khoa
Bang 2 mo ta ty Ig co ndng lye thyc hign cdc thu thuat ngi khoa theo Quylt dinh 23/2005/
QO-BYT giO'a nhdm tram y t l xa phyang c6 vd khdng eo bac sT CK1 -YHGD Idm vigc.
Bang 2. Ty le CO nang lyc thyc hien thu thuat noi khoa Stt.
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2.
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7.
Thu thuat
Thut thao phdn Dgt sonde hgu mon Tet lay da (Prick test) Tet ngi bi Tet ap bi (Patch test) Tiem trong da, du'd'i da. bdp thjt Tiem tmh mach, truyen tTnh mgeh
Tram co BSYHGD 10(100%) 10(100%) 10(100%) 10(100%) 10(100%) 10(100%) 10(100%)
Tram khong CO BSYHGD
4 (40%) 4 (40%) 4 (40%) 3 (30%) 2 (20%) 1 (10%) 1 (10%)
Gia trj p 0,011 0,011 0,011 0,003 0,001
< 0,001
< 0,001 100% trgm y t l xa/ phtrang co bdc sT CK1-YHGD dlu co nang lyc thye hign dugc tat ca cae thu thugt ngi khoa theo Quylt dinh 23/2006/QO-BYT trong khi nhom cac trgm y t l xa/ phuo'ng khong eo bdc si CK1 -YHGD chi eo ndng lyc thye hign dugc tu' 10 - 40% danh myc. Sy khde bigt gi&a hai nhom a tat ca cdc thu thugt dlu c6 ^ nghTa thing ke cao.
3.3, Thu thugt nhi khoa
Bang 3 mo ta ty Ig co nang lyc thyc hign ede thu thugt nhi khoa theo Quylt djnh 23/2005/
TCNCYH Phy trUOng 80 (3B) - 2012
Stt.
1.
2.
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12.
Bang 3. Ty Ig co nang ThiJ thugt
Thyt thdo phdn Thii nggt B6p bdng Ambu
£p tim ngodi ling ngyc Thu thudt Heimlich Bdng b6 vlt thuang
ii,pc thyc hign thij thugt nhi khoa
C l djnh tgm thd'i bdnh nhdn gdy xuang e l m mdu (vlt thu'ang chdy mdu) Ddt Ing Ihdng dg ddy Cho dn qua Ing thdng dg ddy Rgch rOng vOng thdt nghgt bao quy dlu Dgt ong thong bdng quang
Trgm co BSYHGD n(%)
10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100) 10(100)
Trgm khong co BSYHGD n(%)
4(40) 4(40) 4(40) 3(30) 2(20) 1(10) 1(10) 4(40) 3(30) 2(20) 1(10) 1(10)
Gia trj p
0,011 0,011 0,011 0,003 0,001
< 0,001
< 0,001 0,011 0,003 0,001
< 0,001
< 0,001 100% trgm y t l xa/phudng cb bdc sTCKI-YHGD dlu cb ndng lyc thyc hi0n duyc tat ca cac thu thugt nhi khoa theo Quylt djnh 23/2005/QD-BYT. trong khi nhbm cdc trgm y te xa/ phudng khbng cb bde sTCKI-YHGD chlcb nang lye thye hi0n duyctd 10 -40% danh mye. Sy khaebi0t giua hai nhbm d tat ea cde thu thugt dlu cb ^ nghTa thing kd cao.
Trong chuang trinh ddo tgo CK1-YHGE), IV. BAN LUAN
100% cdc trgm y te xd/ phudng cb bdc sT CK1-YHGD deu eb nang lyc thyc hi0n duye tat ea cac thu thugt thugc cdc chuyen nganh ngi khoa theo Quylt djnh 23/2005/QD-BYT. Ty 10 nay d nhbm trgm y t l xa/ phudng khbng cb bdc sTCKI-YHGD dao dbng tu 10-50%. Nhbm trgm y t l xa/ phudng cb bdc sT CK1-YHGD eb ndng lye thye hi0n tit han nhbm trgm y t l xa khbng eb bde sT CK1-YHGD d t i t cd cdc thii thugt thupc ede ehuyen nganh ngi khoa vdi y nghTa thong ke. Trong khi db, ndng lyc thyc hi0n 4/10 thii thu0t ngogi khog, 6/13 thii thugt phy san vd 12/12 thu thudt y hgc c6 truyen Igi khbng cb sy khdc bi0t mang y nghTa thong ke giua hai nhbm [5],
hpc vign hgc 14 dan vi hgc trinh (210 tiet) npi khoa, 10 dan vj hgc trinh (150 tilt) nhi khoa vd 2 dan vj hgc trinh (30 till) hoi sue cap cuu [6], nhieu han so vdi ting khoi ngogi gom 6 dan vj hgc trinh (90 tiet) ngogi khoa, 8 don vi hgc trinh (120 tilt) san khoa vd 4 dan vj hpc trinh (60 tilt) y hgc c6 tmyen. Cac ehi tieu IJ thuylt va thye hanh ciia ddo tgo CK1-YHG0 tgp trung han vao ede ehuyen ngdnh thu0c khii npi giiip hpe vipn cb duyc k? nang thyc hi0n cdc thu thugt hqi sue elp cuu, ehong d0c, ngi khoa vd nhi khoa tot han Id eae thu thu^t ngogi khoa, sdn khoa vd y hgc e l truyen khi so sanh vdi cdc bdc sT khbng duyc ddo t?o CK1-YHGD.
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V. K t T L U A N V A KlfeN N G H I 100% bde sT tot nghigp CK1 - Y H G D sau khi tro Igi vi tri eong tdc tgi cac trgm y t l xa eija Ha Ngi d l u t h y c hign d u g c cac thu thudt d u g c BO y t l cho phep y t l xa theo Q u y l t d|nh 23/2005/
QB-BYT Trong khi do ty Id ndy o nhom cdc tram y t l xa chung khong co bde sT t i t nghigp CK1-YHG0 d l u d y a i 5 0 % . Y hgc gia dinh la chuyen ngdnh dag tgo phij h g p vd giup tang cucrng ddng k l c h i t l u g n g t h y c hien cde thu thuat h l i si>c d p c u u , c h l n g dgc, ngi khoa vd nhi khoa a cae trgm t l xd/ p h u a n g . M o rgng hinh thye ddo tgo y hgc gia dinh, bdt huge eho can bg Y t l tuyen c a s a giijp cdi thign c h i t lu'ong chdm soe s u e khoe ban d l u a Ha Ngi.
T A I L I E U T H A M K H A O 1. Bg Chinh trj (2005). Nghi q u y l t 4 6 - NQ/TW ra ngay 23/02/2005 ve cong tdc bao ve, Cham soc va nang cao site khoe nhdn dan trong tinh hlnh md'i
2. Bg tru'dng Bo Y te (2005). Q u y l t dinh so 23/2005/QQ-BYT ngdy 30 thang 8
ndm 2005 v l vl^e ban hdnh quy djnh phan t u y l n ky thugt vd danh mye ky thudt trong kham chua bgnh.
3. Montagut Alain, Nguyen Thj Kim Chijc (2007). Main concepts of Family Medicine. Family Medicine in Vietnam Presentation in the Family Medicine Workshop at the Hanoi Medical University in 2007.
4. N g u y i n Thj Kim Chuc, Pham Nhat An, Pham Huy Tuan Kiet (2006). Oanh gid tdc dOng cua Y hgc gia dinh trong ndng cao e h i t l u g n g djeh vy y t l a cdc trgm y te xd. Dgi hgc Y Ha Ngi
5. Nguyen Van KhU'ang, Pham Huy Tuan Kiel (2012). Khao sdt viee thyc hign thiJ thudt ngogi khoa, phy san va y hoc co t r u y i n giu'a tram y t l xa/ p h u a n g eo va khong eo bac sT t i t nghiep ehuyen khoa 1 - Y hgc gia dinh - Ha Ngi Y hoc t h y e hanh 5(822): 84 - 86
6. Pham Nhat An, Nguyen Thj Kim Chuc (2005). Bai giang giai thieu Y hgc gia dinh cho Chuyen khoa 1 - Y hgc gia dinh.
Summary
ABILITY FOR IMPLEMENTATION OF INTENSIVE CARE,
TOXICOLOGICAL C A R E , INTERNAL MEDICINE AND PEDIATRIC INTERVENTIONS BETWEEN C O M M U N E HEALTH CENTERS WITH AND WITHOUT DOCTOR SPECIALTY
LEVEL I IN FAMILY MEDICINE
Objectives of the research were to compare ability for implementation of intensive care, toxicological care, intemet medicine andpediathe inten/entidns according to the Decision 23/2005/QD-BYT of the Health Minister between commune health centers with and without doctor Specialty level 1 - Family medicine.
Method used a cross-sectional survey In 20 commune heath centers in Hanoi, the same sampling from the joint research on surgical interventions with the Department of Family Medicine/ University of Manila/
Philippines. The results shown that 100% of commune health centers with family doctor could implement the intenrentions according the study objectives, while the percentage by the control group varied from 10 to 50%. Family medicine training of Specialty level 1 with comprehensive knowledge and sidlls of internal medicine is appropriate to improve quality of primary doctors at commune health centers in Hanoi.
Keywords: Family medicine, commune health center