Nghien
CLFU- Ky thuat 'n
Cac benh vien c i n t i l p tuc ung dung edng nghe thdng tin trong qua trinh dau thau de giam bdt thdi gian va edng sue.
Summary
As medical establishments have purchased medicines for medical examinations and treatments by bidding, this study assessed the actual status of the hospital drug procurement. In 2010. 90% drug list were contract-awarded. The contract-awarded prices in 2010 mainly ranged at
± 10% against 66.7%o for 2009. In 2010, the contract-awarded prices were not higher than the wholesale ones. Generally, a complete bidding process in hospitals took ca. 5-7 months
Tai lieu tham khao
1 Bp Y te Bo Tai chinh, Huong din diu thau mua thude trong cac ca sd y te cong lap. Thdng tir hen tich 10/2007nTLT-BYT-BTC (2007).
2. Bo Thuang mai, Trung tam thdng tin thugng mai. Tap chi thdng tin thuang mai, chuyen nganh dugc va trang thiet bi y te (2010).
3. Chinh phii, Hudng dan thi hanh mdt s6 dilu cua Luat dau thiu, Nghi djnh 85/2009/ND - CP (2009).
4. Cue quan ly Dugc Viet Nam, Bao cao tong ket cong tac dugc nam 2009, trien khai ke ho^ch nam 2010(2009).
5. Quoc hgi, Luat dau thiu, Luat so 61/2005/QH11 (2005).
Thirc trang ton trfr thuoc fr cac ho gia dinh tai
"7
hai xa Thieu Long va Cam Binh tinh Thanh Hoa
Dat van de
Thude tdn trii' tai nha la mdt trong cac thdng tin phan anh viee ty sii' dung thude cua cac hd gia dinh, mac dau cd tii thude tai nha cung thuan tien khi gia dinh ed ngudi bi dm nhe va ngudi diing eung ed hieu bilt v l nhung loai thude thdng dung nhu paracetamol va mdt sd loai thude cam. Tuy nhien, n l u qua lam dung tii thude tai nha d l t u dieu tri ed the gay ra nhung hau qua rIt dang tile, n h l t la ty sir dung cac thude khang sinh va cae thude phai ke dan. Mat khac. ngudi sir dung thude d u trir se khd tranh khdi diing phai thude m i t pham c h i t do bao quan khdng tdt, do thude qua han, hoac diing sai chi djnh, sai lilu...va la s y lang phi dang ke.
Viee d u trii' thude tai gia dinh, n h l t la cac khang sinh edn ehii'a dyng nguy ea khdng tuan thu y lenh, vi ngudi dan thudng khdng diing thude dii lilu, nhat la vdi thude d u trir k i l u "de danh" '''' Mdt sd tac gia nudc ngoai nhu Kiyingi (1993) eung da ehi rd viec d y trii' thuoc vira lang phi vLj'a nguy hiem '^' Viec d y tru thuoc tai^gia dinh
Tran Thi Thoa', Truong Viet Dung", Nguyen Thi Thu', Pham Quoc Bao'
Trumm dgi hgc Y Hu .\'gi. 'Bg )'le de sir dung cd nhieu mdi nguy c a anh hudng din sifc khde nhu vay nhung tai Viet Nam, sd lugng cac nghien ciru v l tinh hinh thuoc cd tai nha va du tru" thude d hd gia dinh cdn chua nhilu, do vay nghien cii'u nay dugc t i l n hanh n h i m mue tieu Xae djnh ty le hd gia dinh cd tdn trir thude d nha va md ta tinh hinh d u trir thuoc ciia cac hd dan tai hai xa Thieu Long va Cam Binh tinh Thanh Hda.
Doi tu'O'ng va phu'O'ng phap nghien
CLFUDja d i l m , doi tu-ang va thd'i gian nghien
CUPU
Dia diem nghien ciru: Nghien cifU dugc tiln hanh tai hai xa; Thieu Long (xa ddng bing) thude huyen Thieu Hda, Cam Binh (xa mien niii) huyen Cam Thiiy tinh Thanh Hda
Doi tUKyng nghien cim: chii hd gia dinh (c^c ba me/dng bd); ngudi 6m.
Thai gian nghien ciru: viec thu thap sd lieu dugc t i l n hanh lam 2 dgt; dgt 1 vao thang 4 nam 2008 va dot 2 vao thang 12 nam 2008.
Phu'O'ng phap nghien cii'u
Thiet ke nghien ciru: Nghien eifu md ta e l t ngang.
Ky thuat thu thap thong tin: Phong v i n tai cac hd gia dinh (HGO) bing bd cau hdi v l tinh hinh sif dung thude trong thdi gian dilu tra, k i t hgp vdi quan sat tu thuoe/hdp thuoc ciia hd gia dinh va ghi chep lai cac thdng tin v l thuoc cd tai nha theo bieu mau dugc thilt k l s i n . Viec phdng v i n duge thue hien trong 2 dgt nghien ciru.
Ca mau nghien ciru
Ca m i u dugc tinh theo cdng thifc udc tinh mdt tl le trong nghien ciru md ta e l t ngang. Oan vi chgn m i u la hd gia dinh. Sd hg gia dinh dilu tra cho mdi xa nghien ciru la;
pq
'i - ^ (1 - aJ2)
(ep)'
+ Vdi dp tin cay 95%; Z , , . ^2) = 1,96.
+ p = 0,5 (gia dinh la tl le hd gia dinh cd thude tai nha la 50%); q = 1- p ; s = 0,1; n=384.
Lam trdn m i u la 400 hd. Nhu vay, mdi xa e i n chpn 400 hd gia dinh, mdi dgt ia 800 hd gia dinh tai 2 xa nghien ciru. Thye t l , sd hd d i l u tra trong 2 dgt nghien ciru la 1614 hd gia dinh (dgt 1 la 814 hd; dgt 2 la 800 hd). So hd cd sd lieu ve ton tru thude la 1608 hd.
+ Cach chpn miu; Tir danh sach hd gia dinh trong xa dugc chpn (xIp theo thir ty ABC), boc tham ngau nhien chpn hd d i u tien, eac hd tilp theo chpn theo phuang phap "cdng liln edng" de
Ket qua nghien
CLFUTy le ho gia dinh co ton trO thuoc tai nha
dugc 400 hd trong mdt xa. Trong qua trinh dieu tra, cac hd v i n g hoac ddng cira hoac tif choi tham gia nghien ciru dugc thay the bing hd k l tilp.
Phwang phap phan tich xir ly sd lieu So lieu sau khi thu thap dugc lam sach va nhap vao may vi tinh b i n g p h i n m I m Epidata 3.02 va dugc xd ly, phan tich tren phan m I m Stata 10. Sir dung thuat toan x^ de so sanh hai hay nhilu ty le d mire y nghTa t h i n g ke a=0,05.
Mot s6 khai niem trong nghien cii'u Thude thifa: Thude de lai tii' lin dieu trj trudc.
Thude dy tri)'; Thude mua d y phdng
Thude hien cd (ton trCr) tai nha; gdm thuoc thifa, thude dang sir dung va thude dii' trif.
Thude duge bao quan tdt va bao quan khdng tdt; Vi nghien ciru thude d cdng ddng nen chi xet theo tieu ehi cam quan:
+ Thude dugc bao quan tot; Thude dugc de rieng trong hop thude, tii thude hoac trong cac tiii ni Ion, duge giu sach se, khd rao. Nhin cam quan VI thude, Ip thude khd, sach, dep, khdng bj raeh, khdng biln mau, khdng am mdc, khdng dinh kit.
+ Thude bao quan khdng tdt; Nai giu thuoc trdng khdng duge sach se, khd rao. Nhin cam quan vi thude, Ip thude, gdi thude bj am, mdc, raeh vi, biln mau, k i t dinh.
Phan loai giau ngheo: Sir dung thdng tin udc tinh ve tdng thu nhap hg gia dinh de chia dan sd thanh 5 nhdm mipc song: ngheo nhat, can ngheo, trung binh, kha gia, giau n h l t ed sd ngudi bing nhau ehilm 20% dan so (Quintile).
B a n g 1 : Thude hien co tai Ccic hd gia dinh va phan loai Ccic thude nay
^ , . , ^ Xa Thieu n
Tong sd hp gia dinh nghien cuu 811 Ty le hp gia dinh cd ton trCr thuoc 538
Long
%
100 66,1
Xa Cam Binh n
797 645
%
100 80,6
theo xa
Chung hai xa n
1608 1,183
%
100 73,3
P
<0,05 Phan loai thuoc hien cd
Thuoc thua ciia l i n dieu tri trudc 197
Thuoc d u trO' 159 Thuoc dang sir dung 361
36,6 29,6 67,1
309 235 286
47,9 36,4 44,3
506 394 647
42,8 33,3 54,7
<0,05
<0,05
<0,05 Ghi chu: Thude hien cd d nha trong nghien
ciru nay bao gom thude tan duge va thude ed ngudn gdc dugc lieu nhung da duge san x u l t thanh thude vien, thude vi, cao xoa. Theo hudng d i n cua d i l u tra Y te Qude gia nam 2002 gpi chung la thude tay y.
Cu 5 hd thi g i n 4 hd ed thude tai nha (73,3%).
Ty le nay d xa Cam Binh (mien niii) cao han h§n xa Thieu Long (dong bing) (80,6% so vdi 66,6%)).
Thude ed s i n tai nha cd the dang sir dung (Thieu Long cao han Cam Binh) hoac de dy tru phdng khi dau dm, hoac thude thi^a eiia l i n dilu trj trudc (Cam Binh cao han Thieu Long). Sy kh^c bi$t giii'a 2 xa cd y nghia thdng ke vdi p<0,05.
TAP CHi DUOC HOC - 8/2011 (SO 424 NAM 51) IS
Nghien
CLFU- Ky thuat
Ngudn gdc cac thude tai nha theo nhdm thu nhap
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ill 20.2
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19.1 20.6 20.3 19.8
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Ngiieo iiliat Cfia ngheo Tniiigbuili ICJiagw GiauiilKit
Hinh 1 : Ty le ho gia dinh co thude a nha va mua thude dw trO theo nhom thu nhap Giii'a eac nhdm thu nhap khdng cd s y
khac biet v l ty le hd gia dinh cd thude d nha nhung cd s u khac biet v l ty le hd mua d y trii' Cac nhdm thude d y trip tai cae ho gia dinh K i t qua nghien ciru dugc the hien trong hinh 2:
thude. Hd gia dinh cd miPC thu nhap cang cao, ty le mua thude d y t r y cang cao (p<0,05).
L:..
D X ; I d o i i y t i j i i i g Xri iiueii milSS80
70 60 50 40 30 20 10 0
7 i : 5 "
28 3 Tr.s"
-32rr
4-.^ 3.3,.. .4.,4-5^^j).-
Kh;n I'J .smli H ; i . ,<>1 LIKlIll t t . l l l
X ' l l M i u m T i j u c l i j u . A l l t l i a i i
Hinh 2: Cac nhdm thuoc gia dinh dw trO Nhdm thude cac gia dinh du trir nhilu nhlt la
cac nhdm ha nhiet giam dau, gan 2/3 sd hd gia dinh d hai xa dang du trir nhdm thude nay (ty le tuang irng la 58,5% xa Thieu Long; 71,5% xa Cam Binh).
- G i n 1/3 sd hd gia dinh d y tru" thude khang Tinh hinh bao quan thude
sinh (Thieu Long 28,3%.; Cam binh 31,5%).
- Cae hd gia dinh g xa mien nui Cam Binh c6 xu hydng d u trCr thuoc nhieu han cac hd gia dinh xa ddng b i n g Thieu Long a hau h i t t i t ca cae nhdm thuoc.
Bang 2: Tinh hinh bao quan thuoc va chat Iwang thuoc tai hCp, tu thuoc gia dinh
Nhdm thuoc
Thuoc dugc bao quan tdt Thuoc bao quan khdng tdt
Thude h i t han diing Tong
Xa Thieu Long n
386 146 31 538
%
71,8 27,1 5,8 100,0
Xa Cam Binh
n Vo 503 78,0
147 22,8 56 8,7 645 100,0
Ch n 889 293 87 1,183
ung 2xa
%
75,2 24,8 7,4 100,0 P h i n Idn thuoc cd tai nha dugc bao quan tot
(75,2%) nhung van cdn 1/4 gia dinh cd thude bao quan khdng tdt va cd d i n 7,4%o thude cd tai nha h i t han diing. Ti le nay d xa m i l n niii Cam Binh nhilu han xa ddng b i n g Thieu Long (p<0,05).
Ban luan
Cd the ndi r i n g hau het cac hg gia dinh trong mau khao sat vi n h i l u ly do khac nhau d i u eo tdn trir thude, trung binh cip 5 hp thi cd 4 hd c6 thude d nha (73,3%)). Ty le nay d cae hp gia dinh xa Cam Long ( m i l n niii) cao han xa Thieu
Long (ddng bing) (80,6% so vdi 66,6%)). K i t qua nghien cifu nay tuang duang vdi k i t qua ciia dilu tra y t l qude gia nam 2002, ty le thude tay y hien ed d nha la 68% '^' (thuoc tay y dugc xae djnh nhu nghien ciru nay). Khi phan tich sau han v l ngudn gdc cac thude nay cho thIy; thude cd s i n tai nha cd the dang sir dung (54%) hoac de dy triJ" phdng khi dau dm (33,3%), hoac thude ciia l i n dieu trj trudc dd cdn thica (42,8%)). Nhu vay, thude thi^a sau khi sir dung hay duge ngudi dan giu lai, cac loai thude nay ciing vdi thude mua dy trir cd t h i d i n den viec sir dung cae thude qua han hoac thuoc hdng neu ngudi dan khdng de y d i n han diing va c h i t lugng thude.
v l cac nhdm thude gia dinh d y trii' (hinh 2), nhdm thude hay dugc dy trir nhlt la nhdm ha nhiet giam dau, phai g i n 2/3 cae gia dinh du tru' nhdm thude nay (66,2%), xep thir hai la cac thude khang sinh (30,2%). Oay la d i l u rIt dang quan tam vl khang sinh la nhdm thude chi diing khi ed sy ehi djnh eua thay thude va ban theo dan nhung v i n duge eac gia dinh dy trir de ty sii' dung. Viec ty sir dung cae thuoc khang sinh nay dang lam tSng tinh trang khang thuoc trong cdng ddng va trd thanh mdt v i n de kha nan giai de dga tdi nhii'ng thanh tyu trong nganh Y t l . Xem xet tinh hinh bao quan va c h i t lygng thude tai tu thude hd gia dinh (bang 2) eho thIy: ty le thude bao quan khdng tdt kha eao ca d 2 xa (xa ddng bing 27,1% nhieu han xa mien nui 22,8%)) va ed den 7,4% thude da h i t han sir dung (xa miln niii nhilu han xa ddng bing). Cae k i t qua nay cung tuang ty nhu d cac nudc dang phat then; Thude duge dy tru- tai nha hoac do diing chua h i t de danh lai eho nhii'ng l i n sau ma khdng bilt d i n han diing, ke ea nhilu thuoc b i t budc phai ke dan va cac thude dang dung dich d l hdng eung thIy d eac hop thude cua cac gia dinh'^'^'
Phan tich thude eac hd gia dinh d y trLP theo mire thu nhap (hinh 1) eho thIy; ty le thuoc cd d nha cua eac nhdm thu nhap g i n nhu nhau nhung thude dy trii' tai cac gia dinh lai tang theo mifc sdng. Mirc sdng cang eao, ty le thude dy trir cang cao (nhdm giau 25,4%, trong khi nhdm ngheo la 15,4%,). Ngudn gdc cac thude d y trtp chii y i u la mua nen cae gia dinh cd mirc song t h I p it cd dieu kien de d y tru' han.
Ngoai ra, cac gia dinh d xa miln niii Cam Binh cd xu hudng dy trir thuoc nhieu han cac gia dinh xa ddng bing Thieu Long d hau h i t t i t ca cac
nhdm thuoc (hinh 2). Cd the do di lai xa han nen cac gia dinh xa mien niii Cam Binh hay dy trij' thuoc han. Tuy nhien, xa miln niii Cam Binh lai cd thude diing thira nhieu han xa ddng bing Thieu Long (47,9% so vdi 36,6%) (bang 1).
Tir k i t qua tren, ca 2 xa deu ed nguy ca diing thude qua han/thudc hdng, trong dd x§
miln niii Cam Binh nguy ca cao han xa ddng bing Thieu Long. N l u nhu khi sir dung thuoc, cac gia dinh khdng ehii y d i n han diing, khdng kiem tra han diing va c h i t lugng thude thi rat nguy hiem. Thude qua han cung nguy hiem nhu thude gia vi nd cung cd nguy ea khdng cdn t^e dung '^' Thude da qua han sir dung se d l bj phan huy, len nam moc va ph^t sinh nhu'ng chat ddc cd hai cho sifc khoe. Khi sir dung thuoc quci han nghTa la thude khdng dam bao chat lugng nen viec dieu tri se khdng hieu qua, tham chi nd ed nguy ca xay ra nhii'ng bien chirng vd ngd ddc thude.
Nhu vay, thuoc cd tai nha vd d u tru' thuoc de ty sir dung lam tSng nguy ca viec sir dung thuoc khdng diing, khdng ari todn, khdng hgp ly. Trong khi v i n de nay dang dang bao ddng d Viet Nam '^' Ket qua nghien ciru tren cho thay viec d u trii' thude tai eac hd gia dinh de t u sir dung dang Id van de phd bien. Oe giam nhirng nguy hai do viee t u sir dung thude gay ra, eac chuang trinh truyin thdng, giao due sire khde e I n phai tdng eudng de cung d p thdng tin ve sir dung thude an todn, hgp ly cho ngudi dan.
K§t luan
Ty le hd gia dinh ton trir thude kha pho bien;
66% vdi xa Thieu Long (ddng bdng), 80,6% d x§
e l m Binh (mien niii); tinh trang giir thude thira tdi 47% vdi xa Cam Binh, 36,6% vdi xd Thidu Long vd ed d i n 1/4 thude tai cae hd gia dinh d 2 xd trong tinh trang bao quan khdng tdt; 7,4% so gia dinh cd thude h i t han cho thdy nguy ca dung thude qud han hodc khdng cd chat lugng khd cao, ddc biet Id xd mien niii Cam Binh.
Ty le hd gia dinh mua thude de d y trir khd eao (29,6% sd gia dinh d xd ddng bdng Thieu Long vd 36,4% sd gia dinh xa mien niii Cam Binh). Sy d y trii' thude tdng theo mirc sdng, nhdm gidu dy trir thuoc nhieu han edc nhdm nghdo (24,5% so vdi 15,4%). Ty le hd gia dinh dy trO thude khdng sinh cung kha Idn (1/3 sd hO gia dinh) cho thay viec ty sir dung khdng sinh khd pho bien trong cdng ddng ca d 2 xd.
TAP CHi DUOC HOC-8/2011 (SO 424 NAM 51)
17Nghien CLFU - Ky thuat
Summary
The study was carried out in 2 communes:
Thieu Hoa (a commune in plain area) and Cam Binh (a mountainous commune) of Thanh Hoa Province. Result: The percentage of households keeping medications at home is quite high (plain: 66%, Cam Binh: 80.6%), the percentage of people maintaining leftover medication reaches 47%, in Cam Binh and 36.6%o in plain communes, and 1/4 of medications at the households of the two communes are not preserved correctly: 7.4%o of the families keep expired medicines which means that the risk of using expired or unqualified drugs is quite high, especially in the Cam Binh commune. The rate of households buying drugs for reserve is quite high. There is a difference of drug reserve between the two communes and between living conditions: households in the mountainous commune reserve drugs more than the households in the commune in plain area (36.4%, vs 29.6%,): rich households reserve drugs more than the poor (24.5%, and 15.4%o). The significant rate of households reserving antibiotics (1/3 of the households) demonstrates that the use of antibiotics for self-medication is quite common in both communes.
Tai lieu tham khao
1. Bd Y t§, Tong cue thong ke, Bao cao ket qua dilu tra y t l Qude gia 2001-2002, Nha xuit ban Y hpc, (2003), Tr. 168-215.
2. Bo Y te -Trudng Dai hoc Y Ha Ndi, Nghien ciru tinh bat hgp ly trong chi djnh thude va d l xult nang cao tinh hgp ly trong sir dung thuoc tai mot sd b?nh vi§n d Miln Bic Viet Nam, Sao cao de tai nghien ciru khoa hoc cip bo. Bo Yte. (2010), Tr 7-8
3. Luu Hoai Chuan , Vin de cung irng thuoc cho ngudi ngheo d viing ndng thdn va mien niii, Cung ifng thuoc thiet yeu de cham sdc SLPC khoe cho ddi t- ugng chinh sach, ngudi ngheo, viing ngheo, Nha xuat ban Y hoc, (1996), Tr 59-64.
4. Nguydn Van Hiing, Nghien ciru vai trd ciia thay thuoc ngudi benh ngudi ban thuoc trong viec sir dung an toan va hgp ly thuoc d cdng ddng xa, Luan an tiln sT Y hgc. Trudng Dai hoc Y Ha Noi, (2002), Tr 110-111.
5. ICDRA, An influential forum for drug regulations, WHO drug infomnation, (1994), 8(2), pp.43.
6. Kiyingi KS, Lauw/o JA , Drug in the home:
danger and waste. World Health Forum, 1993, 14: p.
381-384.
7. Saeed Asefzadeh, Drugs at Home in Qazvin, Iran: Community Based Participatory Researcli, European Joumal of Scientific Research .ISSN 1450- 216X Vol.32 No.1 (2009), pp.42-46.
Nghien CIIU tac dung dieu tri viem gan man tinh cua che tan anganic
Dat van de
Viem gan man tinh (VGMT) Id tinh trang viem nhiem hoai tip t l bao gan do nhilu nguyen nhan gay ra keo ddi it nhdt 6 thdng. VGIVIT thudng la hau qua cua viem gan cdp, tuy nhien d nhilu trudng hgp benh tien trien am tham vd chi the hien d giai doan man tinh. Tien then cua VGMT cd the khoi nhung nhirng truang hgp ndng thudng din tdi xa gan va ung thu te bdo gan (ddc biet la VGIVIT hoat ddng do cdc virut viem gan B, C). Cd nhieu nguyen nhan gdy VGMT, nhung nguyen nhdn chu yeu la do virus, do thuoc vd tu miln'^'^'^'
Nguyen Xuan Khu Benh vien Y hgc co truyen Sam La
