Phu-ong Y TUYEN Ca THIEN LITCTNG

Y HOC VIET NAM THANG 6 - SO 1/2014 t lang 5. Yeu to thuan Idi xuat hien benh may

Cac yeu to thuan \d\

Khong Co

Khi thay doi thdi tiet Khi ap da lanh An tom cua Khi bi nong Tiep xuc bui nha Uong bia ru'du Con trung dot Cac nquyen nhan khac Khonq co nquyen nhan

day (n= 135) n 47 88 82 24 40 19 12 13 10 36 45

o/o 38,4 61,6 60,7 17,8 29,6 14,1 8,9 9,6 7,4 26,6 34,8

Tmng so co yeu to Hen quan thi yeu to thay dol thdi tiet co ty le cao nhat (60,7%). khong thay yeu ft lien quan chiem 38,4%.

IV. KET LUAN

Qua nghien culi 135 benh nhan may day man tinh den kham va dieu trj tai Benh vien Quan y 103. Chung toi rut ra mot so ket luan ve dac diem lam sang, yeu to lien quan benh may day man tinh nhu" sau:

- Benh hay gap nhat d tuoi lao dong, trong do tuoi ttr 20 - 49 chiem 6 6 . 6 % . Ty le benh gSp d ca hai gicfi b^ng nhau. Tien sCr ban than co 9 4 , 1 % benh nhan mac cac benh dj ling. Benh xuat hien quanh nam, tuy nhien miia xuan - ha zb so benh nhan mac benh nhieu hcfn ( 3 0 , 4 % va 3 7 % ) . Da so benh nhan co tuoi benh dirdi 1 nam: 6 9 , 6 % , CO 1 1 , 1 % benh nhan co tuoi benh tren 5 nam.

I^LTC do benh chu yeu d mii'c do nang chiem 65,9%, vi/S 31,9% va nhe 2 , 2 % .

- Co 14 yeu to thuan ldi lam khdi phat benh may day man tinh. Trong do, thay doi thdi tiet chiem ty le cao nhat: 6 0 , 7 % va co tdi 3 4 , 8 % khong tim ra yeu to lien quan.

TAI L l | U T H A M K H A O

1 . Nguyen Nang An (2003), "May day va phu Quincke", Bach khoa thu" vien hpc tap 3, Nha xuat ban tiy dien bach khoa Ha Ngi, trang 266-269. "

2. Bo mdn da lieu Tru'dng d^j hpc y Ha Noi (1994), "May day va phu mach", Benh da lieii, Nha xuat ban y hgc, trang 81-85.

3. Bo mon Da U e u Hpc vien Quan y (2001), "May day va phu mach", Giao trinh benh da va hoa iieu dao tao sau dai hoc, Nha xuat ban quan doi niian dan, trang 225-229.

4. Bo m d n Dj u'ng-Tru'dng dai hoc y Ha N ^ (2008), "^May day va phu Quincke ", Bai giang "

liYig - mien djch lam sang ( Sach danh cho bac va hpc vien sau dai hoc), Nha xuat ban y ' trang: 55-70.

5. Dang Tran Huyen Thu'dng (2009), Nghien ciili tinh hinh, dac diem lam sang va anh hu'dng oJa benh may day man tmh den chat lu'dng cuoc song cua ngu'di benh, Luan van thac syy hoc, trangl?

6. Hoang Hffu Hao(2007)," Nghien diw tac dung cua que chi thang gia v| trong dieu trj may day ifi utig man ti'nh do bui nha', Luan an tien sT y hp^

Oai hgc y Ha Noi.

/ . Asero R..,ribbldi P,.et al (2007), " Chronic urticaria" A diseasea at a reviews 7, pp 71-76.

DANH GIA CHAT LITCTNG KHAM CHU'A BENH C O A B A C SI GIA DINH

a Y TE TUYEN C a SO* TAI DAC LAC v A THCTA THIEN - HUE N A M 2 0 1 1

Nguyen Phu-ong Hoa*, Nguyen Thi Tuyet Nhung*

Danh gia chat lu'dng kham chu'a benh aia bac sT g | dinh tCr phfa benh nhan, d mgt so cd sd y te tuySn)§

va huyen tai t'nh Dac Lic va Thifa Thien-Hue, ^m 2011. Phu'dng phap: mo ta cat ngang. Thu tfiSp thong tin bang phu'dng phap phong van benh nhSn.

Ket qua: Ty le benh nhan dUdc BSGD giai thich ti mi T O M TAT

Hien nay, hoat dgng cua mang lu'di y te cd sd dang gap nhieu kho khan va thach thu'c. Muc Beu;

* Tnfdng Dai hqc YHa Noi

Phan bien khoa hgc: PGS.TS Pham Thj Lan

Y HQC VlgT NAM THAHG 6 - s6 1/2014 ve benh mSc phai dat 65,2%, cao hdn d d nhom du'dc

BSDK kham benh (41,7%; p<0,001). 75,3% benh nhan du'dc BSGD hudng dan chi tiet phUdng phap dieu tri (nhom benh nhan cua BSDK la 36,6%; p<0,001).

87,6% cac benh nhan danh gia BSGD co thai do tot va 64% benh nhan danh gia BSGD cd trinh do diuyen mon ^ Ket luan: Ket qua nghien cuU nay da cho thay mpt so khia canh lien quan den chat lu'dng KCB cua BSGD du'dc ngu'di benh danh gia cao hdn BSDK.

Day la bang chutig quan trpng khang dinh viec phat tri^n mang lu'di BSGD se giiip cai thien chat lu'dng ciia cac tuyen y te cd sd.

Tui khda: bac sT gia dinh, cham soc siic khoe, y te cdsd

S U M M A R Y

ASSESS THE Q U A L I T Y OF HEALTH CARE OF FAMILY DOCTORS AT GRASSROOT

LEVEL I N DAK LAK A N D THUA T H I E N HUE PROVINCES Currently, the activities of the primary health care networit are difficult and challenging. Objective: To assess the quality of health care of family doctors from patient's perspective In communal and district health facilities In Dak Lak and Thua Thien Hue provinces in 2011. Method: A descriptive cross-sectional study.

Data was collected by interviewing patients. Results:

65.2% patients received detailed explanation about the disease by family doctors, higher than that among group of other doctors (41.7%, p<0.001). 75.3%

patients got detailed guide d-eabnents from family doctors (this rate among group of other doctors was 36.6%, p<0,001). 87.6% patients assessed that family doctors had good attitude and 64% family doctors were evaluated well qualified. Conclusions: this study showed that a number of aspects related to quality of health care among femily doctors higher than among other doctors. The findings provided further evidences of development family doctor network. It will help to Improve the quality of health service facilities In grassnut level.

Keywords: family doctors, health care, grassroot level.

LDATVXNOI

s y phat trien manh me cua nen kinh te cung nhu* sy chuyen doi mo hinh benh tat tren toan cSu da d§n den sir thay doi ve nhu cau cham soc sire khde cua c$ng dong. Viec chSm sdc cac benh man tfnh nhu": dai th^o du'dng, tSng huyet ap, benh phoi t5c nghen man tfnh (COPD), hen phe quan,.., da chuyen tir phonp b^nh npi tru ra phdng kh^m ngoai tru vdl cac ph^c do dieu trj duidc xSy di/ng (ihSm phSn cap cac giai doan dieu tr| vdl su* ph6i hdp cua cac chuyen khoa lien quan. Trong' boi cSnh do, su" ra ddi cua cac

chu'dng trinh cham soc site khoe ban dau va chuyen nganh Y hpc gia dinh (YHGD) trong nhutig nam 1960 la mpt dap utig kjp thdi ciia he thong y te doi vdi s i / thay doi nhu a u cham soc su'c khoe ciia ngu'di dan tren the gidi [ 6 ] .

Hien nay, tai Viet Nam phat trien mo hinh bac sT gia dinh 6iidc ky vpng la mot giai phap quan trpng de nang cao chat lu'dng djch vu y te d tuyen cd sd va giam tai cho cac benh vien tuyen tren. Viec dao tao bac si chuyen klioa I Y hpc gia dinh (BSGD) da du'dc trien khai tai mpt so tru'dng dai hpc y trong ca nu'dc [ 1 ] , Chung tdi tien hanh nghien ciTu nay vd^ muc tieu: Danh gia chat lu'dng kham chO^ benh cua bac si gia dinh tit phia benh nhin, d mot socdsdy t i tuyen xa va huyen tai tinh Dac iJc va Thu^ Thien-Hue, nMm 2011.

II. DOI TU'ONG VA PHUONG P H A P NGHIEN COU 2 . 1 . D j a d i e m n g h i d n CIJTU

Dieu tra du'dc tien hanh tai 2 tinh Oac LSC va ThCm Thien-Hue, 2 tinh nay thupc khu vu'c mien trung ciia Viet Nam.

Tai mSi tinh se chon 2 Benh vien qu$n/huy§n va 4 Tram y te xa/ phu'dng tai 2 quan/huy$n tu'dng utig va 01 phong kham BSGO cong va 01 phong kham BSGO tu' nhan (neu co). Phong van cac b i n h nhan den kham chG& b?nh tai c i c phong kham d moi tuyen, tong se cd 8 phong kham/ tinh.

T^i D^c LSC: thu thap so II^u tai thanh pho Buon Ma TTiupt va huyen Cu' M'gar.

Tpi Ttiita TtiiSn-Hue: thu thap so li^u t^l thanh pho Hue va thj xa Hu'dng Tliiiy.

2.2. Ooi t u ' d n g n g h i d n c u t i

Tat ca cac lienh nhan den kham chiiS b?nh tai cac cd sd y te tuyen quan/huyen va xa/phu'dng trong thdi gian thu thap so lieu dude lUa chpn vao mau nghien CLIIJ.

Tai moi cd sd kham benh tien hanh phdng van 30 benh nhan. Tong cpng cd 2 tinh phdng van du'dc 422 benh nhan.

2.3. T h i e t ke n g h i d n c i ^ u : Nghien ciTu md ta c3t ngang

2.4. T h u t h a p so i i $ u :

Phong van doi tu'dng nghien cu'u bSng bp cau hdi thiet ke s i n . Bp cau hoi thiet ke sSn bao gom 15 cau hdi, trong dd 4 cau dau la thdng tin hanh chinh, va 11 cau hdi cdn Ial lien quan den npi dung nghien cuU. hiau het c i c cau hoi du'dc thiet ke du'cR dang cau hdi Cd/Khong hoSc cau

67

Y HOC VIET NAM THANG 6 - SO 1Q014 hoi nhieu lifa chpn, nham tao thuan tien cho dieu

tra vien va doi tu'dng. Mpt so cau hoi co phu'dng an "khac", doi tu'dng se neu ro phu'dng an tra Idi cua minh.

Thcri gian t h u t h a p so lieu t a i thu'c d i a : thang 5 - 1 2 / 2 0 1 1 .

2 . 5 . Phan tich so liSu:

Nghien etfu siJ dung phan mem Stata 12.0 de phan tich sp iieu. Test Khi binh phu'dng (x _) duBC sil dung nham sp sanh s i / khac biet giuei cac nhom. Nghien culj sit dung mi^c y nghTa a = 0,05.

111. KET QUA NGHIEN CO'U

Oieu tra da phpng van du'dc 422 benh nhan di kham chifa benh tai mpt so c d sd y te huyen va tram y te xa thuoc 2 tinh Dac Lac va Thija Thien Hue.

3 . 1 . e ^ c d i e m cua dol tu'dng nghien c i h i

Tfnh Chung ca hai tinh Dac l i e va ThDS Tliien Hue co 56,4% benh nhan duSC phpng van tai cac TYT x l / phu'dng; 28,9% benh nhan tai PK BV quan/ huySn va 14,2% benh nhan tai cac PK BSGO.

Bing 1. Phan bp benh nhan den kham theo chuyen khoa bac

Bic si

BSGO BSOK

S a c L i c n

1 180

0,6

%

99,4

Jhita t h i e n - H u e n

88

153

36,5

%

63,5

si

TSng n 89

333

21,1

%

78,9 Tnxig so 422 bvdng hdp benh nhan phong van dude cd 89 benh nhan (21,1%) didc kham bdi bac s chuyinkhoal Y hoc g'la dinh (BSGD), ty IS benh nhan trong nlidm nghien cU dWdc khim bdi BSGD chi yeu li dHuechiSn 36,5%. So binh nhin ituoc bic si da khoa (BSDK) khim chia binh chiem 78,9%.

3 . 2 . Ly do chpn I c h i m t a i c d sd y t e

Bing 2. Ly do benh nhan l u ^ chgn cd sd y te di kham chu'a benh L ^ d o

Gan nha Bao hiem v te Trinh do bac si

Chuyen tuyen

PK BSGO n 12 11 33 5

20,0

%

18,3 55,0 8,3

CSYT k h i c n

230 150 15 37

»/o 63,5 41,4

4,1

10,2

P

<0,001

<0,001

<0,001

>0,05 Bing 2 cho t h i y t i le benh nhan l u ^ chpn den kham tai cac PK BSGO vi chuyen mon t o t cap hdn co y nghTa thong ke sp vdi cac CSVT khac. Ngu'dc l?l, d cac CSYT khac ty le lua chpn vi gan nha, t h u i n Men dl Ial h o i c do cp the bap hiem y te 1^1 cap hdn cp y nghTa thpng ke so vdl PK BSGO (p<0,05).

3 . 3 . B^nh n h i n d i n h g i i t h i i do ciJa b i c sT t r o n g q u i t r i n h t i e p xuc Biiu da 1. Thai dp ciJa b i c sT trpng qua trinh kham chua benh

-rNAMTHANG6'S6l/2014

Kit qua nghiin ahi cho thay ty li benh nhin dinh gii dc BSGD cd thai do tot cao hdn so vdi d nhdm BSDK (87,6% so vdi 53,5%; p<0,001).

3 . 4 . B i c sT g i a i t h i c h v e b f n h t a t c h o b e n h n h a n Bleu dio 2. Bac sT giai thich ve benh cho benh nhan

K h o n g S o sai T i m i

Kit qui dieu b-a cho thiy ty le benh nhin den khim BSGD dinh gii da dddc giii thich ti mi ve binh cao hdn so vdi binh nhin dddc khim bdi nhdm bac si khic (65,2% so vdi 41,7%; p<0,001). T'y li binh nhin danh gii. chl du'dc glil thich sd salve benh dnhom BSDK cao hdn.

3.5. Hu'dng d i n p h u ' d n g j > h i p diSu t r j v i c i c h dCing t h u o c c h o b e n h n h i n BingS. Hu'dng'dan dieu tri cho benh nhan

B i c s T BSGD BSOK

P

K h o n g

n 1 21

%

1,1 6,3

> 0 , 0 5

Sdsii n 1 %

21 23,6 190 1 57,1

< 0,001

Chi t i e t

n 67

122

%

75,3 36,6

< 0,001

TV 1$ benh nhin didc hudng dan chl Uit, can ke ve phidng phip dieu bl vi cich dung thuSc d nhdm BSGD cao hdn nhim BSDK cd y nghia thdng ki (75,3% so vdi 36,6%; p<0,Ml).

3 . 6 . B$nh n h a n d i n h g i i c h u n g v e t r i n h d p c h u y e n m o n cua b i c sT Bing 4. Bac sT co trinh do chuyen mon tot

B i c s T BSGD BSDK T£na

C h u y S n m o n taft

n

57

108 165

•/o 64,0 32,4 39,1

C h u y e n m o n chu'a t o t

n

32

225 257

36,0

%

67,6 60,9

P

< 0,001

Bing 4 cho thiy ty li binh nhin danh gii BSGD cd trinh dd chuyin mon tot cao hdn d nhdm BSDK (64,0% so vdl32,4%, p<0,001).

IV. BAN LU$N

K i t qua dieu tra cho thay ly do quan trpng n h i t khien c i c b^nh nhan lua chpn den k h i m chiia b?nh tai y tS tuyen cd sd la dp gan nha, thu?n tl$n giap th6ng 57,3% (OSc L i c 74,6%;

Hue 44,4%), d^c biet la iS D i e L i e ndi dja hinh rCing nui chiem iTu the thi vi?c ngu'di dan lua chpn c i c cd sd y t l gan nha l i rat php b l l n . O i u niy chp t h i y , n i u chat lu'dng djch vu ciJa c i c cd

sd y te nay ( t u y i n gan dan nhat) duBc n i n g cao thi ty le ngu'di dan lua chpn su' dung djch vu d day se tang len. Vi|c thu hut ngu'di b i n h den k h i m chua benh t^i y t l t u y i n xa, huyen ma khong dl kham benh vu'dt t u y i n la y i u to quan trpng giup giam qua tai b i n h nhan tai c i c b^nh vien Idn t u y i n tren.

Ly dp dimg thiJ hai khiln b|nh nhSn Iga chpn cd sd y te la dp cp bap h i l m y t l tai c i c cd

Y HOC VIET HAIW THAHG 6 - SO 1/201 sd nay c h i l m 3 8 , 1 % . Oay la bang chutig quan

trpng, can cac nha hpach djnh chinh sach dua ra cd che phil hdp de qui BHYT tham gia chi tra cho hoat dpng KCB cua cac cd sd y t l tuyen cd sd cd trien khai hoat dong Y hpc gia dinh bao gom ca he thdng cong lap va tu' nhan.

Khi SP sanh cac chi sp danh gia ciia benh nhan ve chat lu'dng kham chua benh giu'a nhom BSGO va nhpm BSDK, ket qua dieu tra cho thay benh nhan danh gia nhom BSGD cap hdn ve trinh dp chuyen mpn ciing nhu' thai dp phuc v u .

Ve thai dp cua cac bac si, 8 7 , 6 % benh nhan danh gia cac BSGO cc thai dp tPt. Ty le nay la 53,3% d nhpm BSOK, su' khac biet nay co y nghla thong ke (p<0,001).

K i t qua nghien ciiu cho thay cac ky nang t U van chp benh nhan nhU: glal thfch ve van de su'c khpe/benh ma benh nhan mac phai cung nhu' hu'dng dan benh nhan each diing thuoc ciia BSGO deu du'dc benh nhan danh gia cap hdn BSOK. Oieu nay la do cac BSCKI YHGO da du'dc chii trpng dap tap cac k i l n thirc va ky nang p h i t hi$n, xif t r i cac van de s i k khce thu'dng ^ a p tai cpng dpng, Ben canh dp BSGO ccn k i t hdp t d t Hnh VLTC lam sang va ccng tac phdng benh; ky nSng giao tiep va tii van chp benh nhan va gia dinh benh nhan. K i t qua nay cung tu'dng t i f nhtf k i t qua dieu tra ciia Pham Thj Ngpc Bich [1] va mpt so ket qua dieu tra 6 cac nu'dc thupc Chau au (Phip, Anh, Bi...) [ 7 ] . Trpng qua trinh t i l p xuc vdl ngu'di benh, bac si can the hien ai thau hieu, Slf thu'dng yeu va ten trpng ngu'di benh. Ngu'di thay thupc c6 ky nang tu van tpt se lam tang sU hai idng cua benh n h i n , tang stf tuan t h i i dieu trj, giiip lam giam c i c tri?u chirUg (gSm ca trieu chifng thifc the va tinh than) va giam cac hanh vi khpng cp ldi cho sifc khoe. Day la cac ky nang can chu trpng trpng qua trinh dap tap chp c i n bp y te [ 4 ] , [ 5 ] . Trpng thifc hanh lam sang, ca nhpm BSGO va BSOK can du'dc c i i thien d Hnh vifc khuyen khfch benh nhan tham gia thao luan k l hp?ch dieu tri [ 2 ] , [ 3 ] . Ty le benh nhan danh gia c i c BSGO CP trinh dp chuyen mdn t c t la 6 4 , 0 %

va nhom BSOK la 3 2 , 4 % ; sU khac biet nay co y nghTa thong ke (p<0,001).

Ket qua nghien cifu nay da cho thay mpt so khia canh lien quan den chat lu'dng kham chOs benh ciia cac BSGO du'dc danh gia cao hdn cac BSDK. Day la bang chifng quan trpng khang dinh viec phat trien mang ludi BSGO se giiip cai thien chat lu'dng ciia cac tuyen y te cd sd.

V . KET L U A N

- Ty le benh nhan dUdc BSGD glai thich ti mi ve benh mac phai dat 6 5 , 2 % (nhpm BSDK la 4 1 , 7 % ; p < 0,001)

- 75,3% benh nhan da dUdc c i c BSGD huSng dan chl tiet ve phu'dng p h i p dieu trj (nhpm BSOK la 3 6 , 6 % ; p < 0,001)

- 8 7 , 6 % benh nhan danh gia BSGO cc thai il}

t p t trpng q u i trinh kham chOa benh va 64,0%

cac BSGD dUdc danh gia cp trinh dp chuyen mon tct. Cac ty le nay cap hdn d nhpm BSDK co y nghla thpng ke (p < 0,05).

T A I L i f U THAIVI K H A O

1 . Phgm Thj Ngpc Bich ( 2 0 0 8 ) . So sanh mi^c dg hai long ciia benh nhan vdi bac si CK I Y hpc gia dinh va bac si da khoa tai mot so tr^m y te xa cl Ha Noi; Tap chi nghiin cthi yhoc. 67(2): 198-203.

2. Freeman G, Hjortdahl P ( 1 9 9 7 ) . What futun for continuity of care in general pratice? Biitislt Medicaljournal. 314(7098): 1870-1873.

3. Mainous AG ( 2 0 0 1 ) . Continuity of care and tmst in one's physician: evidence from primary care in the US and UK. Family Medicine. 33(1): 22-27.

4 . Stock Keister ( 2 0 0 4 ) . Wfhat people want from their family physician? Am Fam Physician. 69(10):

23- 30.

5. Tahepold H ( 2 0 0 6 ) . Patient expectations from consultation with family physician; OoatMedJ.

47(1): 148-54.

6. WONCA ( 1 9 9 1 ) . The role of the General Practitioner/Family Physician in health care systems: A statement from Wonca; W/ONCA.

7. Zebiene ( 2 0 0 8 ) . Agreement in patlent-physidan communication in primary care: a study frwi Central and Eastern Europe; Patient Educ Com.

73(2): 246-250.