TAP CHi Y DUpc L A M S A N G 108 Tgp 6 - S6 6/2011
Hieu qua cua mo hinh quan ly, cham soc sue khoe va phuc hoi chu-c nang cho nguoi tan tat dua vao cong dong
The Effect of Management Model, Health Care and Rehabilitation for Disabled Persons Based on Community
Nguyen Thi IVIinh*, Le Van Bao** *Trung tdm Y te Qudn Hodng Mai Pham Le Tuan *** **Hpc vien Qudny
***BoYte
T d m tat
Sau 2 nam can thiep da kham chQa benh cho 2706 lupt ngudi tan tat tai tram y te va 227 lUpt cap cUu, kham chCfa benh tai nha. Ket qua cho thay: nguyen vpng cham sdc sUc khde va phuc hdi chUc nang cua ngUdi tan tat cd sU thay doi rd ret. Ty le mudn dUpc theo ddi va kham sUc khde djnh ky tai tram phudng tang tU 30,1% len 60,8% (p<0,001); mudn dUpc cham sdc tai nha 14,2% len 45,6%; 66% ngUdi tan tat mudn dUPc luyen tap phuc hdi chUc nang tai tram y te phudng cao hon trudc can thiep (30,9%); 51,6% mudn dUpc luyen tap phuc hdi chUc nang tai nha so vdi 17,9%; va 86% mudn nhan vien y te hudng dan tap luyen phuc hdi chUc nang so vdi 36,5%. Ty le ngUdi tan tat cd hoat ddng tap the due tang len 95,6%, cao hon trUdc can thiep (14,7%); ty le ngUdi khdng hoat dpng the lUc giam cdn 4,4% so vdi 41,2% trUdc can thiep (p<0,001).
TUkhoa: ngUdi tan tat, cham sdc sUc khde, phuc hdi chUc nang, dUa vao cdng ddng.
Summary
After 2 years of medical intervention for 2,706 turns of people with disabilities at the clinic and 227 turns of emergency, home healthcare, results showed that the expectation of the people with disabilities for healthcare and rehabilitation has changed dramatically. The rate of those who wanted to be monitored and had periodic health examined at the ward clinic increased from 30.1% to 60.8% (p <0.001); the rate of those who want home-based care increased from 14.2% to 45.6%. 66% of disabled people wanted to rehabilitate in ward at the clinic, higher than the rate before the intervention (30.9%). 51.6% wanted to practise rehabilitation at home, compared with 17.9%; 86% wanted health workers to guide training and rehabilitation, compared with 36.5%. The rate of people with disabilities do exercise activities increased to 95.6%, higher than before the intervention (14.7%) and the ratio of non-physical activities decreased to 4.4%, compared with 41.2% before the intervention (p <0.001).
Keywords: disabled persons, health care, rehabilitation, community-based.
LDatvande [9][11][6][2]. Quan H o i n g Mai, H I Ngi ty le n i y Theo Ude t i n h tren the gidi cd k h o i n g 10% d i n k h o i n g 9,51 %[7]. Han ai het, ngudi tan tat can dugc so m I e tan tat [3][12][4]. Tai Viet Nam cd k h o i n g e h i m sdc y te trong ciJng m g t he t h d n g n h u mgi 6,3% dan so (sd lieu dieu tra t h d n g ke qudc gia n i m thanh vien k h i c trong x l hdi[1]. DUa tren ket q u i 1995). Tai eae t i n h , thanh pho ty le n i y khac nhau t h u dugc qua dieu tra thUc trang ve tan tat v l sUe
Phan bien khoa hoc: PGS.TS. NGUYEN TRONG LUU
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARIVIACY Vol 6 - N°6/2011 khde, nhu clu ehIm sdc sUe khde (CSSK) v l phuc hoi
chUe n i n g (PHCN) cua ngUdi t i n tat tai quan Hoing Mai, t i c g i l da nghien cUu, dUa ra mgt sd gili phip, thU nghiem xiy dUng "md hinh q u i n ly, CSSK v l PHCN eho ngudi t i n tat dUa v i o cdng ddng" n h i m tao dieu kien tdt nhl't de ngUdi t i n tat dugc hUdng elc djch vu CSSK qua do n i n g cao hieu q u i eua ehuong trinh PHCN
2. Ooi tugng va phUcrng phap nghien cdu
1. Ooi tugng nghien cUu: NgUdi t i n tat ed nhu c l u PHCN tU 18 tuoi trd len tai cle phUdng nghien eUu v l t u nguyen tham gia nghien cUu.
2. Phuang p h i p nghien eUu: Oieu tra c i t ngang (trudc v l sau ean thiep) ket hgp vdi nghien cUu can thiep (ed nhdm ehUng).
3. Oia diem nghien cUu: Trong 4/14 phUdng dugc chgn chu dich, lUa chgn n g l u nhien 2 phUdng ehUng v l 2 phudng can thiep. Mdi phudng chgn
n g l u nhien 126 ngUdi tan tat d i p Ung cle tieu clii doi tugng nghien cUu.
4. Thdi gian nghien eUu: 2 n i m 2010-2011 5. Thu thap thdng tin: Phieu phdng van di/ac thiet ke sin; ket q u i k h i m xlc dinh thUc trang sufc khde, khuyet tat theo mau hd so k h i m chUa benh.
6. Gili p h i p can thiep:
Thinh lap to djch vu q u i n ly, CSSK va PHCN cho ngUdi t i n tat dUa v i o cdng ddng.
Truyen thdng g i i o due sUc khde.
Lap so q u i n ly, CSSK v l PHCN eho cac doi tugng nghien cUu.
To chUe k h i m sUe khde djnh ky, kham chiJfa benh, PHCN eho ngUdi t i n tat tai tram y te phudng.
- d p cUu, k h i m chUa benh cho ngUdi tan tat tai n h i khi cd yeu c l u . Hudng d i n tap luyen PHCN tai n h i v l l l m dung cu PHCN.
3. Ket qua va ban luan
1. Su thay doi nguyen vgng cua ngudi t i n tat trong CSSK sau ean thiep Bang 1: Nguyen vong trong cham sdc suTc khde
Nguyen vgng trong ehIm sdc sUe khde
Ouac theo ddi v l khim sUe khde djnh ky tai tram Ouge theo ddi va khim sUc khde dinh ky tai PKOK quan Ouge theo ddi va khim sUc khde djnh ky tai BV t h i n h phd, trung uong
Ouge c h i m sdc tai n h i
ouge n h i n vien y te cung c i p thdng tin ve CSSK Ouge n h i n vien y te hudng dan each cham sdc mdt sd benh thdng thudng
SL
% SL
% SL
% SL
% SL
% SL
% SL
%
Nhdm ean thiep Trudc CT
(n=252) 76 30,1
44 17,5
114 45,2 36 14,2
132 52,4 89 35,3
SauCT (n=250) 152 60,8 25 10,0
72 28,8
114 45,6 224 89,6 209 83,6
Nhdm Trudt (r^252)
70 27,8
51 20,2
106 42,1 40 15,9
135 53,5 85 33,7
chdng Sau (n=250)
65 26,0
35 14,0 121 48,4 38 15,2
141 56,4 83 33,2
p va CSHQ
P,2<0,001 P24<0,001 CSHQ=101,6
P,2<0,001 P24<0,001 CSHQ=212,9
Pi2<0,001 P24<0,001 CSHQ=71,1
Pi2<0,001 P24<0,001 CSHQ=136,7
TAP CHi Y DUOC LAM S A N G 108 Tap 6-So 6/2011 Sau can thiep, 60,8% ngudi t i n tat cd nguyen vgng dugc theo ddi v l khim sUe khde djnh ky tai tram te phudng, 45,6% mudn dugc c h i m sdc tai n h i , 89,6% muon dugc nhin vien y te cung elp thdng tin ve CSSK v l 83,6% muon dugc hUdng dan elch chim sdc mdt so benh thdng thudng. Cle ty le nay t i n g ed y nghia thdng ke so vdi trudc can thiep v l cao han nhdm chUng (p<0,001).
2. SU thay doi nguyen vgng cua ngudi tan tat trong PHCN sau can thiep Bang 2: Nguyen vong trong PHCN Nguyen vgng trong phuc hoi
chUe ning ouac t i p luyen PHCN tai Tram
Ouge tap luyen PHCN tai PKOK quan
Ouge tap luyen PHCN tai BV TP,TU
Ouge tap luyen PHCN tai n h i Ouge n h i n vien y te cung elp thdng tin ve PHCN Ouge n h i n vien y te hudng dan tap luyen PHCN
SL
% SL
% SL
% SL
% SL
% SL
% SL
%
Nhdm can thiep Trudc CT
(n=252) 78 30,9
33 13,1
106 42,1 38 17,9
132 52,3 92 36,5
SauCT (n=250)
165 66,0 17 6,8 71 28,4
129 51,6 218 87,2 215 86,0
Nhdm ehUng Tnjdc
(n=252) 73 29,0
35 13,9 107 42,4 43 17,1
137 54,4 87 34,5
Sau (n=250)
64 25,6
40 16,0 110 44,0 54 21,6
140 56,0 93 37,2
pvaCSHQ Pi2<0,001 P24<0,001 CSHQ=113,2
Pi2<0,001 P24<0,001 CSHQ=66,5
Pi2<0,001 P24<0,001 CSHQ=135,6 Sau ean thiep, 66% ngUdi t i n tat mudn dUgc luyen tap PHCN tai tram y te phudng, 51,6% mudn dugc luyen tap PHCN tai n h i , 87,2% mudn nhin vien y te cung d p thdng tin ve PHCN v l 86% mudn nhin vien y te hudng dan tap luyen PHCN. Cac ty le n i y t i n g cd y nghTa thdng ke so vdi trUde can thiep v l cao hon nhdm chUng (p<0,001).
3. Ket q u i khim chUa benh cho ngUdi t i n tat cua 2 tram y te phudng ean thiep trong 18 t h i n g thUe hien md hinh
Bang 3: Ket qua kham chuTa benh tai tram y te phi/dng
STT 1 2 3 4
Ket q u i Tong sd lan khim ehUa benh Sd lan khim chUa benh tai tram y te phudng trung binh 1 t h i n g
Tan suat k h i m chUa benh trung binh 1 ngay eua 2 phudng
Tan suit kham chUa benh trung binh 1 ngiy cua 1 phudng
Nam 1279
NU 1427
Chung 2706 150,3
5
2,5
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 6 - N°6/2011
STT
B i n g 4: Ket quit kham chuTa benh tai nha Nam
Ket q u i Tong sd l l n khim chUa benh
Sd l l n k h i m chUa benh tai n h i trung binh 1 t h i n g
Tan suit khim chUa benh tai n h i trung binh 1 ngay cua 2 phUdng
T i n suit khim chUa benh tai nha trung binh 1 ngiy eua 1 phudng
116
12,6
0,42
0,21
Sau 18 t h i n g thUe hien md hinh, 2 tram y te phUdng da k h i m chUa benh cho 2706 lugt ngUdi tan tat (dat t i n suit 2,5 lugt/tram y te/ngly) v l cap eUu, kham ehUa benh tai nha cho 227 lugt (dat tan suat 0,21 l l n / t r a m y t e / n g l y ) .
4. SU thay doi ve hoat dgng the lUc ma ngUdi t i n tat d l thuc hien sau can thiep CSSK, PHCN Bing 5: Cac hoat dong the lUc thi/c h i e n
Cle hoat ddng the lUe
Llm viec n h i (ngi trg)
Lao ddng (trdng ely, lam vUdn)
Oibg
Tap the due
Khdng thUe hien/khdng lam SL
% SL
% SL
% SL
% SL
% SL
%
Nhdm can thiep Trudc CT
(n=252) 82 32,5
15 6 57 22,6
37 14,7
98 39,2
SauCT (n=250)
96 38,4
14 5,7 110 44,0 239 95,6
11 4,4
Nhdm chUng Trudc
(n=252) 83 32,9
9 3,6
67 26,5
32 12,7
106 42,1
Sau (n=250)
83 33,2
11 4,4 71 28,4
25 10 103 41,2
p v l CSHQ
P,2<0,001 P24<0,001 CSHQ=551,1
Pi2<0,001 P24<0,001 CSHQ=88,7 Sau can thiep, 95,6% ngUdi t i n tat cd hoat ddng tap the due, cao hon trUde ean thiep (14,7%) v l cao hdn nhdm ehUng (10%) (p<0,001). Chi cdn 4,4% khdng thUe hien/khdng l l m , giam so vdi trUde can thiep (39,2%!
v l nhdm ehiJTng (41,2%) (p<0,001).
TAP CHi Y DUOC LAM S A N G 108 Tap 6 - S o 6/2011
4. Ket l u a n
Sau g i n 2 n i m nghien cUu, thU nghiem m d hinh q u i n ly, CSSK v l PHCN, bang c l e bien p h i p ean thiep, 2 p h u d n g can thiep d l k h i m ehUa benh cho 2706 lugt ngudi t i n tat tai tram y te (2,5 lugt/tram y te/ngay) va 227 lUgt cap cUu, k h i m ehUa benh tai nha (0,21 lugt/tram y t e / n g l y ) .
Sau can thiep, nguyen vgng CSSK v l PHCN cua ngUdi t i n tat ed sU thay doi rd ret. Ty le m u d n dugc theo ddi v l k h i m sUe khde dinh ky tai tram p h u d n g v l m u d n dugc cham sdc tai n h i tang lan lugt tU 3 0 , 1 % va 14,2% trUde ean thiep len 60,8% v l 45,6% sau can thiep (p<0,001); m u d n dUgc cung cap t h d n g tin CSSK tU 52,3% len 89,6% (p<0,001) v l 35,3% m u d n dugc hUdng dan e l c h cham sdc m g t sd benh t h d n g t h u d n g len 83,6% (p<0,001). Ooi vdi PHCN, ngUdi t i n tat m u d n dugc luyen tap PHCN tai tram y te p h u d n g v l tai n h i cao han l l n lugt I I 66%
v l 51,6% so vdi 30,9% v l 17,9% (p<0,001); 87,2%
m u d n n h i n vien y te cung e l p t h d n g tin ve PHCN so vdi 52,3% (p<0,001) v l 86% m u d n n h i n vien y te h u d n g dan tap luyen PHCN so vdi 36,5% (p<0,001).
Ty le ngUdi t i n tat cd hoat d g n g tap the due t i n g len 95,6%, cao hon (14,7%) (p<0,001); ty le ngUdi khdng hoat d g n g the lUe g i i m edn 4,4% so vdi 41,2%
(p<0,001).
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