NHU CAU CHAM S6C SLPC KHdE TAI N H A CQA BENH NHAN Dieu TR! NOl TRU T^l BENH VI$N P H 6 | TRUNG U-ONG
B|ng Dut Nhu'*, Hoing Hum ToanS Tr4n Vfin Ti4n^
'Khoa YDupc - Dpi hpc Quoc gia Hd Npi 'B^nh vifn Phoi Trung uomg
'Tru&ng Dpi hpc YHd Npi
TOM TAT
Nghidn cdu m6 t i cit ngang du>ac thi/c hi^n trdn 345 b$nh nhdn npi tm v^ nhu c i u djch vii cham sPc sftc khde t9i nhd d B$nh vi$n Ph6i Trung uo-ng nSm 2014. KSt qui cho thiy. co 215 nam gidi (62,32%) v i 130 nQ gidi (37.68%), chi cd 31,59% d6i tipgrng c6 nhu ciu chSm sdc sdc khde t^i nha, trong dd tip tnjng chi^
ySu vdo nhu ciu tu vin sdc khde (26,54%) vd nhu ciu khdm chuydn khoa (22,96%). V^ khi ning chl tri cd 33,71% ddi tupng sin sing chi tra khi dii phi tdng Idn 30% cpng vdi chi phi di lai cho dich vg ndy. Cin ndng cao nh$n thdc cOa ddi tuang \h lo^i hinh chdm sdc sdc khde tai nha
Td khda: Chim sdc sdc khde tgi nha, bdnh nhdn npi tnJ, Bdnh vi§n Phdi Trung uwng.
L D A T V A N D E
Nhu ciu chara sfic sue khfie (CSSK) di cfi tft rat lau trfin thfi gifii, dac bifit li eic nude phit trien [1]. C) Vifl Nam, tft sau khi dat nufirc giinh dupc dpe Igp, nginh Y tfi cung nhu nfin kinh tfi cua dit nufirc ngiy cing dupc nang eao keo tbeo dfi li nhu eau CSSK cua ngufii din cung ngiy cing Ifim [2]. Theo bio eao dinh gii tinh ttgng qua tii efta mpt sfl Bfnh vifin tai Hi Npi v i Thinh pho Hfl Chi Minh (2008) do Vifin Chifin lupc vi Chinh sich Y tl thye hien, tit ci bfnh vifn dupc dieu tra dfiu hogt dfing vupt cflng sual thiet kfi: cong suit sft dpng giudng bfnh lufln tft 165% den 200%; sfl giudng bfinh thyc kfi vupt so vdi s6 giudng chi tifiu dfin 200%. Tmh trang qua tii xiy ra d ci khu vyc difiu tri nfii ttm vi khim bfnh ngogi ttm [3]. Bio eao da ki^n nghj mpt sfi giii phip lau dii de kifira soat tinb tt^g niy, trong do cfi giii phip da dgng hfia eie loai binh dieh vp y tfi, bfnh vifn nhu mfi hinh bfnh vien ban ngiy, phat ttifin mfi Wnh bic sT gia dhih vi djch vu CSSK tai nhi [3]. Djch vu CSSK tgi nhi da vi dang mang lai nhieu tifn ieh nhit djnh
cho ngudi bfnh vi giup mpt sfi bfnh vifn giim tinh trgng qui tii nhu Bfnh vifn sin Trung uong sau 5 nira trifin khai CSSK sin lgi nhi, di giam tii bfnh nhin npi trft trung binh 58 bpnh nhan/
ngiy [4]. Mae dft ^ ed rat nhifiu nghifin cftu ve djch vy CSSK lgi nhi ttfin the gifii. Tiiy nhien, d Vifl Nam con chua nhifiu, d$c bift doi vfii bfnh vifn diu nginh nhu Bfnh vifn Phoi Tmng uomg vi trfin dfii tupng bfnh nhin nfii tni da phin mic bfinh ning, man tinh dl bj tii phit thi nhu eau dupe CSSK tai nhi dfi dupc chim sdc tflt ban li khi lom [5]. Vi vgy, nhim eung eap bing ehftng cho Ban linh dgo vi quin li Bfnh vipn Phfli Trung uong ttong vipc lgp ke hogch, giii phip nhira dip ftng tot hon nhu ciu CSSK eua ngudi bfnh, ehung tfli tifin hinh nghifin eftu niy voi myc tieu mfl ti nhu eau vfi djeh vy CSSK tgi nha cua bfnh nhin npi tni tai Bfnh vifn Phfii Tnmg uong nira 2014.
IL PHU'ONG PHAP NGHIEN CtTU 2.1 D6i tupng vi thfii gian nghien ctru
*Tac gia: DJng Dure Nbu Dja chi: B?i hpc Quoc gia Hil Ngi Di?nth09i: 0912.186.919 Email: [email protected] 100
Ng^ynh§n bdi: 25/02/2015 NgSy phin bien: 20/03/2015 Ngiy dang bii: 20/04/2015
Tgp Chi Y hpc dy phfing, Up XXV, Sfi 3 (163) 2015
Wgnien cuu duae tifin hinb ttfin 345 benh nhan nfii tru difiu tri tgi Bpnh vipn Phfii Trung utnig tft tiling 11/2013 dfin thing 9/2014.
Cic dfii tupng dupe chpn vio nghifin cftu neu dip ftng ,3ay du eic lieu chuin lya ehpn nhu sau: i) bpnh nbin difiu trj nfii trft; ii) tt^n 18 tufli; ill) khflng co cic diu bieu tfln thuomg ve tinh ttiin vi nhin tiiftc inh hufimg dfin vifc tti Ifi'i hoin thipn bp cau hfii; i) dfing y tham gia vio nghien cuu.
2.2 Phuorng p h i p
Su dpng thifit kfi mfl li eit ngang.
2.3 Cfl- mau
Dya vio ed mau ude tinh tiieo mpt ly If cho trude qua cong thftc sau:
„ = ,= p('-p) Trong do:
n: Cd mau can thifit
a: Mfte y nghi thflng kfi (ehpn a=0,05 ung vdi dp tin eiy 95% thay vio bang ta dupe p=0,35: Ty If bfnh nhan npi trft efi nhu eau vfi djeh vy CSSK tgi nhaqua dieu tra Ihu.
E=0,I5: Sai so mong mufin gifta miu nghifin ciiu vi quin the
Ta tinh dupe co miu li 317, trfin thyc tfi ehftng tfii thu thgp dupc 345 dfii tuong.
2.4 Cich chpn mau
Cd mau eho nghifin eftu dupe lya chpn theo phuang phip ehpn mau ngiu nhifin cfi hf tbong. E>ya vio so sich ta Ifindanh sich tit c i cic bpnh nbin bien dang difiu tti d tning khoa phfing tgi Bfinh vifn Phfii Trung uong, sau dfi dya vio cd mau, sfi bfnh nhan dang difiu bi tgi ning khoa phfing ta tinh dupc khoang mau k cho tftng khoa phdng. Tgi tiingkhoa phfing, ta ehpn n ^ u nhifin so i trong khoing tft 1 den k, cie bfnh nhin dupc chpn efi eon sfi thft ty lin lupt la i:
i-Hk; i+2k;.... eho dfin khi kfit thuc danb sieb.
Cic dfii tupmg tham gia nghien cuu dupe phdng vin bing bp cau hfii ducrc tt^ Uiifil kfi.
Bp ciu hfii bao gflm eic nhom bifin sfl vfi die difim, thflng tin chung cua dfli tupng (tuoi, gidi, trinh dp hpc van, nghfi nghifp, thdi gian lam viec, thfii gian tft nhi dfin vien, tinh trang sue khoe, bio hifira y te..) vi bifin sfl xac djnh nhu ciu CSSK lgi nhi efta dfli tupng (nhu cau CSSK tgi nhi, nhu cau ve chuyfin khoa dupc CSSK tai nhi vi khi ning ehi tri phi djeh vy gia ling).
2.5 Xu ly v i phin tich so lifu
Sfi heu sau khi thu thap sfi dupc lira sach va nhgp vio miy linh bing phin mfim EpiData 3.1.
Dupe phin tich bing pbin mem STATA 12.0.
IH. K E T QUA
3.1 Die diem chung cua d^i tupmg nghien cum
Bang 1. ogc di4m chung cua ddi Ur<)mg nghidn cdu (n=34S) Dgc di4m c
Gk!n
Bio hilm y t4 (BHVT)
Thdi gtan td nhd tdi vidn
Mdc dd bdnh
ua ddi tupmg Nam NO Cd Khdng S I giir
> 1 gid Nh9 Vda Ndng
n=345 215 130 265 80 85 260 71 149 125
62,32
%
37,68 76,81%
23,19%
24.64 75.36 20,58 43,19 36.23 T?p chl Y hpc iv phong, Tjip XXV, S6 3 (163) 2015
Trong tfing so 345 doi ttrpng tiiam gia nghifin 75,36% dfii tirpng ed thdi gian tii nhi dfin vifn eftu efi 215 nam gifii (62,32%) vi 130 nu gifii trfin 1 gid. Vfi mftc dp bpnh a pbin Idn cic dfii (37,68%), tt/ Ip dfii tupng cd BHYT chifim phin ttrong li mftc d^ bpnh viia (43,24%), sau dfi ldn (76,81% so vdi 23,19%). Cic dfii ttrpng da l i mue dp bfnh ning (36,23%) vi tiiip nhat li sfl tti cic vung xa bfnh vifn v i tinh khic, cfi tfii mfte dp bfnh nhp (20,58%).
Bing 2. Ly do d6i taPp^g nghien cdu lya chpn Bdnh vidn Ph6i Trung u^mg
Ly do 1 ^ chpn bdnh vi$n Bfnh nhdn n$l trO
Gin nha Cd ngudi nhd Idm d ddy Tuyin dudi chuyin ISn Trinh d$ chuydn mon cua Bdc sy Thdi dd phgc vg cua nhdn vidn y t l Khde
Tdng
9 16 133 182 2 3 345
2,61 4,64 38.55 52.75 0.58 0,87 100
Ly do ehft yfiu khifin dfii tupng lya ehpn dp phye vy cfta nhin vifin y te tbi it dupc mpi bfnh vifn li trinh dp chuyen mfin cfta bie sy ngufii Iya chpn.
vfii 52,75% dfii tupng. Theo sau la tti tuyfin 3.2 Nhu ciu ciia b^nh nhan npi tru vl dich dufii chuyfin len, mpt so ly do khae nhu, thii vu chim sfic SUY: khofi tai nhi
Bang 3. Ty If ddi tip^^g cd nhu c i u v l djch vu chim sdc sdc khde tgi nhd Bfnh nhdn n$i trii
Nhu ciu Chung Khdm chuyfin khoa Phgc h6l chirc nang Chdm sdc sau di^u tn Chdm s6c t^i nhd Ldy mdu xdt nghi#m Jv vdn si>c V.h6e Khde Ting s6
N 109 142 54 117 96 40 164
5 618
31,59
%
22,98 8,74 18.93 15,53 6,47 26,54 0,81
Kfit qui difiu tracho thiy nhu eiu cua eie vin sftc khfie (26,54%) vi khim ehuyfin khoa dfii ttrpng vfi djch vy CSSK tai nhi li 31,59%. (22,89%). Cac djch vy khie nhu chim sfic sfic Trong dfi, chft yeu lgp trung vio djeh vy tu difiu tri hay ehim sfic tai nhi chifira ti If ft han.
102 Tgp chi Y hpe dy phfing, Tgp XXV, Sfi 3 (163) 2015
• CSSK t?i nhA ting 30% + chi phi dl 1^1
• XN tfi nhii ting 20% + chi phidi lfi
Hinh 1. Khd ndng chi tri cua bfnh nhdn nfi tru vdn djch vg chdm sdc sdc khde tgi nhd
Hinh 1 cho thay khi nang ehi tti cbo djch vp CSSK tgi nha vfii ting 30% chi phi cfing vdi chi phi di lgi li 33,71%. Cdn vfi djeh vy xet nghifm tai nhi cie dfli tupng ed kha ning chi tri cao han dgt 44,43% vdi chi phi ling len 20% cpng vdi chi phi di Igi.
IV. BAN LUAN
Nghien eftu ttfin 345 bfnh nhin npi tru tgi Bfnh vifn Phoi Trung uong tft thing 11/2013 dfin thing 9/2014. Ty If nam gidi cao han rat nhifiu so vdi nft gidi (nam li 62,32%, nft li 37,68%). Kfit qui niy co sy khie bift rat Ifim so voi nghifin cuu efta Trin Thanh Long nim (2011) tgi Bfinh vifn Dai bpc Y Hi Npi vdi ti If nam/nft la tuang duomg nhau [5]. Dieu niy cung dfi hieu do d§c thft Benh vipn Phfii Trung uang, li bfnh vifn diu nginh ve eie bfnh phfli. Bfin cgnh do hut thufle li li mpt ttong nhirng nguyfin nhin bing dau din dfin nhirng bpnh niy mi dfii tirpng hftt lgi ehu yfiu la din fing. Difiu niy giii thich tgi sao li If nam vi nft lai cfi sy ehfinh Ifch nhu v i y
Kfit qui nghien eftu ebo thiy ttinh dp chuyen mfln cfta bic sJ li yfiu tfi quyfit djnh lya chpn bfnh vifn (52,72%) vi efi 31,59% doi tuyng CO nhu ciu sft dyng djeh vy CSSK lai nhi. K^t qui niy thip hom so vfii nghifin cftu
khic cua Trin Thanh Long (2011) tgi Bfnh vifin Dgi hpc Y Hi Nfii cho thiy ed 76,6% d6i tupng efi nguyfn vpng dupc CSSK tai nhi [5].
Theo nghifin eftu cfta Huber C A vi cpng sy (2011) da kbao sit nhu eiu CSSK d Thyy SJ eho rang hiu bfit mpi ngudi dfiu cfi nhu eiu CSSK tgi nhi eao ban rit nhifiu so vdi CSSK tgi bfnh vifn [6]. Sy khie nhau niy cfi thfi do d6i tupng cfta chung toi li bfnh nhin nfii tru da pban mic nhfhig bfnh ning, man tinh ho$c dh liy tmyfin qua duomg hfl hap. Do viy, vifc difiu tri vi chim sfic dfli tupmg thudng fi bfnh vipn. Hom nft^ ttong nghifin eftu eua ehftng tfli ed 75,35% dfli tupng phii mat han 1 gid dfi di tft nhi den vifn, do viy, hp cho ring CSSK tai nhi li khflng khi thi.
Chi efi 33,71%! dfli tupng khi nang ehi tri cie djeh vy CSSK tgi nhi vdi ting 30% ehi phi cpng vdi ehi phi di iai. Kfit qua niy khi thip so vdi nghifin eftm eua Bui Thuy Duong (2010), efi thfi do nghifin eftu cua chung tfii tifin hinh ttfin Benh vifn Phfii Tnmg uang, dfli tupng cfta ehftng toi deu li nflng din (54,49%),Han nfta, trong nghifin cftu efta ehftng toi cfi 75,35% dfli tupng phii rait ban 1 gid dfi di tft nhi den vifn vi chu yfiu sft dyng BHYT dfi khim vi difiu tri bpnh. Do vgy, lo ling ngoii ehi phi eho vifc CSSK m thi chi phi eho vife di lai eung rat eao so vfii dieu kifn cfta hp [7].
Tgp cbi Y hpe dy phdng. Tip XXV, S6 3 (163) 2015 103
Nghien cihi niy cdn rapt sfi hgn che. Vfi dfii tupng l i bfnh nhan nfii tni da phan mic nhftng bfnh ning, min tinh cin chim sfic v i dieu tr;
lgi bpnh vifin nfin nhu ciu chim sfic sftc khoe tai nhi chi ap dyng khi doi tupng tifip tpc dieu tii ngoai tim hoic khi xuit vipn v6 nhi. Do dfi, giy sai sfi vi dan tdi nhu cau tinh toin chua sit vdi tiiyc tfi. Bfin cgnh dfi, nghifin cuu cung chi mdi khio sat nhu ciu ttfin dfii tupng bfinh nhan nfli trft ma chua cfi difiu kipn dfi khio sit nhu ciu niy d ngufii dan ttong epng dong. Nhfira nghifin cuu khuyen nghj cin co nhieu nghifin cftu tten quy rafi Ifim hom de, nhim cung cap cic bang chiing ve nhu eiu thyc sy cua ngufii dan ttong vife ehim sfic sftc khfie tai nhi.
V. KET LUAN
Qua nghifin cihi 345 bfnh nhin npi tru difiu tri tii Bpnh vifin Phfli trung uong, kfit qui cbo thiy. Nhu ciu chim sfic sfte khde tai nhi cfta bpnh nhin nfii ttm li thip voi 33,71%,ttong dfi, tap tmng chu yfiu vio nhu ciu tu van sftc khfie (26,54%) vi nhu ciu khim chuyen khoa (22,98%i). Khi nang ehi tti efta dfii tupng cho djch vy CSSK lgi nhi li 33,71%. Vi viy, cin ning cao nhgn thftc cua ngudi dan ve logi hinh
djch vy CSSK n i y
TAI LIEU T H A M KHAO
1. WHO, World heahh statistics. Geneva: World Health Organization ISBN,2011.978-92-4-156419-9 2. Chinh phu Yiet Nam. Quy§t dinh so 30/2008/C^-
TTg ban hanh ngiy 22/02/2008 phe duyft Quy hoach phat trien mang luoi k h ^ chita bfnh den n^m 2010 vi tim nhin den nSm 2020.
3. Lfi Quang Cirdng. Danh gia tinh hlnh qui lai cua mOt s6 bfnh vifn tai Ha Nfi & TP Ho Chi Minh v^
de xuit giai phip khic phvic, Vifn Chi^n lupc vi Chinh sich Y t^. Bp Y tS; 2008.
4. Le Ho^ Chuong E)anh gia hifu qua dich vy CSSK sinh sdn tai nha cua Bfnh vien Phg sdn Trung uong. Y hgc th\tc hinh, 2013; 4:58-61.
5 Tiin Thanh Long. Khao sat nhu cau djch vy CSSK ngoii gid va t ^ nha cua ngudi sft dgng djch vg t^i Benh vifn E>ai hgc Y Ha Nfi, Lugn van thgc sJ Y t^
cdng cfng, Tncimg E)9i hpc Y Hi Nfi, 2011.
6. Huber CA, Rosemann T, Zoller M et al Out-of- hours demand m preimaiy care: frequency, mode of contact and reasons for encounter in Switzerland, J Eval Clin Pract, 201;. 1: 174-179
7. Bill Thuy Duong. Nhu cau ch5m sdc sftc khoe ngodi gid va 191 nh^ ciia bfnh nhan den khdm t^i bfnh vifn vifn D^ii hpc Y Ha Noi ndm 2010. Lugn vSn tot ng- hifp bdc sJ da khoa. D ^ hpc Y Hd Npi, 2010.
THE DEMAND FOR HEALTHCARE SERVICE AT HOME OF INPATIENTS IN VIETNAM NATIONAL LUNG HOSPITAL
Dang Due Nhu', Hoang Huu ToanS Tran Van Tien*
'School of Medicine and Pharmacy - Vietnam National University, Hanoi 'Vietnam National Lung Hospital
'Hanoi Medical University
A cross-sectional study was conducted on 345 inpatients in Vietnam National Lung Hospital in 2014 to describe theu demand for healthcare service at home. The result showed that there were 215 male participants (62.32%) and 130 female participants (37.68%), and only 31.59% participants had the need of hav- ing healthcare service at home, in which the demand for health consulting (26.54%) and
specialized medical exams (22.98%) played the most important roles. There were 33.71%
participants willingly to pay when tbe cost of this service increased 30% plus ttavel cost. We need to improve inpatient's awareness of this service.
Keywords: Healthcare, at home, inpatient, Vietnam National Lung Hospital
104 Tap chi Y hpc dy phdng, Tgp XXV, Sfl 3 (163) 2015
