NGHIEN c a u KHOA HQC
THUC TRANG NHU CAU DICH VU KHAM CHUTA B I N H TAI KHOA flIEU TRI TU NGUYEN A, BENH VllN NHI TRUNG UONG, NAM 2014
ThS. DO THANH TUNG Khoa Chin doSn hinh inh - B$nh vt$n Nhi Thing uotig
NgtrOi thim dinh: ThS. N G U Y E N BICH L y U
TdMTlT
Muc tifiu:
Md la nhu e l u dich vy kham chua b f n h tgi khoa Dieu tri l u nguyfn A - B f n h v i f n Nhi Tmng uang nam 2014.
Mo la m f l s l y l u to lifin quan d i n nhu e l u dieh vu kham chda b f n h tgi khog Dieu In t y nguyf n A.
Doi t u y n g nghien c u u : La bo, mg, ong,~ bd b f n h nhi dua trfi d i n khdm b f n h tgi khoa D i l u trj t u nguyfin A - B f n h v i f n Nhi Tmng uang.
P h u a n g phap nghien c u u : Md ta e l l ngang.
P h u a n g phap chpn m i u : N g l u nhien. Phong v l n 527 doi tuang nghien edu (DTNC) vdl bfi cdu hoi t h i l t k l san.
K i t q u i va ban l u f n: 86,34% d l l tuang d dp l u l l 21 d i n 40; 83,49% Id ddn toe Kinh; 98,66%
ed trinh d f hpc v l n t d pho thdng trung hpc d i n sau dai hpc; 82,73% cfi thu nhap binh quan trfin 1 0 - ^ f u ding/lhang 96,39% OTNC d i n khdm tgi day la linh trgng benh c l p tinh; 78,56% Ihye s u cfi nhu c l u ; 91,27% lin tudng vao khoa e h i t lupng cao; 64,33% la do khfing phdi chd dpi lau.
90,70% d l i tupng cd nhu cau giao s u kham b f n h cho trfi; 92,03% doi tuang cd nhu e l u d u a c bac sT chuyen khoa kham eho b f n h nhi. 98,29% gia dinh benh nhi cd kha nang ehi trd doi vdl dieh vy y l l (DVYT) tai day.
DTNC cd trinh dp hpc van dgi hpe/sau dai hpc ed nhu eau cao gap 21,78 l l n d l i tuang co Irinh dfi hpc van pho thfing trung hpc (OR = 21,78);
DTNC sinh s i n g d thdnh thi eo nhu c l u cao g i p 9,41 l l n nfing thon (OR = 9,41), DTNC cfi thai gian t u nhd d i n benh vifin tren 1 gid cd nhu c l u I h l p han 0,12 l l n nhom dudi 1 gid (OR = 0,12).
K i t luan: DTNC chu y l u la bo, me d d f tuoi 21- 40; cd trinh dp h i l u b i l l ; dan lpc Kinh Id chu yeu; thu nhgp binh qudn dau ngudi/thdng trfin 10
trifiu; cfi nhu eau eao d l l vdi cdc DVYT tgi day va phan Idn ed kha nang ehi tra cho ede dieh vy do.
Mfil so y l u to nhu trinh dp hpe v l n , sinh song d thdnh thj hay nong thfin, thdi gian t u nha den benh vipn la cd lien quan d i n nhu cau djch vu kham ehua bfinh tgi khoa Oieu Irj t y nguyen A.
Con e a C y l u t l nhu cfi the bdo hiem y l l hay khong, thu nhap binh qudn, khd nang chi trd, thi nhu cau ve dich vy khdm chd'a bfinh tgi khoa Dilu trj t u nguyf n A la nhu nhau.
T I P khda: D l i t u p n g nghifin edu; dich vu y te;
nhu e l d dieh v u .
tllATVJ^Bl
Nhu cau s d dyng dieh vy kham chira l^fnh (KCB)''ty n g u y f n Id s y ddi hoi, s y lua chpnxua b f n h rihdn va gia dinh b f n h nhdn d l i vdi t d c DVYT vao muc dieh cham sdc sde khoe, khdm chua benh cho ban than hay ngudi nha bfnh nhan m f l each l y nguyfin, phu hap vdi dieu kign kinh t l xa hfii va thfia man nhu eau,cua hp. Hp sln^sdng chitra mde phi s d d u n g cac DVYT eho nhd'eung cap. Khi kinh le cang phdt t r i l n thi nhu e l u v l jlich vy kham ehua b f n h cua nhdn ddn cang cao. Trude linh hinh do Chfnh phu da dgi ra muc tifiu v l quy hogch, phdt-trien mang ludi KCB va tdm nhin nam 2020: "Xay di/ng va phat trien '••
mang luoi kharii; chOa benh phii hgp vai dieu kien phat thin kinh ti - xa hgi cua dit nu&c. nang cao chit iugng dich vu y ti ngang tim cac nu&c tien tiin trong khu vyc, dap img nhu cau kham, chua binh cua nhan dan huong (dt muc tiiu cong bing, hiiu qua va phit triih"['\].
Trong nhung nam g i n day h i f n l u a n g qud tai b f n h vifin da lam anh hudng tdi c h l l lupng KCB
•i,' va thai dp phyc vy ngudi bfinh. Theo s l l i f u thing kfi eua Cue Quan ly KCB B f Y le (BYT) linh d i n h i t nam 2011, tinh trgng qua ldi lgi cde b f n h vifn (BV) luyen Trung u a n g len dlr1:'364% lgp trung d ede chuyfin khoa sdu nhu Benh v i f n K, Benh vifn
I 1
NGHltN CCrU KHOA HOC
Phy san Trung ipcyng, B f n h v i f n N f i t i l l , B f n h v i f n Nhi dong 1, Nhi dong 2. Tgi B f n h v i f n Nhi Trung u a n g tf i f qud tai Ifin d i n 200% [2].
Mae du Bfinh vifin Nhi Trung u a n g da cd nhi>ng gldi phdp, nhung b u d c di ey t h l de cai t h i f n linh trgng ndy n h u t r i l n khai mot so djeh vu KCB Iheo yeu c l u d cae khoa khdm b f n h A, B, C. Dgc bift la d khoa O i l u In l u nguyfin A (DTTN A) vdi s u d i u t u ve c a s d hg t i n g cung n h u trang t h i l l bj h i f n dai, p h i n nao da dap ung tot nhu c l u kham chda bfnh t y nguypn (KCBTN) cua gia dinh b f n h nhi (GDBN). Thue t l ehua cd nghien cdu nao v l thye trgng nay trudc day, nham eung e l p bdng ehung cho Ban Lanh dgo va cdng tde quan ly cua Bpnh vifin Nhi Trung u a n g trong v i f c lap k l hogch, tnen khai cung e l p eae logi hinh djch vu y t l l y nguyf n, ddp ung lot han nhu c l u KCBTN ngdy edng cao eua GDBN, ehdng ldi l i l n hanh nghifin edu ten de lai "Thyv trang nhu cau djch vu kham chira benh tai Khoa Diiu tri tir nguydn A - B$nh viin Nhi Trung uxmg nam 2014" va\ hai mye tieu:
- Md ta nhu eau djch vu kham ehiFa b f n h tgi khoa D T T N A - Bfinh v i f n Nhi Trung u a n g nam 2014.
- Mfi la mfil s l y l u t l lifin quan den nhu cau djch vu kham ehua bfinh tai khoa DTTNA.
2. fl6l Tir0N6 VA PHlTdNG PHAP NGHIEN ClHl
2.1. Dja d i l m va th6>i gian nghifin ci>u Nghifin c u u d u y c t i l n hdnh t u thdng 12/2013 d i n thdng 9/2014 tgi Khoa DTTNA - Bfinh vifin Nhi Trung u a n g .
2.2. Thiet ke n g h i e n ci>u: Nghifin euu md ta eat ngang.
2.3. D o i t u v n g n g h i e n c u u 2.3.1. Tieu chuin lu'a chgn
Ld b l , me, dng, ba d u a Ire d i n kham b f n h lgi Khoa OTTNA, du d i l u kifin nhu:
- Khfing co b i l u h i f n roi logn ve tinh than va y thuc;
- Nhgn thde d u a c , ed kha nang trd Idi todn bp cau hoi;
- Dong y tham gia nghien c u u sau khi d u p c cac d i l u tra vien gidi thich ly do va mye dieh cua nghien cdu.
2.3.2. Tliu chuin loai trir
Cae doi t u p n g khong thupc tieu c h u i n lya ehpn d tren.
2.4. Co* m a u v d each c h p n m a u C d m i u n = 504. Trong nghien edu ndy nhfim d i l u tra vifin da phdng v l n 527 doi tupng de phong sai so do do n = 527 tang (4,36%). Phuang phap chpn mau ngau nhifin.
2.5. M u c dp nhu c a u s u d y n g djch v y KCBTN: d u a c do ludng bdng thang do t u 1 d i n 5 d l l m ( d i l m = 1 r l l eo nhu cau... diem = 5 rat khong eo nhu eau).
3. KET QUA NGHliN Cim
3.1. Dac d i l m cua doi t u p ' n g nghien e u u
Biiu d o 3.1. Phin bo doi tirgng nghien c&u theo nhom tu6i
Nhan xit: D l l t u p n g nghien c u u (DTNC) ed dp tuoi l u 21 den 40 c h i l m trfin 80%, trong do nhom l u l l t u 21 d i n 30 la 46,68% va nhfim l u l l l u 31 d i n 40 td 39,66%.
Bang 3.1. T h o n g tin ve doi tup'ng nghien c u u Dac dllm cua dol tuong
Dan t$c Noi»
Trinh d$ h9C van Kinh Khac Thanh thi Nong thon Trung hoc co so Tmng hoc pho thong Trung cap/cao ding Oa' hpc/sau dai hgc
n = 527 440
87 282 245 8 201 214 104
83,49
%
16,51 53,51 46,49 1,52 LJ8,21 40,68 19,77
,jlSU DUONG
N G H I E N C C r u K H O A H O C
D i e diem cija doi t u ^ n g
Nghe nghifp
Thcri gian lam viec Thoi gian tCr nha t d i v i i n Bao hiem y te
Thu nhap hinh
Lao dong ti^ do Cong nhan vi&n chux;
Huu tri T u d c Co dmh S I giir
> 1 g i a Co KhOng
< 5 tneu 5-10 trieu
>10 trieu
n = 527 224 292 11 294 233 212 315 511 16 4 87 436
42,50
%
55,41 2,09 55,79 44,30 40,23 59,77 96,96 3,04 0,75 16,50 82,73 Nhan xit: P h i n ldn c^c DTNC Id dan tdc Kinh vdl 83,49%. Cd 53,51% s i n g d thdnh thj vd 46,49% sfing d ndng thfin. Trinh dp hpc v l n : cd 19,77% trinh dp dai hpe/sau dgi hpc, 40,68%
trinh dp trung cip/cao dang, 38,21% t i t nghifp trung hpe pho thdng.
Nghe nghifp cong nhan vien chuc c h i l m 55,41%, lao dpng t y do 42,5% Vfi thdi gian iam vific t y do chiem 55,79%, lam gid hdnh chinh 44,3%. Cd 59,77% OTNC di t d nha ldi vifin trfin 1 gid va 40,23% dudi 1 gid. Nhdm ed Ihfi bao h i l m y te c h i l m 96,96%.
P h i n Idn DTNC cd ttiu nhap trfin 10 trieu d i n g / thang vdi 82,73%. T u 5-10 trif u/thang la 16,50%.
Chf CO 0,75% thu nhgp dudi 5 trifiu/thang.
Bang 3.2. Ly do d l i t u a n g nghien c u u l u a chpn Khoa DTTNA
Ly do 1 ^ chpn G^n nh^
Co ngucri nha lam o day Tinh trang benh (clp tinh) Tu nguyf n den khf m theo nhu cau Tre so sinh (du^i 1 thang tuoi) Tin tuong vao khoa chat luong cao Do phong kham chung dong qu^
Con hiem muon Khong phfl cha dpi lfu Cd nguoi gioi thieu
Gia dinh benh nhi n = 527
55 6 508 414 33 481 79 31 339 10
%
10,44 1,14 96,39 78,56 6,26 91,27 14,99 5,88 64,33 1,89
Nh$n xet: Ly do chu y l u k h i l n DTNC lya chpn Khoa DTTNA la tin l u d n g vao khoa d i l l luang cao c h i l m 91,27%; tinh trgng b f n h clp Ifnh 96,39%; l y nguyf n d i n khdm theo nhu cau 78,56%; khfing phdi c h d dpi ldu c h i l m 64,33%.
3.2. M u c d p nhu cau s u d y n g djch vuicham chira bfinh cQa doi t u w n g nghien cCni tai khoa DTTNA
., • Rat khong co nhu cau
• khdng c6 nhu c^u
• binh thi.fdng
• cd nhu cau
• r^tconhu c^u
Bieu do 3.2. Nhu cau djch vu khim bac si chuyen khoa tai Khoa DTTNA Nb^n xit: H l u h i t (92,03%) cdc dol tupng d i u cd nhu cau d u a e bdc sT chuyfin khoa khdm cho b f n h .nhi tai Khoa DTTNA. Cd 7,02% doi
tuang rat ed nhu e l u . * Bang 3.3. Nhu c a u d u p ' c giao sir kham benh
cua gia d i n h bfinh nhi Muc do nhu cau
Rk khong cb nhu cau Khong cd nhu cau Binh thuong Co nhu cau Rai CO nhu cau
Gia dinh benh nhi n = 527
4 5 15 478 25
0,76
%
0,95 2,85 90,70 4,74 Whan xit: Cd 90,70% DTNC cfi nhu e l u gido s u kham benh cho trfi va 4,74% cfi nhu c l u r i t cao.
•^ 1
NGHI6N ClJU KHOA HOC
100.00%
90.00%
80.00%
70.00% • 60.00% ' 50.00% • 40.00%
30.00%
20.00%
10.00%
0.00% •
/ 94.31%
• Rilt khong cd nhu cau
• khdngcdnhucau
• b i n h t h u d n g
• cd nhu cau
• rated nhu cau
4.74%
/ y
\
Biiu do 3.3. Nhu cau cua gia dinh V-e doi v&i djch vg xet nghidm chan doan hinh anh ky thu$t cao Nhin xit: Cd 94,31 % DTNC cd nhu c l u , 4,74% cd nhu c l u r l l eao.
kham tong quat d j n h ky
kham, d i e u tri ngogi t r u
kham Bac sy chuyen khoa
98.29%
0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120,00%
• kh6ng cd khii n3ng dii tr^ • co kh^ nang chi trS Biiu di 3.4. Phan bo kha nang chi tra cac dfch vg KCBTN cua gia dinh benh nhi Nhan xet: 98,29% gia dinh b f n h nhi cd kha nang ehi tra d l i vdi djch vu kham bdc sT chuyfin khoa tang 2 0 % va 94,12% cd kha nang chi tra vdi djch vg kham giao s u tang 30%. Djch vu kham t i n g quat
^ n h ky tang 10% va khdm, d i l u trj ngogi tru tang 20% thi tf If gia dinh b f n h nhi cd kha nang chl tra thap han (67,17% va 53,70%).
c u DUONG I I
NGHIEN CtJU KHOA HOC
Bang 3.4, M6i lien quan gJCra mot so d^c d i e m cua doi tu>9rng ngtiien c(pu den nhu cau sip d^ng djch Vll KCB t^i Khoa DTTNA
,
No'io
Trinh d9 hoc van
Nghe nghiep cua nguoi duffc phong van
Nhdm tuoi cua nguoi duuc phong van
Nhdm tuoi cua benh nhi
Thoi gian den bfnh vifn Thdn gian lam vifc
Thf bf 0 hiem y te
Thu nhap binh quan nguoi/thang Ndng thf n Thanh th!
Trung hoc ccr sd Trung hgc ph6 thong Tnjng cSp/cao dang Dai hpe/sau dai hoc Lao dfng tu do Cong nhfn vifn chuc Huu tri
<21 21-30 31-40
>40 tir 1 - < 6 tuoi tLr6-<10tu6i Iir10-<18tu6l
<1 gicr
> 1 gio GIO CO i^nh Gicr tu do Cdsudung Khdng su dung
< 5 trif u dfng 5- lOtnfudong
> 10 trif u dong
OR thd OR
1 9,41
1 0,94 4,74 21,78 1 6,04
3,2 1 4,07 4,97 3,33 1 1,82 2,22 1 0,12
1 5,76
1 0,45
1 0,7 2,23
95%CI 6,1-14,5
*.-
•0,2-4,3-
1,02-21,9 3,94-120,3 4,03-9,05 0,84-12,56 1,67-9,91 2,02-12,34 1,19-9,34 1,07-3,11 1,28-3,86 0,075 - 0,2 3,86-8,6
_
0,13-1,62 0,06 - 7,96 0,2 - 24,8
OR hlfu chinh OR
1 2,68
1 0,99 3,2 9,77 1 0,2 2,02 1 1,4 1,9 1,06 1 1,4 1,16 1 0,43
1 3,5 1 0,93
9S%CI 1,28-5,62
C|2-4,84 0,5-20,35 1,25-76,2 0,01-4,0 0,31 -13,2
"
0,52-3,8 0,64-5,79 0,31-3,64 0,7-2,84 0,48-2,79 li,'l9-0,95 0,2 - 594
_
0,2-4,4 1 1 1,54 ' 0,02-115,4
2,3 1 0,03-167,2 Nhan xit: DTNC ed trinh do hoc v l n dgi hge/sau dai hoc cd nhu c l u eao g i p 21,78 lan d l l luang CO trinh do hoe v l n trung hQc pho thong (OR = 21,78); DTNC sinh s i n g d thanh thj cd nhu c l u eao gap 9,41 l l n nong thon (OR = 9,41). DTNC cd thdi gian t u nha d i n bfinh v i f n tren > 1 gid cd nhu c l u thap han 0,12 lan nhom < 1 gid (OR = 0,12).
4. BAN LUAN
Qua phdng v l n 527 d l i tuang la bo me, ong ba cLia bfinh nhi den kham tgi Khoa DTTNA - B f n h vifin Nhi Trung uang t u thdng 02 nam 2014 d i n thang 4 nam 2014 cho I h l y k i t qua la phan Idn cde dol tuang nghien cuu nam trong do l u i i l u 21 d i n 40 tuoi, ehllm li If 86,34%. K i t qua nay khd phu hap vdi k i t qua nghifin cuu eua Nguyfin
Th! Kim Dung (2013) Id 87,5% [3]. Bang 3.1 cho;^
thay dai da so gia dinh benh nhi Id ngudi dan I f c Kinh vdl 83,49% con lgi 16,51%. K i t qud ndy eho Ihay ed s y ehfinh Igeh rfi rang v l viec t i l p cgn va , s u dung cac djch vu KCB tai Khoa DTTNA. Ti If nay r i t phu hap vdi k l l qud Tong dleu Ira dan s l vd nha d V i f l Nam nam 2009 (86,2%) [4].
^ Vdl 53,51 % DTNC s l r i g d th^'nh thi va 46,41%
d l i l u a n g d nfing thfin, rd'rdn'g s u ehenh ifch I 90
*^
NGHIEN c a u KHOA HOC
nay la khong n h i l u vi h i f n nay nude ta dang phdt t r i l n n l n kinh t l thj trudng djnh hudng xa h f l ehu nghTa. Day ehfnh Id v l n de dam bao s y cfing b i n g trong KCB, n h u nghien cuu cOa Dfi Nguyfin P h u a n g (2001) [5]. Trinh dp hpc v l n eua cde DTNC phu hap vdl k l l qua nghifin euu cua N g u y i n Thi Kim Dung 2013 [1]. Chung minh rang eae DTNC la nhung ngudi cd trinh dp h i l u biet, do vdy hp cd nhung nhu e l u doi hdi, chgn lya nhdng nai ed djeh vu y t l eao, c h i t luang va thieh hep n h i t .
Cd 59,77% DTNC phdi m i l trfin 1 gid va 40,23% d l i t u a n g cd thai gian t u nha tdi v i f n dudi 1 gid. Tf If nay cao han mfit chut so vdi k i t qua eua Nguyen T h l Luang (2002) [6]. Cae b f n h nhi h l u h i t ed the bao hiem y te vdi 96,96% cao han eua N g u y i n !\^inh T u i n (2002) [7] bdi vi b f n h nhi d u d i 6 l u l l d u a e c l p the bao h i l m y t l 100%.
Dgi da so eac gia dinh b f n h nhi cd thu nhdp tuang doi cao, cd kha nang l y chi tra ede dieh vu khdm, xet n g h i f m l y n g u y f n ti If cao han nghifin cuu cua Bui Thuy D u a n g 2011 [8]. S d dT cfi s u khae nhau nay la do hai Ihdi diem cua hai nghien euu khac nhau, linh hinh kinh l l xa hpi ngdy edng phdt trien. Thu nhdp binh quan eua ngudi ddn thdi diem hfim nay da cao han h i n thdi diem cua nam 2011.
Mgt so ly do doi t u p n g nghien cdu lya chpn Khoa DTTNA ehu y l u Id tin t u d n g vao khoa chat lupng cao vdi 91,27%; linh trgng benh c l p tinh 99,36% va t y nguyfin d i n kham theo yeu eau 78,56%. Cdc k i t qua ndy trong nghien c d u cua loi eao han k i t qua nghien c d u cua N g u y i n Thi Kim Dung (2013) [3]. Bdi vi doi tuang nghifin cdu cOa Ifii Id tgi Khoa D i l u tn l y n g u y f n A - B f n h vign Nhi Trung u a n g , ddy la t u y i n y t l cao nhat v l nhi khoa, s y lua chgn cua gia dinh b f n h nhi Id loi u u .
Nhu c l u cua gia d i n h b f n h nhi d o i v d i cac djch v u KCB t u n g u y e n
Dgi da s l DTNC deu cd nhu e l u cao la dupe cdc bdc sT chuyen khoa kham cho b f n h nhi lgi Khoa DTTNA. T h l hifin s y quan tam d^in nhung v l n d l v l ehal lup'ng eung nhu lin l u d n g vdo Irinh dp chuyfin mfin cDa eae bac s t Phu hpp vdl nghifin c u u cOa Bul ThOy Duang (2011) [8].
Mde dp nhu cau cua gia dinh b f n h nhi d u a c cde giao s u kham b f n h eho trfi: Vdl 90,70% ed nhu cau vd thdm ehi 4,74% d l i t u y n g nghien euu cd nhu c l u r l l cao Cho t h i y s y tin l u d n g vdo danh l i i n g va trinh d f chuyen mfin bae t h i y eua eac giao s u dau ngdnh nhi khoa. Cung vdi dgo due chuan myc, h i t Ifing vl b f n h nhi.
B i l u do 3.5 cho t h i y n l u Khoa DTTNA t r i l n khai cde dich vu KCBTN neu trfin vdl muc phi tang them thi mfit s l GDBN van cd kha nang chl tra tuy nhifin mue dp cd khde nhau. K i t qua ndy phCi hffp vdi k i t qua nghifin euu cua Nguyfin Thl Kim Dung (2013) [3].
Moi lien quan g i u a m f t s o dac d i l m cda dol t u a n g nghien c u u v d i nhu cau d j c h v u kham c h u a benh tai Khoa DTTNA
DTNC cd trinh dfi hpe van dgi hpe/sau dgi hpc cd nhu e l u eao g i p 21,78 l l n d l i tupng cd trinh dp hpc van trung hoc pho thong (OR = 21,78) k i t qua ndy cao han n h i l u so vdi nghien cuu cua BCii ThOy Duang (OR = 1,8) [8]; DTNC sinh s i n g d Ihanh thj eo nhu cau eao g i p 9,41 l l n nfing thon (OR = 9,41) k i t qua nay thap han vdi Bul Thuy Duang [8], DTNC eo thdi gian t u nha d i n bfinh vifin trfin > 1 gid cd nhu c l u thap han 0,12 lan nhdm < 1 gid K i t qua nay la phii hap vdi k l l qua nghifin cdu cua Kajal va Guibo (2003) Id khoang each t u nha d i n bfinh v i f n lam giam khd nang lya ehpn djch vy cham soc ngogi vifin [9].
Qua k i t qua nghifin cdu vfi thuc trang nhu c l u djeh vu khdm chua bfinh tgi khoa Dieu Irj t u nguyfn A - B f n h v i f n Nhi Trung u a n g , nhom nghien cdu dua ra mpt so k l l lugn sau:
Doi l u p n g trong nghien euu chu y l u la b l , me eua benh nhi (94,45%) tap trung a dp l u l l l u 21 d i n 40. Dan t f c Kinh e h l l m p h i n ldn (83,49%);
IVlue dp ehfinh Ifich giua nhfim doi tupng nghifin cdu sinh s i n g d thdnh thi vd ndng thon la khfing nhifiu (53,51% so vdl 46,49%). D l i tupng nghien edu cfi thu nhgp binh quan trfin 10 trifiu dong/
thang c h i l m 82,73%.
Phan Idn gia dinh bfinh nhi dua Ire d i n kham tgi Jdioa Dieu lr| t y nguyfn A Id tre d trong tinh
4
; , i ^ . * : D I B J D U O N G 91 INGHIEN c a u KHOA H p c
Irgng bfnh cap linh, b f n h nhg hoae kham sue khoe djnh ky ehiem 96,39%; Ly do t y nguyfn d i n khdm theo nhu e l u chiem 78,56%; lin t u d n g vao khoa c h i t luang cao ehiem 91,27% va ly do khfing phai ehd dpi lau e h l l m 64,33%.
Dol tuang nghifin cuu cd nhu e l u eao d l i vdi mpt s l DVKCB tal khoa D i l u tn t y nguyfn A n h u : kham bdc sy chuyen khoa (92,03%). Nhu eau cdc gido s u kham bfnh cho trfi (90,70); Cd 94,31%
d l i tupng cd nhu c l u dupe xfit nghifim c h i n doan hinh anh ky thudl eao.
P h i n Idn DTNC d i u co khd ndng ehl tra d l i vdl cae DVKCB lai Khoa Dieu trj t u nguyfn A.
Mpt so y l u to nhu trinh dp hoe van, sinh song d thanh thj hay nfing thon, thdi gian t u nha d i n bfnh v i f n la cfi lifin quan d i n nhu c l u djch vu kham ehua b f n h lgi khoa Dieu In t u nguyfin A.
Cdn ede y l u l l nhu cd the bao hiem y t l hay khfing, thu nhgp bfnh quan, kha nang chi tra, thi nhu c l u v l dich vu kham ehua b f n h tgi Khoa D i l u trj t y nguyfn A Id nhu nhau.
6 . K H U Y £ N N G H !
Vdl cac k l l lugn d trfin da eung e l p bang Chung ve thuc trgng nhu d u djch vu kham ehua bfinh tgi khoa Dieu tn t u nguyfin A - Bfnh vien Nhi Tmng uang Id rat cao. Qua dd khuyin nghi:
M d rpng khoa D i l u In t y nguyen A vdl quy mfi h i f n dgi han nua. Xac djnh nhO'ng khd khan, thugn lpi va cfi mpt so giai phap de tang c u d n g t r i l n khai, cung e l p cac djch vu kham ehua bfinh ma d l i t u a n g nghien cuu cd nhu c l u eao, nhu dich vy tra k i t qua xet nghifim, thanh loan phi qua mgng Inlernet va the. Kham giao s u , bac sT chuyen khoa...
T i l p luc nang eao c h i t l u p n g , tinh t h i n thai dp phyc vu cCia nhan vifin y t l lgi khoa D i l u trj t u nguyfn A, l i l n ldi dgt 100% s u hdi long cDa gia dinh bfinh nhi.
Trien khai k l hogch tham dd, khao sat tal ede phong kham l y nguyfin B, C d l xdc djnh tiem nang khdch hdng, nang e l p thdnh Khoa kham va d i l u Irj c h i t lupng cao.
TAI UEU THAM KHAO
1. Chfnh phD V i f t Nam (2008). Q u y l t djnh so 30/2008/QD-TTg bah.hanh ngdy 22/02/2008 phe duyft Quy hoaeh phdt triln mgng ludi khdm, chOa b f n h d i n nam 2010 vd l l m nhin d i n ndm 2020.
2. Bp Y t l - Cyc Qudn 1^ khdm chua bfnh 6$
Y t l (2011), T h i n g ke v l linh trang qud tdi cac b f n h v i f n nam 2011.
3. Nguyin Thj Kim Dung (2013). Thyc trang va mpt so y l u to lien quan d i n s u dyng djch vu kham chua b f n h cho trfi d u d i 5 l u l l cCia ngudi dan xa San Dong huygn Hoai D u e - Ha N f l nam 2012, Lugn vdn t i t nghifp eu nhdn Y hpe d y phfing va Y t l cong cpng, Trudng Dgi hpc Y Ha N f l .
4. T i n g d i l u tra ddn s l vd nhd a (2009). V I . wiklpedia.org/ wiki/Dan t f c - Vifil Nam.
5. D 6 Nguyfin Phuang (2001). Mgl s l v l n d l cdng bdng, h i f u qua trong cdng tdc cham sfic sdc khofi d Vift Nam, Cham sde sue khoe nhan dan theo hudng cong bang vd h i f u qud, Nhd x u l t ban Y h p e ; t r . 3 2 , H a N p i .
6. Nguyen T h l Luang (2002), Nghien cdu mfil so dgc diem nhan khau hpc va nhu e l u , si>
dyng djeh vu y t l tai 3 tfnh m i l n nui, dfing bang va do thi, Ludn van thac sT y t l efing epng, Trudng Dgi hpc Y Ha N f i .
7. Nguyfin Minh T u i n va Hoang Khai Lgp (2002). Thuc trgng khdm chi/a b f n h eCia bfnh nhan cfi bdo h i l m y te va b f n h nhdn phdi trd vign phi tgi m f t s l b f n h v i f n thufic tfnh Ldo Cai. Tgp ehi Y hpc Ihuc hdnh, (9) trang 37 - 39.
8. BGI ThLjy D u a n g (2011). Khao sal nhu d u cham sdc sue khde ngodi gid va tai nha cua bfnh nhdn va gia dinh bfinh nhan d i n khdm bfinh lgi B f n h v i f n Dai hpc Y Hd N f i , Lugn van l i t nghifp Bac sT da khoa, Trudng Dgi hpc Y Hd N f i .
9. Kajal and Guibo Xing (2003). An empirical analysis of Medicare - eligible Veterans'demand of outpatient health care services. Health Sen/ice and outcomes research Methodology, 4(4): p.
221-240.
I 92
N G H I E N c a u KHOA HOC
Phg Lgc 1 Ma so:
Khoa/phong:.,
BO cAu Hdi CHO r^Guiyi NHA BENH NHAN Ngdy: / / 20
1/ THdNG TIN CHUNG V £ GIA D I N H B $ N H NHI
A O L T u l i cua n g u ^ i nha: Tuoi cua b f n h nhi:
A02. Quan he vfi'i b f n h nhi: I . B o 2. Me 3. Ong 4.1 A03. D a n t o c : i . K i n h 2. Khac
A04. Nai d-: Quan/Huyfn: Tinh/Thdnhpho:..
I . T h a n h thj A05. Trinh do hpc van:
1. Tre nhd 2. MLI c h u 3. C l p 1 4. Cap 2 A06. N g h i nghiep:
1. Cong nhan vien chue 2. Lao dpng l y do A07. Thfi'i gian lam viec:
1. T y do
A08. Nghi lam dua tre di kham chira benh:
1. R l l khd khan 2. Khd khdn
A09. T h M gian t u nha den b f n h vien:
1. D u d i 1 t i i n g
A10. Su" dyng bao hiem y te:
1.C6
2. Nong thfin
5. C l p 3 6. Trung d p / c a o dang 7. Dgi hpe/sau dgi hpe
3. Binh thudng 4. De ddng 5. Rat d l ddng
2. Trfin 1 t i i n g
2. Khong
)\CU DUONG 93 I
NGHl£N c a u KHOA HOC
A l l . So c o n t r o n g gia d i n h : . t u l i gidi A12. Thu nhgp binh qudn dau n g u w i / t h a n g : Irifiu d f t n g ^ '
A13. Ly do gia dinh l y a c h p n kham t u n g u y e n c h o trfi? (khoanh trdfi\ao cac li/a chon phO hg^) 1. Gan nha 6. Tin tudng vao khoa c h i t lupng cao 2. Co ngudi nha Idm d day 7. Phong khdm chung dong qua nfin phai vdo
khoa nay
^'' 3. Tinh trang bgnh (a- cap tinh. b- Man tfnh. 8. Con h i l m mupn c- Kham djnh ky)
4. T y dfin theo nhu e l u 9. Khdng phdi c h d dpi ldu 5. Trfi sa sinh (dudi 1 thdng l u l l ) 10. Do cd ngudi gidi thif u A14. Gia dinh da tCrng dira tre den kham tgi khoa t u n g u y $ n A bao g i a c h u a ? 1.Co>4,'; 2. Chua CO
11/ N p i DUNG CHiNH
1. Nhu d u cua gia dinh benh nhi ve djch vy khdm chOa bfinh t u nguyen
Theo anh/chj, b f n h v i f n cfi nfin trien khai ede djch vu d u d i day hay khdng? N l u ed, xin cho bilt mdc dp uu tlen. (Danh diu V vio cic 6 phu hgp)
Mi
B01 B02 B03 B04 B05 606 B07 B08 B09 BIO Bit B12
^ ^ _____^ Mucdfmififn
Teh dich vu 1 2 3 4 5
t : Wrongrr^n, 2:Wennl\mgkb6hhaibi,3:Khongro,4.Nen,5.Hatn&n Kham bac si chuydn khoa
Khfm giao su Kham, d i i u Iri ngoai tnj Kham long quft, dinh ky
Kham, theo ddi trang ngay ' ' Dang k)? khfm qua difn Ihoai
Dang ky kham qua internet Xet nghiem theo yeu cau
Tra ket qua x f l nghifm, kf don thuoc qua mang Xet nghiem chf n doan hinh anh ky thuft cao lito theo yeu c f u
Thanh loan phi KCB qua mang
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"i
NGHIEN Cl7U KHOA HOC
Neu CO tre den kham benh t y nguyfn, xin gia dinh cho biet mOK 66 nhu cau ve cdc djch vu du-OT day? (Banh diu V vio cic 6 pha hop)
lila
COI C02 C03 C04 005 C06 C07 COS C09 CIO CII C12
' Muc df nhu cau
Tfn djch vu " 1 2 3 4 5
t Rit tiling cd nt)u ciu, 2: Khing c6 nhll ciu ,3: Khing ro, 4: Cd nho c^o, 5: Rat cd nhu ciu Khfm bfc sT chuyen khoa
Kham gifo su Kham, dilu in ngoai tnj Khfm tong quat, djnh ky Kham, theo doi trong ngf y Dang ky khfm qua difn thoai Dang ky kham qua internet Xet nghifm theo yeu cau
Tra ket qua xet nghifm, kf don thuoc qua mang Xft nghifm chin dof n hinh anh ky thuat cao luio theo yf u clu
Thanh todn phi KCB qua mang
Neu gia dinh co nhu cau ve cac djch vu tr§n, xin cho biet kha nang chi tra ve cdc djch vu dyo-i day. (Danh diu V vio cac 6 phu hgp)
Ua
DOI D02 D03 D04 D05 D06 D07 DOS D09 DIO Dll D12
Khanfngchitra(KNCT)
Tfn dich vu _ _ _ _ ^ 1 2 3 4 5
). Rdt khong cr) KNCT, 2: Khing cd KNOT, 3- Khing ri. A: Co KNCl 5: Rit ci KNCT Kham bac si chuyf n khoa tang 20%
Kham giao su tang 30%
Kham, ^eu tn ngoai inj tang 20%
Kham tong quat, dinh kji tang 10%
Kham, theo ddi trong ngdy tang 30%
Dang k^ ktiftn qua difn thoai tang 15%
Dang ky khfm qua internet tang 15% >
Xft nghifm theo yfu cau tang 5-10%
Tlf ket qua xft nghifm, kd don thufc qua mang lang 30%
Kham chan doan hinh anh ky thuft cao tang 30%
M l theo yeu cau tang 10%
Thanh toan phi KCB qua mang tang 10%
Xin chan thinh cam on stf hop tac ctJa gia dinhl
CfS,f. L-lEU D U O N G
,k^'
NGHIEN CLiU KHOA Hpc
P H U L U C 2
MLFC d$ nhu c l u sir di^ng djch vu kham chira b^nh t^i Khoa DTTNA - B | n h v i | n Nhi Trung i f o n g nam 2014 (thang d i l m ^ 1 den 5 diem)
Miic 6Q m tien t n l n ktiai cung cap cac djcti vy khSm ctiOa b^nti l y nguydn (1 = r i t khflng nen, 2 = ktiong n§n, 3 = blnti thiiong, 4 = nen, 5 = d t n6n)
Mi>c dQ c i n thiet khdm t^i khoa dieu tn ti,!' nguy$n A (1 = riit khflng c^n thilt, 2 = khflng can thiet, 3 = binh thiycmg, 4 = can thiet, 5 = r i t d n (hilt)
Nhu cau ve djch vy kham chij-a benh tif nguydn (1 = rat khdng co nhu d i u , 2 = khflng co nhu cau, 3 = binh thu>crng, 4 = co nhu cau, 5 = nhu cau rat cao)
Nhu cau dat ljch h?n kham qua di§r tho^i/inlemet (1 = r i t khong co nhu c^u, 2 = khong co nhu Cciu, 3 = binh thifcrng, 4 = c6 nhu cau, 5 = nhu c^u rat cao)
Nhu c l u ve djch vy giao su.bSc sT chuygn khoa k h i m benh cho tre (1 = r^t khong co nhu cau, 2 = khong cfl nhu c&u, 3 = binh thuwng, 4 = co nhu c l u , 5 = nhu cau rat cao)
Nhu cau ve ISm cac x6t nghiem (1 = rat khflng co nhu cau, 2 = khong co nhu cau, 3 = binh thuang, 4 = cfl nhu cau, 5 = nhu c l u r i t cao)
Nhu cau ve xel nghiem dian doan hinh anh ky thu|t cao (1 = rat khflng cfl nhu d u , 2 = khflng cfl nhu d u , 3 = binh thucmg, 4 = cfl nhu d u , 5 = nhu d u r i t cao)
Nhu d u ve mo Iheo yeu d u va theo doi tal chfl (1 = rat khflng cfl nhu cau, 2 = khfing cfl nhu d u , 3 = binh Ihuwng, 4 = co nhu d u , 5 = nhu d u r i t cao)
MLPC dfl U'u tien trien khai dich vy thanh loan phi KCB qua the, mgng ( % r i t khfing nen, 2
= khflng nen, 3 = binh thu'dng, 4 = nen, 5 = r l l nen)
Kha nang chi tra phi dich vy gia t^ng (1 = r i t khfing cfl kha nang chi tra, 2 = khflng cfl kha nang chi tra, 3 = binh thifflng, 4 = cfl kha nang chi tra, 5 = r l l co khS nang chi trfl)
B9 cau hfli
B$ cau hfli
Bfl c3u hfli
Bfl cau hoi
Bfl c§u hoi
Bfi cdu hdi
Bfi cau hoi
6 o cau hfli
66 c3u hfli
Bfl cdu hfli
Phflng v4n
Phfing v l n
Phflng v l n
Phflng v l n
Phflng van
Phflng van
Phong v l n ^
Phong van
Phflng van
Phflng v l n