VIETNAM MEDICAL JOURNAL N°2 - OCTOBER - 2017 68%). Tha hda trong hanh vi tac phong (71,57%
xuong cdn 39,22%). Hanh vi ky quai trong the gidi tu-ky 22,55% xuong cdn 12,57%).
- biem thang P ANSS.Oiem tdng sd thang PANSS qua khao sat (202,4 ± 42,6 xuong cdn 123,2 ± 25,7). Diem so nhdm trieu chifng am tinh (29,5 ± 7,2 xuong cdn 19,4 ± 4,5) TAI LIEU THAM KHAO
1. Ellingrod VL, Lund BC, Miller D et. al (2005).
"5-liT2A receptor promoter polymorphism, - 1438G/A and negative symptom response to olanzapine in schizophrenia. Psychopharmacol Bull. Spring; 37(2):109-112.
2. Kaplan H. I. , Sadock B. J. , Grebb J. A. , (1994).''Synopsis of psychiatry'. Seventh edition.
Williams and Wilkins. p: 470- 485.
3. Ruhrmann S, Kissling W, Lesch OM (20071
"Efficacy of flupentixol and risperidone m dironic schizophrenia with predominantly negatL symptoms". Prog Neuropsychopharmacol Bini Psychiatry. Jun 30;31{5): 1012-1022. Epub Mar 1 4. Sadock B.J., Sadock V.A. (2007). "Kaplan and
Sadoek's Synopsis of psychitry". TenSi edition William and Wilkins. p: 468- 497.
5. Stefan M., Travis M., Mun^y R. M. (2002), 'f^
atlas of schizophrenia". The parthenon Publishinq group. Washington DC. Chapter 1. Oinical features D. Stephen M. Stahl (2008). "Stahi's e^enSal
psychopharmacology". Third edition. Cambridge university press, p: 97-188.
/ . Zhao ] , He X, Liu Z, Yang D. (2006). "The effects of clozapine on cognitive function and regional cerebral blood Pow in the negative symptom profile schizophrenia". Int J Psychiatrv
Med. 36(2):171-181. *
THU'C TRANG THU'C HIEN BO TIEU CHI QUOC GIA VE Y TE XA TAI TINH H A GIANG NAM 2 0 1 6
T 6 M TAT
M^c tieu: Danh gia ket qua thiTc hien Bp Tieu chf Quoc gia ve y te xa tai tinh Ha Giang, nam 2016.
Phu'tfng phap nghien eifu: Mo ta cat ngang tai 193 Kit qua thiTc hien Bp Tieu chi Quoc gia ve y te xa tai 195 Tram V te xa, phu'dng, thi tran cua 11 huyen, thanh pho tren dja ban tinh Ha Giang. Ket qua: cho thay cdng Isc chi dao dieu hanh cong tac cham sdc su'c Wioe (CSSK) nhin dan la tot dat 82,6%. Mot sd tiSu chi chu^ dat du'dc nhU: tieu chi 2 danh gia ve ngudn nhan lu'c y te sd xa dat diem tdi da tieu clii 2 la 20,5%. Van de ve sinh moi tru'dng da so la chu'a dat (tieu chi 6). Cong tac Cham soc siTc khoe ba me - tre em con chu'a tot (tieu chi 8), Ket luan va khuyen nghj: CSn co sU qu^an tam hOn niTa tiT UBND xa va lanh dao cac cap de nang cao chat lu'dng tram y te nham tiiu'c hien cong tac cham soc siTc khoe nhan dan du'pctothOn.
TO'khda: Ha Giang; Bp teu chi Quoc gia ve y te >^.
SUMMARY
REALITY OF IMPLEMENTING THE NATIONAL STANDARD OF COMMUNITY HEALTH I N HA GIANG PROVINCE I N 2016
Objectives: To evaluate the results of implementing the national standard in Ha Giang in 2016. Methods of study: a eross-sectional descriptive study at 195 community health stations (CHS) of 11 districts and cities in Ha Giang province.
^Sd Yte Ha Giang
^Tn/dng Dai hoc Y Dddc, Dai hoc Thai Nguyen Chju trach nhiem chinh: Do Thi My Email: [email protected] Ngay nhan bai: 25.8,2017 Ngay phan bien khoa hoc: 9.10.2017 Ngay duyet b^l: 16.10.2017
D6 Thi M y \ Nguyen Thi To Uyen^
Results: Most of communities have good health care management (82,6%). Some critenas do not meet requirement such as: standard 2 on human resource (20,5%). Environmental sanitation issues are not good (standard 6). Maternal and Child Health Care remains poor (standard 8). Therefore, more attention should be paid from the Commune People's Committee and the leaders at all levels l» improve the quality of the health station in order to better serve the people's health care.
I. OJC^T VAN OE
Tram Y te cd vai trd quan trpng trong thut hien cdng tac phdng benh gop phan han ehe^
le mac benh va ngan ngifa djch benh trong cong dong [2]. Tram Y te la tuyen y te gan dan nhat, cd chiTe nang cung cap, thifc hien cac djch yu cham sdc siTc khde ban dau cho nhan dan nen ddng vai trd het sifc quan trpng trong viec tjep can djch vu y te, gan chat vdi viec kham diiJ^
benh cho nhan dan d viing dieu kien kinh te )a hpi cd khd khan, ty le ngu'di ngheo cao, khoang each den benh vien tuyen tinh, trung u'dng xa, bao dam cho mpi ngu'di dan du'dc cham sdc sut khde cd ban vdi chi phf thap, gdp phan thifc h[en cdng bang xa hpi, xda ddi giam ngheo, tao niem tin CLia nhan dan vdi che dd xa hpi chii nghia [1], [5]. Ha Giang la mot tinh khd khan, eo 6/11 huyen thudc huyen ngheo, toan tinh cd 195 Tram Y te xa, phu'dng, thi tran. He thong Tram Y te nay da va dang du'dc cimg co de dat hieu qua hoat ddng cao trong cham sdc va bao ve silt khde nhan dan. Trong qua trinh thiTc hien Bo tieu chf Quoc gia ve y te xa tai Ha Giang con nhieu khd khan va vu'dng mac i:3]. Chfnh vi vay
90
TAP CHi Y HOC VIET HAM TAP 459 - THANG 10 - SO 2 - 2017 I chiing tdi nghien eifu de tai "Thifc trang thdc
hien Bo tieu chi Quoc gia ve y te xa tai tinh Ha
! Giang nam 2016"v&\ muc tieu: Oanh gia ket qua 1 thu'c hien Bo Tieu chi Qudc gia ve y te xa tai tinh I Ha Giang, nam 2016.
I H.roiTU'plSIGVAPHU'aNG PHAP NGHIEN COXJ 2.1. Bdi tu'dng nghien cii'u: 195 Tram Y te xa, phu'dng, thj tran ciia 11 huyen, thanh pho
! tren dja ban tinh Ha Giang.
2.2. Dia diem vi thdi gian nghien cii'u:
' TiT thang 06/2016 den thang 05/2017, tai 195 xa
eua tinh Ha Giang.
2.3. Phu'dng phap nghien cuV 2.3.1. Thiet kenghiin c&u: Mo ta cat ngang.
2.3.2. Cd mau va each chon: Toan bp 195 P i T xa, phudng, thi tran tren dia ban tinh Ha Giang.
2.3.3. Phudng phap thu thap so lieu: Cham diem cua tifng xa theo mau phieu bang kiem danh gia thu'c trang thifc hien Bd Tieu chi qudc gia ve y t e x a .
2.2.4. Phddng phap xiy ly so lieu: So lieu du'dc nhap va phan tfch theo phan mem SPSS 20.0.
III. KET QUA NGHIEN CLTU VA BAN LUAN
Bang 1. Ket qui thUc Men tieu chi 1: Chi dao dieu hinh cong tic CSSKND 1 . Ban chi dao CSSK nhan darT"
TL ( % )
So xa cd ban ehi dao CSSK nhan dan
So xa cd quy che lam viec, ed ke hoach hoat ddng hang nam, hop dinh
ky 6 thang/1 lan hogc dot xuat, cd bien ban cac cupc hpp. 95,9 2. Ke hoach va trien khai thifc hien cong tac CSSKND
So xa eo nghi quyet cua Dang uy, HDI^ID ve cong tac ve trien khai eac
ehifcJng trinh muc tieu y te quoc gia, 92,3
So xa dat diem toi da tieu chi 1
161 82,6So x§ khong dat diem tdi da tieu chi 1 I 34 I 17,4 100% so xa co^Ban chi dao CSSK nhan dan, trong do eo 180 xa co nghi quyet cua Dang uy, H£)ND ve cdng tae ve trien khai cac ehifOnq trinh muc tieu y te quoc gia (92,3%).
Bang 2. Ket qua thu'c Men tieu chi 2 ve nhin lu'c y te
SL T L ( % ) 1 . Bi§n che va cd cau can bo
Sd xa cd dii sd ngu'di lam viec theo de an vj tri viec lam ciia TVT.
So xa cd cd dii chife danh nghe nghiep tai TYT theo quy djnh.
Sdxa cd can bd du'dc dao tao va dao tao lien tuc, tap huan chuyen mdn theo quy dinh.
81,5 2. Co bac sT lam viec thu'dng xuyen tai TYT
Sd xa ed bac sT lam viec thu'dng xuyen tai 'TYT.
Sd xa cd bac sT lam viec tai TVT toi thieu 2 buol/tuan theo Ijch du'dc thdng bao tru'dc Sd xa khdng cd bac sT lam viec.
3. Y t e thon ban
So xa ed tdi thieu 1 NVYTTB hoat ddng/mdi thdn, ban
So xa cd NVYTTB, cd dd thon ban du'dc dao tao theo chudng trinh do BYT quy djnh.
So xa dat diem toi da tieu chi 2 4 0 20,5
So xa khong dat diem tdi da tieu chi 2
Ve nhan ILTC 183 sd xa cd dii sd ngu'di lam vlee theo de an vj t d viee lam eiia TYT (ty le 93,8). Sd xa cd bac sT lam viec thu'dng xuyen tai TYT 136/195 xa dat 69,7%. Sd xa dat diem tdi da Tieu chi 2 thap chi cd 40/195 xa dat ty le 20,5%, da sd eac xa chu'a dat diem tdi da (155/195 xa - 79,5%), hien nay benh vien va Trung tam Y te tuyen huyen van cdn ttiieu bac sy nen ehi cd 20% sd xa' du'dc bac sy ho trd khdm, chD'a benh 2 buoi/tuan, chi cd 68,2% sd thdn ed NVYTTB ed tieu ehuan, chiTc nang, nhiem vu theo quy djnh hien hanh do nhat the hda chifc danh can bd xa, gan mot niTa y te thdn ban chu^ du'dc dao tao theo quy djnh ciia Bd Y te. So vdi nghien eifu ciia Tran Quang Khanh (2015) [4], ve thu'c hien Bd Tieu chi Qudc gia ve y te xa tai tinh Hda Binh, sd xa dam bao sd lu'dng can bd y te/tram theo quy dinh dat 80,5% thi nghien ciru cua chimg tdi cho ket qua cao hdn.
Bing 3. Kit qua thu'c tieu chi 4: Trang thiet bi, thudc vi phddng tien khac Chi so
1 . Trang thiet bj TYT xa
SL TL C/o)
Sd TYT xa CO day du cac trang thiet bj ran thiet de thu'c hien tot cac chu'c nang nhiem 26,2
VIETNAM MEOICAL JOURNAL N°2 - OCTOBER-2017
chi so
vu difcJc qiao, can bo V te CO kha nanq sii dunq cac tranq thiet bi v te du'dc cap.
So VfT xa CO day du cac tranq thiet bi can tliiet.
2. Thuoc chu'a benh
SoTYTxa co dii thuoc chu^a benh, thuoc chonq soc va thuoc cap cuU thonq thu&nq.
So TYT xa CO khoang 70% ioai thuoc trong danh muc thuoc thiet yeu theo quy dinh cua Bo Y te.
So TYT xa CO quan iv thuoc theo dunq quy dinh Bo Y te.
So TYT xa SLT dunq thuoc an toan hdp iy.
3. Vat tn, hoa chat tai TYT xa
So TYT xa cd du va kjp thdi vat tu' tieu hao, hoa chat phuc vu kham chu'a benh, phonq chonq dich.
So xa dat diem toi da tieu chi 4 So xa Ichonq dat di€m toi da tieu chi 4
SL
104 92 - 96 139 187 163 22 173
JkiS
_ J I , 3 _ _ f i 2 _ 49,2 71,3 95,9 83,6 11,3 88,7 Oa so cac Tram Y te xa thi/c hien tot viec sCf dung thuoc an toan hdp iy (95,9%) co du va iqp ttidi vatb/
tieu hao, hoa chat phuc vu kh^m chu^ benh, phong chong djch (83,6%). Tuy nhien ty ie chi co hdn mot nu5 TYT xa CO day du cac trang thiet bi ran thiet de thu'c hien tot cac chLTc nang nhiem vu (53,3%).
Bang 4. Ket qua thu'c hien tieu chi 6; YTDP, VSMT, cac chu'dng trinh MTQG ve v te Chi 50
1 . Phong chong dich va cac CTMTQG trong ilnh vu'c y t e
So TYT xa trien khai thu'c hien tot cac bien phap phong, chong djch benh, bao cac kip thdi cac dich benh truyen nhiem theo quy dinh ciia Bo Y te So TYT xa thuc hien dat > 90% cac chi tieu du'dc qiao ve y te dU phong.
2. Nu'dc sinh hoat hdp ve sinh (HVS)
So xa CO ty ie HGD trong xa, phirdng, thi tran su' dung nu'dc sinh hoat HVS dat yeu cau
3. Nha t i i u hdp ve sinh
Ty ie HGO trong xa su'dung nha tieu HVS dat yeu cau.
4. Ve sinh an toan thu'c pham
So xa CO ke hoach va trien khai thi/c hien thanh kiem tra dinh ky, dot xuat cac cd sd san xuat, kinh doanh dich vu an uong va kinh doanii thirc an du'dng pho tren dia ban quan \<f.
So xa dat diem toi da tieu chi 6 So xa l<hdng dat di€m tSi da tiSu chi 6
SL
189 70 136 66
190 17 178
TL'A
96,9 35,9 69,7 33,8
97,4 8,7 91,3
£)a so cac xa trien khai tot cac bien phap phong chong djch benh (96,9%) va ve sinh an toan thi/c pham (>90%). Tuy nhien chi co 69,7%, so xa co ty le ho gia dinh sir dung nu'dc sinh hoat hdp ve sinh dat yeu cau, so xa co ho su' dung nha tieu hdp ve sinh chi dat ty le 33,8%.
Bangs. Ket aua chuna v'S thi/c hien 10 tieu chi ciia cac TYT xa Unh Ha Giang (n=195) TT
1 2 3 4 5 6 7 8 9 10
Ndi dung
Tieu chi 1 Tieu chi 2 Tieu chi 3 Tieu chf 4 Tieu chi 5 Tieu chi 6 Tieu chi 7 Tieu chi 8 Tieu chi 9 Tieu chi 10 Tong diem 10 TC
Oiem chuan 3 10 11 9 10 17 14 13 9 4
> 8 0
So xa dat toi da diem chuan SL 161 40 131 22 108
17 29 11 41 137 169
TL°/o 82,6 20,5 67,2 11,3 55,4 8,7 14,9
5,6 21,0 70,3 86,7
So xa chu'a dat toi da diem chuan SL 34 155 64 173
87 178 166 184 154 58 26
TL»/o 17,4 79,5 32,8 88,7 44,6 91,3 _ _ 8 5 J _
94,4 79,0 29j7__
13,3
TAP CHi V HOC VlgT NAM TAP 459 • THANG 10 - s 6 2 - 2017 Oa SO cac xa deu thifc hien tot cdng tac chi
dao dieu hanh cdng tac CSSK nhan dan (TCI:
82,6%). Hoat ddng Cham sdc sifc khde ba me - tre em da sd cac xa chu^ thy'c hien tot, chi cd 5,6% sd xa dat diem tdi da (TC 8).
Ve cdng t^c thifc hien ehi dao CSSK nhan dan: 100% so xa cd Ban chi dao CSSK nhan dan, trong dd cd 180 xa cd nghi quyet ciia Dang uy, HDND ve cdng t i c ve trien khai cac chu'dng trinh muc tieu y te qudc gia dat ty le 92,3%, Phan Idn cac xa 6a dda viec duy tri Bd tieu chi vao Nghj quyet cua Oang uy va ke hoach phat trien kinh te xa hdi cua xa; Ban cham sdc SKND xay ddng ke hoach hoat ddng hang thang va to chifc hop djnh ky va dot xuat de chi dao duy tri thifc hien Bd tieu chf, tuy nhien sif phoi hpp eiia cac cd quan, ban, nganh doan tlie vdi nganh Y te trong viec trien khai cac hoat dong cham sdc khde cho niian dan chda dddc thu'dng xuyen, lien tue. Ket qua nghien CLTU cua chimg tdi phii hdp nghien cii'u cua Tran Quang Khanh (2015) [4].
Hoat ddng ve moi tru'dng cung chu^ tot do gap nhieu trd ngai vdi dac thii ciia cae huyen viJng cao nguyen da thieu nu'dc, da sd la cac hp ngheo, ciing vdi phong tuc tap quan lac hau nen ty le hd gia dinh sif dung nha tieu hdp ve sinh, nu'dc sinh hoat hdp ve sinh dat rat thap (33,8%) ttiap hdn nhieu so vdi tinh Hda Binh (54,79%) [4]. Do vay, can cd sif quan tam hdn nu^ tif UBND xa va lanh dao cac cap de nang cao chat luUng tram y te nham thifc hien cdng tac cham sdc su'c khde nhan dan du'dc tot hdn.
Ket qua djnh tinh: Phdng van sau Ong D, Lanh dao Sd Y te... "Tinh Ha Giang da gan viec thifc hien BTCQGVYT xa vdi Chu'dng trinh xay difng Ndng thdn mdi do dd huy dong sif vao cupc ciia ehi'nh quyen tif tinh den xa, coi viec thu'c hien BTCQGVYT la trach nhiem cua chffih quyen va cae ban nganh, khdng phd thac cho rieng nganh y te, ket hdp ngudn ho trd tif Chu'dng trinh xay difng Ndng thdn mdi ho trd ngu'di dan xay difng nha tieu hdp ve sinh, xay be ChiTa nu'dc... khSc phuc tieu chi khd dat nhat la ve sinh mdi bxfdng, dong thcfi huy ddng du'dc cac ban nganh doan the trong thy'c hien chu'dng trinh dan so- ke hoach hda gia dinh, cai thien tinh trang suy dinh duQng. Ve nhan ly'c, tinh Ha Giang da cd chi'nh sach dao tao bac^sy theo dia chi va bac sT chuyen tu tifng bu'dc khac phuc tinh trang thieu bac sT..."
IV. KET LUAN VA KHUYEN NGHj
- Chi dao va dieu hanh cdng tac cham sdc sifc khde nhan dan (dat 100%).
- Cdng tac truyen thdng giao due sifc khde (dat 70,3%).
- Sd xa cd bac sT lam viec thu'dng xuyen tai TYT 136/195 xa dat 69,7%.
- Cd sd ha tang TYT xa dat 67,2%.
Nhij'ng npi dung da sd cac chu^ dat du'dc theo BpTieu chi
- Cdng tac Cham sdc sifc khde ba me - tre em da sd eac xa chu'a thu'c hien tot, ehi ed 5,6% sd xa dat diem tdi da.
- Hoat ddng y te dy' phdng, ve sinh mdi tru'dng, cae chu'dng trinh MTQG ve y te sd xa dat diem toi da la 8,7%.
- Trang thiet bj, thudc va phu'dng tien khac (11,3 sd xa dat diem tdi da).
- Cong tae Kham, chD'a benh, PHCN va YHCT cd 14,9% sd xa dat diem tdi da.
- Tang cu'dng eac nguon life dau tu' cho y te xa de nang cao chat lu'dng va hieu qua hoat ddng ciia tram, dac biet dam bao cd cau can bd hdp ly theo chifc danh nghe nghiep, dii NVYTTB tai cae thdn, ban. Thu'dng xuyen dao tao nang cao, dao tao lai, bo sung day dii trang thiet bi y te phii hop vdi nhu cau hoat ddng cua TYT xa de nang cao chat lu'dng chuyen mdn.
- Can tang cu'dng hoat ddng ciia Ban chi dao CSSK nhan dan cac cap nham day manh cdng tac xa hdi hda y te, huy ddng tdi da su" tham gia eiia eac ban, nganh, doan the va sif iing hd tfch cu'c CLia cdng dong vao viec trien khai xay dytig va duy tri ket qua thy'c hien Bo TCQGVYTX, nham thy'c hien cdng tac cham sdc sifc khde nhan dan du'dc tot hdn.
TAI Ll|U T H A M KHAO
1. Ban Chap hanh Trung u'tfng Dang cong san Viet Nam (2002), ''^Cung cova hoan thien mang idii y te cd sd", Chi thi sd 06 - CT/TW, ngay 22 thang 01 nam 2002, Ha Noi.
2. Bo Y te (2010), "530 cao tong ket eong tacy te nam 2014, mot sd nhiem vu va giai phap trong tam nam 2015, giai doan 2016-2020'.
3. Sd Y te tinh Ha Giang (2017)^ "Bao cao kit qua thdc hien Bo diu chi quoc gia ve y texa nSm 2016 va phddng hddng then khai thdc hien nam 2017 tinh Ha Giang" Bao cao sd 08/BC-SYT ngay 04 thang 01 nam 2017.
4. Tran <^uang Khanh (2015), "'Thdc trang thdc hien Bo Tieu chi Quae gia ve te xa tai tinh Hoa Binh" Luan van chuyen khoa I I chuyen nganh Y te cong cdng. Thai Nguyen, nam 2015.
5. Thii tu'dng Chinh phu (2011), "Quy dinh veyte xa, phddng, thi tran", Nghi dinh so 117/2014/ND- TTg, ngay 08/12/2014.
