Nghien CLFU - Ky t h u a t
Hieu qua can thiep quan ly ton kho tai khoa du-ffc benh vien Nhan dan 115 nam 2008:
• • •
Sir dung chi SO IMAT
Huynh Hien Trung', Doan Minh Phiic', Nguyen Thj Thuy Ha', Nguyen Thanh Binh^ Tir Minh Koong^
^ Benh vien Nhdn ddn 115
^Trudng DH Dugc Hd Noi
Dat van de
Quan ly t6n kho la mot trong nhCpng nhiem vu trpng tam cua cong tac quan ly cung i^ng thu6c, dae biet la cung LPng thuoc trong benh vien '^'''.
Quan ly t6n kho khong hieu qua co the d§n din thu'a hoac thieu hut thuoc SLP dung, sai lech giOa so lu'ang tren so sach va thi/c t§ lam cho chi phi quan ly ton kho tang len'^' va anh hu'o'ng d§n ngan sach benh vien. NhOng nguyen nhan d i n den tinh trang kem hieu qua trong quan ly bao gom p h i n m^m kiem soat ton kho khong tot lam cho s6 lieu khong chinh xac, qui trinh quan ly chu'a phu hop. Tuy nhien, trong thyc ti, day lai la van d§ dang t6n tai kha pho bi§n trong cong tac quan ly thu6c tai cac khoa d y g e benh vien d Viet Nam hien nay.
Tren the gioi, ngu'O'i ta da dL^a ra nhieu giai phap n h i m tang cu-ang c h i t lugng cung nhy la danh gia hieu qua cong tac quan ly t6n try thu6c trong cac benh vien. Tai mot so benh vien cac nyac trong khu vyc nhy Asan, Samsung (Han Qu6c); Elizabeth (H6ng Kong); Siriraj, Bumrungrag (Thai Lan)... he th6ng quan ly t6n trij- r i t chat che nho da ap dung giai phap cong nghe thong tin quan ly toan dien ty khau nhan benh, ke don d i n c i p phat thu6c tai kho, va da p h i n nao gop p h i n cai thien dang ke v i n de quan ly t6n kho. Tuy nhien, giai phap nay phai d y g e phoi hgp dong bp voi viec dieu chinh qui trinh quan ly, kiem tra so lieu thyong xuyen cua nhan vien c i p phat.
De danh gia hieu qua cua viec quan ly t6n kho, Co quan khoa hpe quan ly sue khoe eua My
(MSH) da thiet lap eac chi s6 quan ly ton kho hieu qua (IMAT -Invetory Manangement Assessment Tools) de giam sat va xac djnh c h i i n lygc cai thien cong tac quan ly t6n t r y thu6e '''^l
Benh vien Nhan dan 115 (BVND 115) la mpt trong nhO'ng benh vien da khoa lan cua thanh pho Ho Chi Minh vai 1.600 g i y a n g benh. Hang nam benh vien da tieu thu mpt k h i i lygng Ion t h u i c vai tong gia trj len tai 100 ty ding/nam.
Trong qua trinh eung y n g , benh vien eung gap r i t nhieu kho khan trong cong tac quan ly ton trCf thuoc n h i m dam bao co du thuoc vai c h i t lygng cao dap yng cong tac d i i u trj.
De nang eao hieu qua quan ly eung yng thuie, benh vien da ap dung mpt so giai phap n h i m nang cao hieu qua cung LPng trong do c6 quan ly t i n kho nhy: xay d y n g cae tieu chl trong eong tae quan ly kho dap y n g theo yeu e i u cua IMAT (Invetory Manangement Assessment Tools) '^', trien khai cae p h i n m i m h i t r g trong cong tac quan ly ton try kho t h u i e . . . Vi vay nghien cCfu nay d y g e thyc hien vai muc tieu danh gia hieu qua cua cac giai phap can thiep trong cong tac quan ly ton trCf kho t h u i e BHYT n h i m gop phan nang eao e h i t lygng eung y n g thuoc tai Khoa d y g e benh vien Nhan dan 115.
Phu'O'ng phap nghien
CLFUDay la nghien c y u can thiep d y g e thyc hi^n tren 25 loai t h u i e d y g e s y dung nhieu nhat tai 2 kho le thupc he t h i n g kho eua Khoa dyge BVND115: kho BHYT npi tru va kho BHYT ngoai tru. Thiet ke nghien c y u d y g e bo tri n h y sau:
TAP CHI DUQC HOC - 9/2009 (SO 401 NAM 49)
Nghien CLPU - Ky thuat
S9 dd qui trinh nghien ciPU
KHO BHYT NGOAI TRU25thu6cx55 ngSy=1.375
<C
TCT 11^1 I r- KHO BHYT NOI TRU SosSnh4chis6 i 1—--^ 25 thuocxIOO ng^y=2.500So sdnh SOT
|y6i TCTI
FC
CAN THIEP 2 KHO:
- Dieu chinh theo ggi y IMAT -Thay doi Qui trinh
- Bdo cdo s6 lieu hdng ngdy, (Je ra bi$n phdp <5ieu chinh Trang bj ph^n m&m qudn ly mOT
KHO BHYT NGOAI TRU
25fhu6cx100ngdy=2.500
< : J
SCTSo sdnh 4 chi s6
o
KHO BHYT NOI TRU 25thu6cx100ngdy=2.500Vd'i sa do tren, Ccic giai ph^p can thiep dyge
^p dgng nhy sau:
- Thay doi qui trinh nh$p thuoc v^ sip xip lai thuoc trong kho: nhSn vi6n khoa dyge l^m phieu nh§p kho (thay vl nhSn vien tSi chinh nhy trydc dSy), thuoc chi xuat kho sau khi d§ ISm phieu nh&p, dan thuoc dyge chuyen sang khoa dyge kiem tra tryb'c khi chuyen sang bO phSn t^i chinh Xcic nhan;
- Ty 6/2008 trien khai ^p dung phan mem quan ly mdi-i quan ly thuoc, trong 36 c6 kho BHYT ngoai tru. Dy Ii6u k§ dan cua b^c sT se dyge truyen trye tiep qua mang ve khoa dyge bfenh vi$n, nhSn vifen khoa dyge kiem tra lai dy li$u dan thuoe trydc khi cap ph^t, phan mem eung c^p nhat so Ii6u ton kho tyc thdi de bac sT va nhan vi6n khoa dyge nim dyge so li$u thuoc thyc te trong kho;
- Ty thang 2/2008 den 8/2008, cac so Ii6u ton kho trfen so sach va thyc te eua 25 mat hang dyge bao cao hang ngay trong cae buoi hpp giao ban khoa dyge nhim khic phue nhyng sai I6ch xay ra.
Trydc khi can thi$p(TCT) tien hanh thu thap so li^u Ii6n quan den ton try cua 25 thuoc hang ngay, trong khoang thdi gian 100 ngay (29/10/2007 den 23/1/2008), sau dd so sanh vdi so lieu trfen kho vdi so sach theo cac chi so cua IMAT '^'.
Sau khi can thi6p (SCT), tien hanh thu thap so li$u eua 25 logi thuoc d mii kho nhy da thye hi$n trydc can thifep, so li$u dyge thu thap ty ngay 18/8/2008 den ngay 07/01/2009 (100 ngay); (iv) So sanh cac chl so trydc va sau can thigp.
Sy dyng cac chf so cua IMAT de danh gia hi$u qua cua cac giai phap can thi$p. cac so li$u trydc va sau can thi$p dyge nhap vao phan mim Microsoft Access de tong hgp, sau dd diJ' ii$u dyge dya vao phin mem Minitab Release 14 de phan tieh theo eac chJ so sau''':
Chi s6 1: Ty le ghi nhan ton kho ehinh xac so vdi so lieu tren thye te: xae djnh chat lygng he thong lyu trij blng each xae djnh ti le eua nhOng bao cao ehinh xic.
Chi s6 1a: Ty le ghi nhan ton kho c6 so ton ft han so ton thyc te (thya)
Chi s6 1b: Ty \i ghi nhan ton kho cd so ton nhieu han so ton thyc te (thieu)
Chi s6 2: Ty le tong khac bi§t ton kho (so sach try thye te, liy tri tuy$t doi) so vdi tong ton kho thyc te (cdng tat ea so lygng thyc te) eua 25 mat hang trong 100 ngay.
Chi s6 3: Ty 16 thuoe cd sin trong kho: do lydng hi$u qua eua hi thong trong viee duy tri diy du cac loai san phim trong kho (tai thdi diem kiem tra), la ti \i cua tong chung loai thuoc thyc te cd trong kho so vdi danh sach 25 loai, thu thSp so lifeu trong 100 ngay.
Chi s6 4: Thdi gian trung binh mdt thuoe het hang: thdi gian ty lue thuoc hit trong kho eho den khi cd lai. Dd la ti 16 phin tram giya tong so ngay trong kho (blng 0) cua nhyng loai thuoc trong danh sach so vdi 100 ngay thu thap so li$u cua 25 loai thuoc.
De danh gia myc dd khac bi$t cua cac ehi so
tr§n gilja trydc va sau can thi$p, sy dyng
phyang phap phan tieh hoi quy nhi phan
(binomial regression). Md hinh hoi quy nhj phan
cho ph6p diin giai so li$u ve hi$u qua cua can
thi§p theo ty so tyang doi. Gpi ty l§ trydc va sau
can thiep lin lygt la pi va P2, chung tdi ydc tinh
ty so hi$u qua (viet t i t la RR) RR = p2 / p,. Do
dd, doi vdi ty l# chinh xic, RR = 1 cd nghTa la
khdng cd hi$u qua, RR > 1 cd nghTa la can thi$p
tang ty 1$ chinh xac, va RR < 1 ed nghTa la can
thi$p lam giam ty 1$ chinh xac. Kiem djnh gia
thuyet vd hi$u qua blng each ydc tinh khoang tin
cay (KTC) 95% cho RR.
Nghien CLFU - Ky thuat
Ket qua nghien
CLPUva ban luan
Danh gia diFa vao Chi s d 1
S i lieu v i dp ehinh xae, thya va t h i i u tai kho BHYT npi tru TCT va SCT tren 25 thuoe da d y g e chpn d y g e trinh bay tren Bang 1.
Bang 1: Kit qua phin tich chl sd 1 tai kho BHYT ndi tru
K h o BHYT noi tru
N
Chinh xdc H§t hang
Thi^u ThCra
SCT TCT
2.500 2.500 1158 46,3% 515 20,6%
1 0,04% 48 1,9%
831 33,2% 1018 40,7%
510 20,4% 919 36,8%
Ty s d hieu qua (KTC 95%)
2,25 (2,16-2,34)
0,82 (0,78-0,85)
0,55 (0,54-0,58)
P
<0,05
<0,05
<0,05
K i t qua phan tich eho t h i y trydc can thiep (TCT), ty le ehinh xac giya so sach va so lieu thye t i la 20,6%, nhyng sau khi can thiep, ty le nay tang len 46,3%, do dd he so hieu qua tang 2,25 l i n vdi khoang tin cay 95% [KTC95] dao dpng ty 2,16 d i n 2,34 l i n . Ngyge lai, ty le t h i i u hang trydc va sau can thiep lan lygt la - 4 1 % va 33%, hay giam 18% (KTC95: 15% d i n 22%).
T y a n g ty, ty le thya hang giam 45%) (KTC95:
42% d i n 46%). T i t ea nhyng bien chuyen trydc va sau can thiep d i u cd y nghTa t h i n g ke.
Phan tieh s i lieu d kho BHYT ngoai tru (Bang 2) vdi cac mat hang va thdi gian nhy kho BHYT npi tru, tuy nhien vdi ly do khach quan (do bo tri s i p x i p lai kho tang), ehung tdi ehi thu dyge 55 ngay TCT tyang yng 25 mat hang * 55 ngay = 1.375.
Bang 2: Kit qua phin tich chl sd 1 tai kho BHYT ngoai tru
K h o BHYT ngoai tru
N Chinh xdc
H§t hang Thi4u
Thi>a
SCT
2500 1963 78,5%
21 0,8%
405 16,2%
111 4,5%
TCT
1375 14 1 %
59 4,3%
682 49,6%
620 4 5 , 1 %
Ty s o hieu qua (KTC 95%)
77,1 (71,5-83,1)
0,20 (0,19-0,20)
0,33 (0,31-0,35)
0,10 (0,09-0,10)
P
<0,05
<0,05
<0,05
<0,05
Tuy thdi gian n g i n han so vdi thdi gian d ndi tru, myc dp hieu qua d ngoai tru ed phan eao
4
han. C h i n g han n h y ty le ehfnh xae trydc can thiep chl 1 % , va sau khi can thiep ty le nay tang len 78,5%). Ndi each khac, ty le chinh xae t§ng 77,1 l i n (KTC: 71,5 d i n 83,1). Ty le h i t hang, t h i i u hang, va thya hang l i n lygt giam 80%, 67%), va 90%o. T i t ea cae chi s i hieu qua nay deu ed y nghTa t h i n g ke vdi P < 0,05.
Cae s i lieu tren cho t h i y kho BHYT ngoai tru cd x u i t phat diem chT so chinh xac kem han kho BHYT ndi tru den 19,6%), nhyng hieu qua can thiep da the hien r i t rd qua cae s i lieu biin doi SCT so vdi TCT d kho BHYT ngoai tru la 77,1 l i n so vdi BHYT npi tru la 2,25 lan (gap 34,3 lan).
Myc dp thay doi trydc va sau can thiep ve thuic thiiu d kho BHYT ngoai tru kha rd rang la 67% so vdi kho BHYT npi tru la 18%o (khac biet 49%o).
Nhyng thay doi ve thuoc thya eung khong khac nhiiu so vdi t h u i c t h i i u nhyng a kho BHYT ngoai trCi (giam 90%o) v i n n h i i u han kho BHYT ndi tru (giam 45%) d i n 45%).
NhOng k i t qua tren eho t h i y eac bien phap can thiep giong nhau d ca 2 kho (try p h i n m i m quan ly mdi chT ap dung d kho BHYT ngoai tru), nhyng hieu qua can thiep d kho BHYT ngoai tru rd rang han. T y dd, ed the giai thich r i n g trong goi can thiep ap dung eho nghien cil'u nay, can thiep b i n g p h i n mem da tao nen s y khae biet d 2 kho ndi tren.
Danh gia d i r a v a c c h i s 6 2
Bang 3: Kit qui phan tich chl sd 2 tai kho BHYT ndi trii
Kho BHYT Noi tru Tong sai khac
Tong ton kho t h y c t6 T i s u d t sai khde
so voi ton kho thuc te
SCT
187.329 3.948.473
4,7%
TCT
400.168 2.400.284
16,7%
Bang 4: Kit qui phin tich BHYT ngoai trii
Kho BHYT Ngoai tru Tong sai
khac Tong t6n kho
thyc t§
Ti sudt sai khac so voi t6n kho thyc
Xh
SCT
56.649 7.427.
834
0,8%
TCT 1.953.
917 3 8 9 0 .
800
50,2%
Ty s 6 hieu qua • P
0,28 <0,0001
chl sd 2 tai kho
T y s o p hieu qua
0,02 <0,05
TAP CHI DUQC HQC - 9/2009 (SO 401 NAM 49)
• Nghien CLFU - Ky thuat
Phan tich trinh bay trong bang 3 va bang 4 eho t h i y ty so hieu qua v i ty s u i t sai khac so vdi t i n kho thyc te d kho BHYT npi tru giam 72% (ty 16,7%) trydc can thiep xuong cdn 4,7% sau khi can thiep). Ty so hieu qua d kho BHYT ngoai trCi cdn rd rang han: giam 98%) (ty 50,2yo trydc can thiep x u i n g 0,8% sau can thiep).
Tyang t y ehi so 1, he s i hieu qua SCT so vdi TCT d kho BHYT ngoai tru Idn han kho BHYT ndi tru 17,4 l i n (62,8/3,6) the hien sy sai lech so sach va thyc te da ed nhyng cai thien dang ke bdi nhCrng hieu qua can thiep (nhit la p h i n mem quan ly mdi).
Danh gia dina vao chi s6 3
Sy s i n cd cua san pham d y g e the hien trong bang 5. Theo dd, s y thay doi v i ty le s i n cd trydc va sau can thiep d kha eao (tren 97% d kho npi khoa va tren 86%o d kho ngoai khoa).
Phan tich ty so hieu qua eho t h i y d kho BHYT ngoai tru vdi ty so hieu qua la 1,02 (KTC95 dao ddng t y 0,44 d i n 2,36), trong khi dd ty so hieu qua d kho BHYT nOi tru la 1,14 (KTC95 dao dpng t y 0,78 den 1,68). Tuy cd cai thien, nhyng ca hai ty so nay khdng cd y nghTa thong ke.
Bang 5: Kit qua phin tich chf sd 3
Chls6 3 SCT TCT Kho BHYT 2 494 gg go/^ 2.44I 97,6%
npi tru
T i s 6 hieu qua (KTC 95%)
1.02 (0,44-2,36)
p
>0,05 N 2.500 2.500
Kho BHYT 2 47., 98,8% 1.187 86,3%
ngoai tru
1,14
(0,78-1,68) >0,05 N 2.500 1.375
Danh gia diFa vao chi so 4 Bang 6: Kit qua phan tich chi 'sd 4
Chi so 3
SCT
TCTTi so hieu qua (KTC 95%) Kho BHYT
noi tru So mgt hang Thoi gian het
hang 1 6
3
0,2% 59 2,4%
0,1 (0,101- 0,102)
<0,05 Kho BHYT
ngogi tru So hiat hang Thai gian het
hang 9 29
11
1,2% 188 13,7%
0,08 (0,083- 0,087)
<0,05
Cy chl so ' (thoi gian trung binh " thuoc liet hang), sy khac biet cung co y nghTa thSng ke d ci 2 kho BHYT npi tru va BHYT ngoai tru (p<0,05). Kho BHYT ngoai tru cd sy bien doi thdi gian h i t hang SCT so vdi TCT nhiiu han kho BHYT ndi tru, nhyng thdi gian h i t hang SCT v i n nhiiu han (29 ngay so vdi 6 ngay) va sd mat hang h i t hang eung nhieu han (9 mat hang so vdi 1 mat hang).
Nhy vay k i t qua chi so sy s i n ed cua thude vi thdi gian h i t hang: ea 2 ehi so nay d i u the hien sy dam bao cung i>ng du thuoe trong kho,nhyng ty trydc can thiep kho BHYT npi tru lai cd sy dy try tyang doi tot vdi sy s i n cd eua san pham tyang d i i cao. D i i u nay, the hien sy dy trij thude d ca 2 he thong kho dap yng kha tot nhu e i u dy try ( t h i hien rd han SCT so vdi TCT).
Ban luan
Chat lygng cua he thing quan ly t i n kho la v i n de rat dyge quan tam khi chya dap yng dyge yeu eau cung c i p thuic phuc vu dieu tri va cdn nhieu sai lech giiJa so sach va thye t i . Nghien cyu da danh gia hieu qua eua he thong quan ly ton kho tai 2 kho le BHYT ngoai trij va BHYT npi tru eua BVND115 sau khi thye hien eac giai phap can thiep. K i t qua nghien cyu da ehi ra:
- Giai phap can thiep td ra hieu qua han d kho BHYT ngoai tru so vdi kho BHYT npi tru khi ti le chinh xac, thiiu va thCpa cai thien dang ke sau can thiep. Tuy nhien, d ca 2 kho ti le thiiu SCT (16,2% d kho BHYT ngoai tru; 33,2% d kho BHYT npi tru) va thya SCT (4,5% d kho BHYT ngoai tru; 20,4% d kho BHYT npi tru) cdn kha cao. Dieu nay la do mac du benh vien da trang bi p h i n mem mdi, nhyng kha nang tinh ton kho cua phan mem v i n chya that ehinh xae, eung khdng loai try cdn nhiiu sai sdt trong viec bao quan, c i p phat eua nhan vien kho ( e i n ed nhyng nghien CLPU ky han de k h i n g djnh d i i u nay).
- Tl suit sai khac so vdi t i n kho thye t i da dyge cai thien dang ke SCT, dae biet la kho BHYT ngoai tru ti so nay g i n con so ly tydng eua MSH (0,8% trong nghien cieu nay so vdi 0% cua MSH).
- Sy s i n cd eua t h u i c trong kho d y g e cai thien rd ret d kho BHYT ngoai tru (d kho BHYT npi triJ, chl so nay da tot ngay t y TCT).
- Thdi gian trung binh 1 thuoc h i t hang d y g e cai thien rd ret d ca 2 kho SCT, dSc biet la kho BHYT ngoai tru.
N g h i e n CLFU - Ky t h u a t
Trydc can thiep, nhyng sai sdt trong quan ly tdn kho la v i n de dang quan tam. Nguyen nhan eua vin d i nay, ngoai nhiJng nguyen nhan khach quan: phan m i m quan ly, qui trinh eon cd nguyen nhan chu quan: quan ly t i n kho chya dyge quan tam diJng myc, thiiu he thing kiem soat,...Sau can thiep, nhyng k i t qua tren ed dyge la do benh vien da thay doi phin mim mdi, thay doi thdi quen cua bac sT ty ke dan bing tay sang ke dan bing may tinh; mat khae sy tang cydng quan ly cua khoa dyge, sy kiem soat ke dan cua To phan tieh tai chinh... eung gdp phin cai thien dang ke cac ehi s i tren. Chung tdi elio ring, viee sy dung edng cu danh gia quan ly t i n kho (IMAT) cua nghien cyu nay - l i n d i u tien ap dung tai Viet Nam - tyang d i i dan gian nhyng hieu qua, ed the ap dung cho he thing quan ly t i n kho eua cae khoa dyge benh vien khae trong ca nydc. Tuy nhien, ky thuat xy ly s i lieu theo IMAT qua dan gian (chi sy dung 25 ddng dO lieu va chl sy dung so lieu t i n kho so sach va thye t i ngay kiem ke cuii eung) nen s i lieu ed t h i khdng chinh xac (do nhiJng sai lech khdng phai phat sinh trong ngay kiem ke cuii cung). Khic phue nh&ng sai lech nay, trong phan tieh ehung tdi da sy dung ea mau Idn (2.500 so vdi 25 eua MSH) va kiem tra lai so lieu XLP ly bing each nhap s i lieu hang ngay vao IMAT de kiem tra. Kit qua eua 2 phyang phap thing ke khdng khac nhau.
Cd mau TCT d kho BHYT ngoai tru (1.375) cd nhd han cac lan liy khae (2.500), theo ehung tdi khdng gay ra sai sd khi phan tieh vi ehung tdi ap dung phep kiim so sanh cae ti le.
K§t luan
TCP nhO'ng kit qua tren, ehung tdi k i t luan ring cac giai phap can thiep bing each SLP dung phin mem quan ly mdi k i t hgp vdi IMAT md ta trong nghien
CLPUnay giup cho viec quan ly t i n kho t i t han, nhit la d i i vdi kho thuic BHYT ngoai tru, va qua do gdp phin nang eao hieu qua quan ly thuic d benh vien.
Summary
To assess the impacts of the inventions in inventory management for assurance patients' daigs at People's Hospital 115. The study used many interventional solutions Including changing software,management processes,.. after base line, based on suggestions of IMAT-a tool of Management Sciences for Health.The results showed that after the interventions (i) record- keeping indicators (including Percentage of stock records that is accurate,Percentage of recorded balances that is less than physical counts.
Percentage of recorded balances that is greater than physical counts, Ratio of inventory variation to physical stock) improved statistical significant especially the outpatient bulk; (ii) Stock level monitoring indicators(including Percentage of products available-Indicator 3), Average percentage of time that products are out of stock-indicator 4) were changed a little because they were so good since before the intervention; however indicator 3 wasn't changed statistical significant while Indicator 4 was opposite. They meaned that the inten/ention by using software was more effectively.
Tai lieu tham khao
1. Management Science for Health,IMAT.- Inventory Management Assessment Too/.http://erc.msh.org /toolkit/Tool.cfm?lang=1&CID=6&TID=151.
2. Management Science for Health,Rapid Pharmaceuticalmanagement Assessment:an indicator- based approach (1995).
3. Jonathan D.Quick, James R.Rankin, Richard O.Laing, Ronald W.O'Connor, Hans V.Hoserzeil, M.N.G.Dukes, Andrew Garnett, Managing Drug Supply (1997). Kumarian Press.
4. Jonathan D.Quick, James R.Rankin, Richard O.Laing, Ronald W.O'Connor, Hans V.Hoserzeil, M.N.G.Dukes, Andrew Garnett, Managing Drug Supply Training Series,Second Edition (2000). Kumarian Press.
K i t qua thiH doc cap tinh... (nip trang 18) Tai lieu tham khao
1. Dyge dien Viet Nam III (2002), Nha xuat ban Y hoc. tr. 454-455.
2. Nguyin Th§ Khanh, Pham TLK Dyong (2001), Xet nghiem SLP dung trong lam sang, Nha xuit ban Y hoc. tr. 112-162.
3. Do Tat Loi (2003), NhO'ng cay thu6c va vi thu6c Viet Nam (XuSt ban lan thLp X), NXB Y hgc. Ha Noi. '
4. Bo Y te (1996) Huang dan kem theo quyet dint) so 371/BYT-QD ngay 12/3/1996 vi xae anh dg an toan cho thuoc co truyin Bo Y te.
5. World of health organization (2000) general guidelines on research and evaluation of tradinitional medicine.
6. Sara wolfensohn et al (1998), Small Laboratory Animal, Hand book of Laboratory Animal Management and welfare 2"'^ Edition. PP. 206-216.
TAP CHi DUQC HQC - 9/2009 (SO 401 NAM 49)
