TiBlP CHI NGHIEN CU'U Y HQC
THU'C TRANG TH^C HIEN OI^U TRj LAO N G A N N G A Y
CO KI^M SOAT TRyC TlfeP (DOTS) TAI PHONG KHAM LAO QUAN HAI BA TRU'NG, HA NOI
Hd Thj H i d n \ Udng Thj Mal Loan^
' Trwdng Dpi hpc Y ti Cdng edng,' Bdnh vidn Phii Hd N^i
TInh hinh bdnh lao tmng nhOng ndm gin ddy dd cd xu hwdng quay trd lpi vd trim trpng Idn. ddc bi$t a cdc nwdc dang phdt triin. Hda trj lidu ngin ngdy cd kiim sodt trwc tiip (DOTS) Id bidn phdp hidu qud giCip tdng cwdng tudn thu deu trj, bdo ddm hidu qud diu trj vd trdnh khdng thudc. Muc tidu nghidn cuv nhim mt td thuc trpng vd nhung khd khdn tmng thwc hidn DOTS cua edn bd y ti tai phdng khdm lao qudn Hai Ba
Trwng. iu) Noi K<-l qn.'i nijUiC'it I,Ull l.l It) Ih.iy lliui. liiQn D0T3 u i/huinj klh'nn u'jii nliit-u Ijol cap c/a'/ cJen tudn thil ct\c nguyen tiic dieu tri con cinrn cio Cn 89% liQnh nhan duxyc cap thuoc hang ngay tpi tr^m y te tmng^ai doan tan cong. cap lluioc miu llian<i 1 tan tniixj (jiai doan duy tn la 61%. Giam sat tpi nha chldiKfC thwc hiiv^ vol 627o Ix^nti nlian Giam sat cvi ck/t diaii In tmn mdt tl)ang mpt lan chiem ty 1$ 10.3%, t-tinh ttiik gidm M>t "hdc nlio. gua diCn tlioai van la chu yeu. chiem 58%. Can tUng cuang giam sat thuc hipn DOTS cho cin bo chong lao pliimng, nang cao kinn thuc ve DOTS cho benh nhan va can bo chong lao
Tirkllfta: DOTS, d i c u trj lao ngan ngay co kiem soat tru'c tiep, lao, tuan thu dieu tri
I. OAT
V A N O ^Tudn thu dung nguyen tac dieu tn (NTDT) bOnh Iso la dieu kien tien quyet, quyet dmh ket qua difeu tn, giam tinh trang khang thuoc, Tu' ndm 1999, DOTS (Directly Observed Treat- ment Short Course) do To chuc Y te The giai khuydn cao duoc C h u c n g trinh phong chong bOnh lao Quoc gia (CTCLQG) thuc hien Thuc hiOn DOTS la true tiep giam sat tii'ng lieu thudc cua benh nhan, dam bao benh nhan dimg dung loai thuoc, dung lieu, d6u dSn va d u | ^ gian, DOTS la phuo'ng sach chii y4u nhit dam bao cho su' thanh cong dieu tn rut ngin thoi gian lan truyen benh va trgnh khang thude [2]
Phdng kham lao thuoc quan Hai Ba Trung cd sd benh nhan lao nhieu nhat thanh pho, ty 10 m i c lao cao nhat trong cac quan noi thanh [3]. Mdi nam phong kham nay thu nhan khoang 300 benh nhan lao, Ty le dieu tn khoi ndm 2009 a day chi dat 78%, thap nhat trong tit ea4;ac quan huyen cua Ha Noi. Trong khi
do, muc tieu CTCLQG la dat ty le khoi tren 90% Thuc hien DOTS a phong kham con gap nhieu kho khan. OO tai nghien cuu nhdm muc tieu Mo ta thuc trang va nhung kho khan trong thuc hien DOTS cua can bo y te tai phong kham lao quan Hai Ba Trung Ha Npi.
II.
D61 T U ' O ' N G V APHUO'NG PHAP
Nghien cuu su' dung thiet ke cdt ngang, ket hop dmh luo'ng va dmh tinh Mau dmh lucrng du'O'c chon toan bo 174 benh nhan lao phoi du'O'c thLi nhan quan ly. dieu tn tai phong kham lao Hai Ba Trung ke id thang 1- 12/2009 Mau dinh tinh d u o c chon co chu dich, phong van sau 10 can bo y t^ va 12 benh nhan
Thu thap so lieu dinh lupmg bSng phong van true tiep tai nha benh nhan, su' dung bg cau hoi CO cau true de phong van kien thifC, thai do, thuc hanh cua benh nhan vO viec tuan thu diOu tr| DOTS va tim ra cac yeu to lien quan.
— TAP CHl NGHIEN CU'U YHQC Phdng van sau ve tinh hlnh thyc hlOn Sd HOu djnh lu-p-ng dup-c nhdp bing phin DOTS cua bOnh nhdn vd nhO-ng yeu td anh mem Epidata vd phdn tich bing phin mem hudng ddn vlOe thu'c hiOn DOTS cua bOnh SPSS 16.0. Ojnh tinh dup-c phdn tieh theo nhdn vd edn bO y td. chu de.
III. K^T QUA
1. Tinh hinh thyc hien DOTS ciia cdn bp y t l : Sd HOu djnh lu'p'ng.
Bang 1 vd bang 2 mO ta tinh hinh c l p thude eho bOnh nhdn d giai doan t i n cOng vd duy tri.
Trong giai dogn t i n cOng, ed 155/1^4 (89,1%) bOnh nhdn dup-c cdn bO y td (CBYT) didu trj true tiep hdng ngdy tai tram y td theo dung quy djnh; vdn edn 19 bOnh nhdn (chidm 10,9%) dup-c clp thudc ve nhd tu- dieu tri.
Bdng 1. Thyc hi^n didu trj giai do^n tdn cdng Cach cdp thudc
c l p thudc hdng thdng vd eho bOnh nhdn tu dieu trj tai nhd c l p thudc hang tuin vd eho bOnh nhdn ty dieu tri tai nhd Didu tri tryc tiep eho bOnh nhdn hdng ngdy tai tram y te Tdng
Bang 2. Thyc hien didu trj giai doan Cdch cdp thudc
c l p thudc 1 tuin 1 l l n Clp thudc nu-a thdng 1 l l n Clp thude 1 thdng 1 l l n Udng thudc tai tram Tdng
n 8 11 155 174 duy tri
n 25 106
18 25
174 *
%
4,6 6,3 89,1
100
% 14,4 60,9 10,3 14,4 100
Trong giai doan duy tri, van edn 18/174 bOnh nhdn duec d p thude luOn ca thdng, chidm ty 10 10,3%. Ty 10 bOnh nhdn du-o-c c l p thude nu-a thdng mOt lln van cdn d miPC eao, chiem 60,9%.
Co 14,4% bOnh nhan du-o-c c l p thude 1 tuin 1 lln. Chi cd 14,4% bOnh nhdn dwgc udng thude tai tram.
Bang 3. Tinh hinh kidm tra gidm sdt tai nha benh nhdn ciia CBYT Thyc hien gidm sat tai nhd
CO gidm sdt tai nha KhOng gidm sdt tai nhd Tdng
n 107
67 174
% 61,5 38,5 100
TAP GHl NGHIEN CU'U Y HQC''-
Bing 3 cho thiy ed 61,5% (107/174) bOnh nhdn cd dwgc cdn bO y td ddn gidm sdt tai nhd, Khoing 1/3 sd bOnh nhdn (38,5%) khdng dup-c edn bO y td gidm sdt dimg thude tai nhd.
Bdng 4. Mu>c dd gidm sdt cua CBYT Mu'C dd gidm sdt
1 thdng 1 l l n 2 - 3 thdng 1 lln
1 l l n trong c l dp-t didu trj Tdng
n 96
6 5 174
%
89,7 5,6 4,7 100
Trong sd bOnh nhdn dup-c gidm sdt, da sd bOnh nhdn du-p-c gidm sdt 1 thdng 1 lln (89,7%).
sd luong bOnh nhdn du-oc gidm sdt 2-3 thdng 1 lln chidm ty 10 5,6% vd 4,7% bOnh nhdn dwgc gidm sdt 1 lln trong c l dot didu tri.
Bdng 5. Cdch thirc gidm sdt cua CBYT Cdch thii'c gidm sdt
Nhic nhd udng thudc Dem sd thude edn lai Goi diOn thoai
Gidm sdt tai tram y te Tdng
n 78 64 23 9 174
%
44,8 36,8 13,2 5,2 100
Chl ed 36,8% du-Q-c kiem tra sd thude edn lai, cdch thiPc gidm sdt chu ydu v l n Id nhic nha .bOnh nhdn (44,8%) ho$c qua diOn thoai (13,2%), tdng sd Id 58%. Chf ed 5,2% bOnh nhdn du(?c
gidm sdt udng thude tai tram y te.
2. Thyc tr^ng thyc hifn DOTS cua cdn bO y td: sd HOu djnh tinh.
Cd 8/10 nhdn viOn y td khi du-p-c phdng v l n cho bidt thudn Ip-i eua hp khi phu trdch cdng tdc phdng ehdng lao Id ludn nh$n dyQ-e sy ung hO cua bOnh nhdn, gia dinh vd xd hOi.
Hiu hit cic gia dlnh diu c6 y thwc vi phdng chdng ching lao, hgn nda chi phi thudc men diu dwgc miin phi vi thi hg rit tdn trgng vi tin tudng vio cic cin bd lim cdng tic chdng lao. (Diiu dwdng trwdng phdng khim).
Tdi thiy vide giim sit diiu trj cua cin bd y ti li cin thiit, khi minh qudn mi c6 ngwdi
nhic nhd thi tdt qui. hgn nda i^i cdn dwgc tir vin di vide diiu tri dwgc tdt hgn (Bdnh nhdn nam, 61 tudi).
Tuy nhiOn thye trgng viOc thye hiOn DOTS eua cdn bd y td v l n chu-a du-p-c nghiOm tue theo dung quy djnh. Nhy mdt dieu dudng tru'dng phdng khdm lao dd ndi: "Vide thuc hidn DOTS t^i cic tr^m y ti phwdng hidn nay cd phin bj lgi ldng" Mdt sd edn bO y te noi ring, hp khdng thye hiOn du DOTS nhu ydu c l u , ed ngydi ndi ring hp khdng ein gidm sdt tai nhd md ehi e i n hdi han nhic nhd, c6 khi chl bing gpi diOn thogi. Cd y kidn cua cdn bO y
T/D^P CHl NGHIEN CCKU Y HQC to cho ring, viee hdi han nhu vdy ed the biet
"bOnh nhan cd dOng thude hay khOng" Thyc trang gidm sdt DOTS edn chya chdt che cung da dupe mOt sd bOnh nhdn trong nghiOn ciPU bao cdo.
Cw nwa thing bdnh nhin ra tr^m y ti Unh thudc 1 lin, mdi lin benh nhin din Unh thudc tdi diu hdi thim xem ho didu tri thi nio vi nhdc nhd ho nhd udng thudc diy dO, nhw viy Id tdi cd thi biit benh nhin cd dung thudc hay khdng (Diiu dwdng phwdng).
Chiu vda udng thudc lao, vda udng thudc diiu trj HIV. chiu khdng tidm mi chl c6 udng thudc, cin bd y ti phwdng cip thudc cho chiu ca thdng vi vi nhi ti/ udng, c6 iy khdng din nhd kidm tra mi chi din phii udng thudc diu mdi lin chiu ra Unh thudc (Bdnh nhin nam, 30 tudi).
Chiu khdng biit DOTS la gi ci, chiu cung khdng biit udng thudc thi nio la dung cich, chdu mudn cin bo y td tw vin ky han dd viec didu trj cd hieu qui (Benh nhin nam, 22 tudi).
Cdn bO y td c i n thyc hiOn nghiOm tiic DOTS theo dung quy djnh eiia ehu-ong trinh chdng lao de dam bao bOnh nhdn dupc diing thudc dly du va dung quy djnh. Nhieu CBYT cho ring CTCLQG e i n du'a ra eae biOn phdp khen thudng va xu- phat phii hpp de khuyen khich can bo y te cung nhu quan iy dieu trj DOTS dugc chat che hon,
Viec thuc hien DOTS tai cac tram y tS phwdng hien nay co phdn bi nai long, theo toi cac cip quan ly cSn dinh ky danh gia. thi dua khen thwdng 66 duy tri tdt tinh thin trach nhiem, long nhiet tinh cua can bo chdng lao (dieu dwdng trwang phong kham)
Cin nang cao chit lugng cua DOTS.
Phong kham lao cin xay dwng kd hoach kidm tra giam sat viec thuc hien DOTS tai tuydn phwdng, tang cwdng cong tac dao tao lai kidn thdc cho tuydn phwdng. Cac tram y td cin co
ki ho^ch giim sit diiu trj bdnh nhin theo dung quy dinh vi tw vin diy du cho bdnh nhin (bic sy phdng khim lao).
Cdc cdn bO y td eho ring ein ket hpp vdi gia dlnh bOnh nhdn trong vIOc quan ly gidm sdt, thudng xuyOn nhic nhd bOnh nhdn dung thudc theo dimg quy dinh, theo dOI ljch hpn eua bdc sy de nhic nhd bOnh nhdn Idm xOt nghiOm vd khdm dimg hen. Gia dinh vd ngudi thdn Id nhu-ng tdc dOng tryc tidp den bOnh nhdn trong khi dieu trj bOnh, ein ed nhu-ng biOn phdp dk ngu-dl thdn vd gia dlnh bOnh nhdn hidu rO trdch nhiOm cua minh cung nhu y nghTa cua DOTS trong viOc gliip eho ngudi bOnh dieu trj dgt ket qua tdt.
Gia dinh li noi thin thiit gin gui vdi bdnh nhin nhit, nhwng ngwdi trong gia dinh cin hit sire ddng vidn giup dd ngwdi benh di ho cd didu kidn vi quyit tam dung thudc diu dan, dung each, du thdi gian va thwc hien dung chi dinh cua thiy thudc (cin bo phdng chdng lao phwdng).
Cac c l p chinh quyen, cae doan the quin chung, td chiPC kinh te xa hpi vd cdc ca sd y te ein hO trp tuyOn truyen eho mpi ngudi kien thu-c vd each phong tranh cung nhu dieu tri bOnh lao, co ke hogch hd trp dOng vIOn ngudi bOnh va gia dlnh hp ca ve mdt tinh thin ldn vat chit de ho co no luc TTOT,
Mot sd benh nhan lao la tru cot lo kmh td gia dinh vi vay ho khong yen tam dieu tn co benh nhan dang chua benh nhung vin phai di xa dd kidm tidn. Cac td chwc tCf thien cin giup dd ho trg ngwdi benh lao co hoan canh kinh td kho khan dd ho da kho khan va yen tam chua benh (can bo phong chdng lao phwang).
Ban chi dao chwang trinh chdng lao quan cin CO kd hoach phdi hap chat che vai cac ban nganh. doan thd trong quan phdi hgp hoat dong va hd trg cho chwang trinh lao (bac sy khong kham lao).
TAP CHl NGHliN CLPU Y HQC -
Kdt q u i djnh tinh phii hpp vdi kdt q u i djnh lupng vd kdt q u i hdl ciPU tu- sd sdch. Tinh trgng edn bO y td chu-g thyc hiOn td DOTS Id v l n dd tdn tgi, cd thd do edn bO y td cdn qud bdn do cdng viOc kiOm nhiOm, ho$c chya hidu bidt dly du, chua hidu dype rd t l m quan trpng eua DOTS,
IV. BAN LUAN
Trong giai doan didu trj t i n edng, ed 89,1%
bOnh nhdn du-pc nhdn viOn y td tlOm vd eho udng thude tryc tidp tgi trgm y td, Kdt q u i ndy ed sy khde biOt rit Idn so vdi kdt q u i thu du-pc Id nghiOn cu-u cua bOnh viOn Lao vd bOnh Phdi Trung u-ong ndm 2006 vdi ty 10 ndy chl Id 65,9% [4], Sd dT ed sy khde blOt Id vl d Hd NOi, didu kiOn di Igi tu-ong ddi thudn tiOn.
Trong nghiOn ciFU eua bOnh viOn Lao vd bOnh Phdi Trung u-ong, bOnh nhdn lao tham gia vdo nghiOn ciPU thuOc 8 tinh trong todn qudc vdi nhu-ng dja bdn di Igi khd khdn nhu- Hd TTnh, Quang Nam, Tdy Ninh. Oieu ndy cd the Id han che Idn cho bOnh nhdn trong qud trinh dieu tn hdng ngdy. Kdt qua trong nghlOn cu-u ndy cung eao hon nghiOn ciPU eua Nguydn ViOt Cd vd cOng sy ndm 2000: trong sd nhu-ng bOnh nhdn didu trj tgi xd ehi ed 50% du-pc tlOm thudc hdng ngdy tgi trgm y te xd, edn lgi bOnh nhdn dupe d p thude ea thdng vd nhd ty didu tri hodc nhd ngudi trong xdm tiOm thude giiip.
Thye trgng quan ly didu trj bOnh nhdn nhu- vdy Id do dja bdn qud xa, bOnh nhdn khdng thd ddp trgm y td xd hdng ngdy dd didu trj du'pc, ddc biOt Id bOnh nhdn qud nghOo khOng ed dieu kiOn di lgi ho$c n i m didu trj nOi tru [5].
Chu-ong trinh ehdng lao dd quy djnh trong giai doan dieu trj t i n cdng, nhdn viOn y td b i t buOc phai tryc tidp tiOm vd cho bOnh nhdn udng thude hdng ngdy tai trgm y td. Nhu- vdy, ve CO- ban, quy djnh ndy dd dype thye hlOn.
Tuy vdy, v l n cdn mdt sd cdn bd ehdng lao
phydng bidt rd quy djnh phai tiOm vd phdt thudc tryc tidp eho bOnh nhdn nhu-ng vl hodn cinh khdch quan do phai Idm nhidu viOc kiOm nhiOm, chya thyc sy ed y thiPC thye hiOn vd hidu bidt chu'a d l y du vd DOTS.
Theo quy djnh eua chyo-ng trinh lao Hai Bd Tru-ng thl edn bd y td chf du-pc d p thudc cho bOnh nhdn nu-a thdng mOt l l n dd tiOn eho vide theo ddi, gidm sdt viOc udng thude cua bOnh nhdn vd phdt hiOn cdc d i u hiOu do tdc dyng phy eua thudc gdy nOn. Tuy nhiOn, ty 10 ndy trong nghiOn cu-u cdn thlp, chf chidm 61%.
O glal dogn duy tri, sau khi nhdn thudc tai tram y td phu-dng, bOnh nhdn mang vd nhd vd ty udng theo hu-dng d i n . NhiOm vu ciia cdn bd ehdng lao tuydn phu-dng Id phai gidm sdt viOc dimg thudc tai nhd ciia bOnh nhdn theo dung quy djnh. Ket qua phdng v l n eho thay g i n 2/3 sd bOnh nhdn (61,5%) du-pc CBYT gidm sdt tai nhd, ho-n 1/3 sd bOnh nhdn (38,5%) khdng du-pc CBYT gidm sdt dung thude tgi nhd. Ty 10 bOnh nhdn khOng dupc edn bO y te gidm sdt d ddy cao hon nghiOn ciPU cua Od Anh Lpi tai YOn Phong, Ble Ninh vdi ty 10 khdng dype gidm sdt Id 7,4% (6).
Trong sd ede bOnh nhdn du-pc gidm sdt dimg thude tgi nhd, cd 89,7% bOnh nhdn du-pc gidm sdt thydng xuyOn 1 thdng 1 lln. Nhu vdy cd 10,3% bOnh nhdn du-pc gidm sdt diing thude tgi nhd nhu-ng v l n chya dung quy djnh eua chu-ang trlnh. Hp chf du'pc gidm sdt 1 lan hodc vdi l l n trong ea dpt didu tri.
Cdch gidm sdt dOng thudc tgi nhd phd biln nhit eua nhdn viOn y td van Id nhic nhd bOnh nhdn dung thudc (44,8%). Chf cd han 1/3 s6 bOnh nhdn du-pc gidm sdt dimg thude tgi nhd theo dung qui djnh. Ket qua nghiOn cQ-u ciia chiing tOi thlp han nghiOn cu-u eua bOnh viOn Lao vd BOnh phdi trung yang ndm 2006 vdi ty 10 80% bOnh nhdn dype gidm sdt tgi nhd [4].
Tuy vdy, ty 10 bOnh nhdn du-pc nhdn viOn y t^
T^P CHl NGHliN o i U Y H Q C l gidm sdt eua ehiing tOi vdn eao han nhieu khi
so sdnh vdi nghiOn ciPu eua Daiyu vd cOng sy tiOn hdnh ndm 2008, tgi Trung Qudc vdi kdt qua chf cd 16% bOnh nhdn dupc gidm sdt dieu tri thu-dng xuyOn, 11,9% bOnh nhdn khOng dype gidm sdt dieu tri thu-dng xuyOn vd 72,1% ehua bao gid du-pc gidm sdt didu tn tryc tiep vd du-di 5% bOnh nhdn dupe gidm sdt dieu tri bdi ede nhdn viOn y td [7].
Chuang trinh chdng lao dd quy djnh trong glal dogn dieu trj duy tri, edn bO ehdng lao b i t buOc phai gidm sdt bOnh nhdn didu tri tgi nhd 1 thdng 1 lan, phai nhic nhd bOnh nhdn dimg thude vd dem sd thude cdn lai dd dam bio bOnh nhdn khOng bd thude mOt ngdy ndo. ViOc gidm sdt tgi nhd ngodi muc tiOu giiip bOnh nhdn tudn thu edn cd tdc dung phdt hiOn kjp thdi nhu-ng bidn chipng hodc cdc tdc dung phu ciia thude [8]. Tuy nhiOn, ket qua phdng v l n sdu cung cho thiy thye trang edn bd y te phdt thudc cho bOnh nhan dem ve nha ty dieu tri giai dogn t i n edng, cd khi d p eho bOnh nhdn ca thdng thudc trong giai dogn duy tri. Odi vdi benh nhdn dieu trj lgi, mdt sd cho ring ra trgm y te udng thude giai dPgn duy tri la khong d n thiet ViOc gidm sat tryc tidp tgi nhd edn it ma chu yeu vdn Id hlnh thiPC gpi diOn thogi. Theo quy djnh thi giai dogn duy tri sau 1 tuin ngudi bOnh bo dieu trj edn bd y te d n tim bOnh nhdn vd giai thieh cho hp quay trd Igl dieu tri, nhung vl viOc gidm sat tgi nhd khOng d l y du nOn cd bOnh nhdn bd dieu tri han 1 thdng mdi du-pc cdn bO y te gpi diOn den-mdi ra de tiep tue dieu tri, nhu vay kha ndng ldm vi khuln khdng thudc la rit eao.
V. K^T LUAN
Thye hiOn DOTS d phdng khdm lao Hai Bd Tru-ng cdn nhieu "lai ldng": Giai dogn t i n edng 10,9% bOnh nhdn khdng dype dieu. trj tryc tidp hdng ngdy tgi trgm y te; giai doan duy tri
10,3% bOnh nhdn dupe d p thudc khOng dung quy djnh; cd 38,5% bOnh nhdn khOng dupc gidm sdt tgi nhd; 10,3% khOng dwgc gidm sdt dimg quy djnh vd thdi gian vd ehi cd 36,8%
bOnh nhdn dupe gidm sdt diing cdch.
PhOng khdm lao d n gidm sdt ehdt chO han nu-a viOc thyc hiOn DOTS ciia cdn bp y te phu'dng d n ldp kd hoach cu the tii'ng tuin, thdng, quy. COng tdc gidm sdt bao gdm ea sy hd trp bOnh nhdn bing cdch tu vln, dOng viOn, truydn thOng ndng eao kidn thiPC vd tam quan trpng vd y nghTa eiia tudn thii didu tri. Cin ed chd dO thudng phgt rO rdng vd phai dua ra ede biOn phdp khic phye trong thdi gian tdi.
NOn tdng eu-dng cdng tdc ddo tgo ndng cao kien thu-c, ky ndng thye hiOn DOTS cho cdn bO y te phu'dng. C i n huy ddng sy hd trp ve vdt chit vd tinh thin cua ede ban ngdnh, dodn the tgi dia phu'ang eho bOnh nhdn lao.
TAI LIEU THAM KHAO
1. Trdn Van Sdng (1999). Vi khuln lao khdng thudc cdch phong vd dieu tri, Nhd xult ban Y hpc. Ha Npi.
2. Chu'O'ng trinh chdng lao qudc gia (2001). Hu-dng d i n thyc hiOn lupng gid chu-ang trinh ehdng lao qudc gia, Nhd xult ban Y hpc, Hd NOI.
3. Benh vien iao va benh phdi (2009).
Bdo cdo hogt dpng chu-ang trinh phdng ehdng lao Hd NOi 6 thdng d i u ndm 2009, Hd NOi.
4. Trdn Van Sang va cs (2008). Tlm hieu sy quan tdm cua gia dlnh vd cOng ddng ddi vdi bOnh nhdn lao trong thdi gian dieu trj tgi 8 tfnh - ndm 2006, Hd NOi.
5. NguyOn Viet Cd vd cs (2002). Xdy dyng mdng ludi cOng -tdc viOn chuang trinh chdng lao tgi thOn ban, dam bao thyc hiOn DOTS d 4 xa mien nOI, vimg cao tfnh Thdi NguyOn. NOi san lao vd bOnh phdi, Tdp 38, 7-16.
TAP CHl NGHliN CU'U Y HQC
6. Dd Anh Lp'i (2009). Odnh gid hogt dOng gidm sdt didu trj eua nhdn vIOn y td, ngudi thdn vd eOng ddng ddi vdi bOnh nhdn lao trong thdi gian didu trj tgi YOn Phong Ble Ninh ndm 2008, Ludn vdn thgc s9 y td eOng eOng, Trudng Dgi hpc Y td COng cOng, Hd NOi.
7. Chu'dng trinh chdng lao qudc gia - Vifn lao vd b^nh phdi (1999). Hu'dng d i n
thye hlOn chu'ang trinh chdng lao qudc gia, Nhd xult b i n Y hpc, Hd NOi.
8. Hu. Daiyu, Liu. Xiaoyun, et al (2008).
Direct observation and adherence to tuberculosis treatment In Chongqing, China : a descriptive study. Health Policy and Planning, 23(1), 43- 45, available: http://heapol.oxfordjournals.org, accessed September 15, 2009.
Summary
CURRENT SITUATION OF THE IMPLEMENTATION OF DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) IN HAI BA TRUNG
TUBERCULOSIS CLINIC, HANOI
Recently, tuberculosis situation has been getting worse especially in developing countries.
Directly Observed Treatmet Shorteourse (DOTS) is an effective measure toward enhancing TB adherence, assuring the treatment effectiveness and reducing drug resistance. Objective of the study was to assess the current situation of the implementation of DOTS by TB health staff at Hai Ba Trung TB clinic, Hanoi. The results showed that DOTS implementation at the clinic is not effective, leading to low adherence. 89% patients were provided drugs daily at the clinic in the active treatment period, 6 1 % patients were provided drugs twice per month in the maintenance treatment period. Observations at home were implemented among 62% of patients only, 10.3%
patients were observed less than once monthly. Observation was mainly in the form of reminders or over the phone, 58%. In conclusion, there is urgent need to control for the DOTS implementation by district health .staff, as well as to increase awareness on DOTS for patients as well as health staff.
Key words: DOTS, directly observed treatment shorteourse, tuberculosis, treatment adherence
TI^P CAN TRUYEN THONG C O A NGLfQI DAN V^ PHONG
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