JOURNALOFIOB-CLINICALMEDICINEANDPHARMACY Vol.11 -N°4/2016
So sanh kit qua thirc hien danh muc thudc trung thau phuc vu benh nhan bao hiem y te tai Benh vien Trung uOTig Quan doi 108 nam 2014, 2015
Compare results winning formulary serve health insurance patients at 108 Military Central Hospital 2014, 2015
Nguyen Son Nam, Hoang Anh Tuan Benh vien Trung uang Qudn doi 108
Tom t i t
Muc tieu: D^nh gia l<^t q u ^ thuc hien danh muc thudc triing thau phuc v u benh nhan bSo hiem y te tai Benh vien Trung Udng Quan d6i 108 nam 2014, 2015. Bdi tudng vd phUdng phdp: Ap dung phuang phap mo t l hoi ciJu: Mo t l cac hoat dong sCr dung thuoc t h o n g qua h6i ciJu cac bao cao, cac thdng tin luu trCf tLf danh muc thuoc trung t h i u , sd lieu ve sd dung thudc thuc t ^ nam 2014, 2015 tai BSnh vi#n Trung UOng Quan ddi 108. Ket qua vd bdn ludn: TJ Id sd dung thudc t r o n g danh muc t n i n g thau t\J 66,50% den 75,17%, thudc cd ngudn gde ngoai nhap chldm t i trpng idn t r o n g t d n g gia t n sijf dung thudc cOa 2 nam 2014, 2015 (ti^ 89,68% den 93,43%). Ba nhdm thudc dieu trj ky sinh trung, chdng nhiem l<huan; tim mach; didu tri ung thU va dieu hda mien djch chiem t i trpng idn t r o n g cO cau thudc sCf dung cda Benh v i i n trong 2 nam 2014,2015 (til 61,99% ddn 72,77%).
TCr khda: Sd dung thudc, thudc tim mach, thuoc ung t h u . Summary
Objective: To evaluate the results implement winning formulary serve patient health insurance at 108 Military Central Hospital In 2014, 2015. Subject and method: Applying the method described retrospective: Description of activities through drag use retrospective reports, the stored information from the levy list of drugs, data on drug use real International 2014, 2015 at t h e 108 Military Central Hospital. Result and conclusion: The rate of drug use in the winning list from 66.50% t o 75.17%, Imported drugs originate up a substantial share of the total value of the t w o drugs used in 2014, 2015 (from 89.68% to 93.43%). Three treatment drugs groups of parasites, infection control; heart; treatment of cancer and immunomodulatory up a substantial share In the structure of the hospital drug use in 2014, 2015 (from 61.99% t o 72.77%).
Keyv^ords: Use of drugs, cardiovascular drugs, cancer drugs.
1 . Oat van d e '^° 9 ' * '-^ ' ^ ' P ^^ " ^ ^ ° ^ ' ^ " 9 '^^'^ " l " y d j n h v l dau thau ' mua thudc dang la vdn de cic co s6 y t e va cac nha O Viet Nam, theo. quy djnh cua phap luat hidn quan ly nha nude deu het silc quan t a m hanh, viec cung dng thudc tai cac co s6 y t d cdng i j p Tai Bdnh vidn T r u n g u o n g Quan ddi 108, d d d i m pha, t h o n g qua dau thau. Tuy nhien de lua chpn bSo dCi t h u d c p h u c vu nhu cau khdm vJ didu tri, dupc thuoc Sim bSo chat lupng, d u n g tidu chuSn, hang nam Benh vien t h u c hidn dau t h a u mua thudc theo hi/dng dan cda t h d n g t u lien tjch sd Phan b i f n khoa hgc: GS.TS. NGUYEN THANH B i N H 01/2012/TTLT-BYT-BTC ngay 19/01/2012 cCia lien Bo
T^P CHf Y DUOC LAM SANG 108 Tap11-S64/2016
Y te - B6 Tai chfnh ve HUdng ddn ddu thau mua thuoc trong cdc ca sd y te [3] va Thong tU lien tich s6 36/2013/TTLT-BYT-BTC ngay 11/11/2013 ve viec SCfa doi, bo sung mdt so dieu cda Thdng tU so 01/2012/TTLT-BTC-BYT HUdng ddn ddu thau mua thuoc trong ede easdyte [4].
N h I m danh gia su p h f i h c ^ giOfa ket qua dau thau v6i t h y c te sCf d u n g t h u o c tai Benh vien, chung toi tien hanh nghien CU\J " S O scinh k^t qua thUc hien danh muc thuoc trOng thau phuc vu benh nhSn BHYT tai Benh vien TUQD 108 nam 2014 va nam 2015" vdi muc tieu;
Danh gia ket quS thUc hien danh muc t h u o c trung thau phuc vu benh nhan BHYT tai B^nh vien TUQD l O S n a m 2014 v^ nam 2015.
Ket qua nghidn ctiru la cq sd khoa hgc tCf do dUa ra mot so de xuat giup H6i d6ng dau thau xay d i i n g ke hoach dau thau sat v6i thiic te sijf dung.
2. Doi tUtfng va phUtfng phap 2.1. Doi tuang
Danh muc t h u o c t r u n g thau nam 2014, 2015 cQa Benh vien Tt/QD 108.
Cac bao cao sU d u n g thuoc, bao cao xuat nhap ton nam 2014,2015.
2.2. Phuang phdp
2.2.1. Thiit ke nghiin cdu: Ap dung phUdng phap mo tci hoi cufu: Mo ta cac hoat d p n g dau thau t h u o c thong qua hoi ciiru bao cao, cac t h o n g tin lUu trQ tU cac bao cao, danh muc thuoc t r u n g t h a u , sd lieu ve silf d u n g thuoc thUc t e nam 2014,2015 tai Benh vi&n TUQD 108.
2.2.2. Phucmg phdp thu thdp sSlieu
Tiin hdnh hoi cdu: Cac van ban, bao c^o lien q u a n den hoat d d n g dau t h a u t h u o c tai Benh vien TUQD 108 nam 2014,2015.
Danh muc t h u o c t r u n g t h a u tai Benh vien T U Q D 108 nam 2014,2015.
Cac bao cao sCl d u n g thuoc, bao cao x u ^ t nhap t o n nam 2014,2015.
2.2.3. Phuang phdp xi^l;^ so lieu
S6 lieu sau khi t h u th$p duqc dUa vao phan m^m MicrosoftExcel 2013 dexUly, phan tfch nhusau:
Sap x ^ p so lieu t u y t h e o muc dich phan tich.
Tfnh so lUdng, gia t n va t;^ le tUng bien so.
So sanh, ve d o t h j , bleu do, nhan xet.
2.2.4. Phuang phdp phdn tichsolieu PhUcfng phap so sanh: So sanh ket qua d a n h muc t h u o c t r u n g t h i u vdi danh muc t h u o c sU d u n g nam 2014,2015.
PhUdng phap t i t r o n g : La p h u o n g p h ^ p t f n h t ^ le phan t r a m cua gia t n so lieu cCia m o t hoac m o t n h o m doi tUpng nghidn cUu so vdi t o n g so.
3. K^t q u d
3.1. So sdnh ty le thudc suf dung trdng thau cda mdi gdi thau
So sanh ty 1$ sU dung cac thuoc t r o n g danh muc thuoc t n i n g thau tai Benh vien TUQD 108 t r o n g 2 nam 2014 va 2015, t h u duge k^t quS cu the: ^
Ty le sU d u n g thuoc t r u n g t h i u nam 2014 va nam 2015:
Bdng 1 . So sanh t y \i sd dung thudc trong danh muc thuoc t r u n g thau nam 2 0 1 4 v^ 2 0 1 5
Tdn goi thau
Gdi thau biet duoc Goi Generic Nhom 1 Nhdm 2 Nhdm 3 Nhdm 4 Nhdm 5
Nam 2014 SKTT
290 600 327 192 82
SKSD 218 399 214 135 50
T J I e S D / T T ( % ) 75,17 66,50 66,36 70,31 61,73
Nam 2015 SKTT
293 536 302 23 140
2 69
SKSD 210 382 221 14 107
1 39
T y l d S D / T T ( % ) 71,67 71,27 73,18 60,87 76,43 . 50,00 56,52
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.n-N*4/2016
Nhdn xet: T^ Id sOf d u n g t h u o c t r d n g t h a u Bidt dupc cila nam 2014 cao h o n nam 2015 (75,17%/71,67%), t u y nhidn d goi t h a u Generic, tj Id sil d u n g t h u d c t r i i n g thSu nam 2015 lai cao h o n so vffl nam 2014 (71,27%/66,50%). Oac bidt, t J Id suf d u n g t h u d c triUng t h a u t h u p c n h o m 1 (thudc dat tidu chuan ICH, PICs, EU-GMP) va n h d m t h u d c san
x u a t d a t t i d u chuSn GMP-WHO ( n h o m 2 cOa nam 2 0 1 4 v a n h d m 3 cCia nam 2015) n a m 2015 d d u tang cao h o n so vffl nam 2014. d n h d m t h u d c khdc, t) Id sCf d u n g t h u d c t n i n g t h i u cCia nam 2015 thSp hon nam 2014 (56,52%/62,73%).
Ty Id gia trj sd d y n g cOa cac t h u o c tnJng thau n a m 2 0 1 4 v a nam 2015.
B i n g Z . S o s a n h t y l e g i a t r j s i r d u n g cac t h u o c t r o n g danh muc t h u o c triing t h a u eon wtfnfc 77*5(19
Ten gdi thdu
Gdi t h i u bidt duoc Gdi generic Nhdm 1 Nhdm 2 Nhdm 3 Nhdm 4 Nhdm 5
Gid trj TT 44,11 61,18 41,46 9,55 10,06
Nam 2014 Gia tri SD
44,14 59,17 38,52 10,66 9,99
T y i d S D / T T ( % ) 100,07
96,71 92,91 111,62 99,30
Nam 2 0 1 5 Gia t n TT
41,53 74,8 51,31 3,05 11,77 0,013 8,63
Gia trj SD 39,87 66,92 50,25 4,4 7,02 0,008 5,24
TyldSD/TT(%) 96,00 89,47 97,93 144,26 59,64 61,54 60,72
Nhdn xit: TU hang dO lieu tren cho t h a y gia tri suf d u n g d cac gdi thuoc deu chiem ty le cao, nam 2014 gdi t h i u biet dUdc cd t y le s U d u n g t h u o c t n i n g t h a u chi dat 75,17% nhUng gia tri sCf d u n g cua c^c t h u o c thuoc gdi n^y chiem t^ le 100,07%. Ben canh d d , t^
Ie SLf dung thuoc tai gdi Generic nam 2015 cao hcfn nam 2014 (81,27%/66,50%) nhUng gia tri sU d u n g cCia nam 2015 lai t h ^ p hon so vdi nam 2014
(96,71%/89,47%). T;^ le gia tri sCf d u n g cCia nhdm t h u d c san x u a t t r o n g nude nam 2015 giSm dang ke so vdi nam 2014 {59,64%/111,62%).
3.2. So sdnh ca cdu thudc sd' dung theo ngudn gocxudtxU
Khao sat ctf c£iu thuoc ndi - thuoc ngoai sijf dung theo ket qua t n i n g thau, t h u dUcfc ket q u i sau.
Bdng 3. So sanh ctf cau thuoc sd dung theo n g u o n goc x u a t xd
Ngudn goc
Thudc ndi Thudc ngoai nhap
Tong
Nam 2014 Sd khodn
135 482 617
T J I e % 21,88 78,12 100
Gia trj 10,66 92,65 703,37
TJIe%
10,32 89,68 100
Ban vttinh:Tidong Nam 2015
Sd Ichodn 107 485 592
TJIe%
18,07 81,93 100
Gia tri 7,02 99,77 106,79
Tyld%
6,57 93,43
700
Nhdn xet: TTiuoc cd nguon goc ngoai nhap chiem t y le Idn ve so lupng va gia tri sU d u n g , t u y nhi§n nam 2014 cd t y le sU d u n g t h k p hon so vdi nam 2015, t y le t h e o so luong sCf d u n g la 78,12%/82,93% va gia trj sCf d u n g la 89,68%/93,43%.
Thuoc cd n g u d n g6c Viet Nam c h i ^ m t ^ le theip, t? I§
t h e o s6 l u p n g sCf d u n g cua hai nam lan lUpt la 22,88%/18,08% va t h e o gia t r i sU d u n g 1^
10,32%/6,57%. C d cau xuat xU cac t h u o c sCf d u n g cd n g u o n goc ngoai nhap d a t t i e u chuan PICs, EU-GMP,
TAP CHI Y DUOC U M SANG 108 Tap 11-564/2016
Bling 4 . So sanh CO cau x u a t xiJ c i c thuoc sir d u n g CO ngudn goc ngoai nhap flat tieu chuan PICs-GIMP, EU-GMP
D o n vj t f n h : Tf d o n g
NUdc sdn xuat
W c Phap Romania
•)
Ao dc nude khac
Tdng
Nam 2014 Sd
Ichodn 69 75 10 40 11 170 375
T J I « ( % )
18,40 20,00 2,67 10,67 2,93 45,33
700
Gia tri T ^ i e ( % )
16,16 11,4 4,16 7,33 2,31 25,22 66,57
24,27 17,12 6,25 11,01
3,47 37,88 100
Nam 2015 Sd
Ichodn 74 62 4 39 40 209 428
T y i e ( % )
17,29 14,49 0,93 9,11 9,35 48,83 700
Gid trj
20,86 7,61 2,43 8,92 2,89 30,99 72,35
T ^ i e ( % )
28,83 10,52 3,36 12,33 3,99 42,83 700
Whan xit: 6 n h d m t h u d c dat tieu chuan PICs- GMP, EU-GMP, DUc la nUdc cd thuoc dUdc sU d u n g n h i l u nhat chiem t ^ le 18,40% so lUdng t h u d c sCf dung nam 2014 va chiem t y le 20,86% nam 2015. Gi^
trj s^ d u n g cCia cac thudc cd nguon goc tUDUc cung chiem t y le cao nhat (24,27% nam 2014 va 28,83%
nam 2015). Cac thudc cd nguon goc t U nude Ao c6 su chenh lech ve sd lupng thuoc sU d u n g t r o n g 2 nam, nam 2014 so lupng thudc sU d u n g chiem
2,93% (11/375 thudc), den nam 2015 sd lUdng t h u d c sU d u n g da t a n g len 40 thudc, chiem ty' le 9,35%. Tuy nhien gia trj sU d u n g cCia cac t h u d c nay d cS 2 nam khdng cd sU thay doi nhieu, lan lUdt chiem t^" 1$
3,47% nam 2014 va 3,99% nam 2015.
C d cau xuat xU cac thudc sCf d u n g cd n g u d n gde ngoai nhap khdng dat tieu c h a i n PICs, EU-GMP, WHO-GMP.
Bang 5. So sanh ctf cau xuat xi^cac thuoc sd dung co nguon goc ngoai nhap khong dat tieu chuan PICs-GMP, EU'GMP
Dan vi tfnh: Tl dong
Nude san xuat
Argentina Australia Han Qudc Ul<rainae Thai Lan Trung Qudc C^c nude khdc
Tdng
Nam 2014 Sd
khoan 7 16 33 8 13
3 27 707
T y i e ( % ) 6,54 14,95 30,84 7,48 12,15
2,80 25,23 700
Gia trj 1,0 8,83 7,89 2,17 1,22 1,04 3,92 26,07
T * l e ( % ) 4,51 39,86 35,62 9,80 5,51 4,70 17,70
700
Nam 2015 So
Ichodn 4 20 16 2 6 2 7 57
T J I e ( % ) 7,02 35,09 28,07 3,51 10,53 3,51 12,28
700 Gia tri
1,05 14,47
8,1 0,72 0,53 1,53 1,02 27,42
T ^ i e ( % ) 3,83 52,77 29,54 2,63 1,93 5,58 3,72 700
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11-N°4/2016
Nhdn xet: 6 n h d m thudc ngoai nhap khong d^t tieu chuSn PICs-GMP, EU-GMP va WHO-GMP, cac thudc cd nguon goc tir Han Qudc va Australia duoc sCr d u n g nhieu t r o n g c i hai nam, sd luong t h u d c sOfdung cd ngudn goc t a hai nUdc nay chiem t y Id cao flat 47,79% nam 2014 (49/127 thudc) va 63,16% nam 2015 (36/57 thudc). Gia trj sOf d u n g ciia cac thudc cd ngudn gde tCr Han Qudc khdng thay ddi nhidu giOfa hai nSm (7,89 tl/8,1 ti) nhUng sd lUflng thudc sd d u n g 6 nam 2015 gi5m nhieii so vdi nam 2014 (16 thudc/33 Bang 6. Ty Id gia trj thudc si)r dung thuc t £ vdi
thudc). Nguoc lai, gia tri sCf d u n g cOa cac t h u d c cd n g u d n gde td Australia cd sU chdnh Idch Idn giOa hai nam, gia trj sCr d u n g da t a n g len 5,64 t l (8,83 tJ nam 2014/14,47ti nam 2015).
3.3. So sdnh ctf cau thudc s&duttg thae tetheo nhdm tac dung duac ly
Kh^o sat g i ^ trj sCr d u n g thUc t d cda cac nhdm t h u d c t h e o tac d u n g ddOc 1^ tai Benh vien TUHB 108 t r o n g hai nam 2014,2015 t h u duoc ket qud sau.
gia trj t r u n g t h I u t h e o n h d m tac d u n g dUorc ly Dan vi tlnh: Vddng
TT
1
2
3 4
5 6
Nhdm thudc
Thudc didu trj ky sinh trCing, chdng nhidm khudn
Thudc dieu trj ung thU va dieu hda mien dich
Thudc tim mach Thudc dudng tidu hda Thudc g l i m dau, ha sdt, chdng viem khdng steroid.
Cac nhdm thudc cdn lai Tdng
Nam 2014
TT
15,5
32,03
13,01 6,07 7,86
30,82 705,29
SD
25,31
36,84
26,98
— 8,68 6,6
46,94 750,76
T^ldSD/TT
(%)
163,29
115,02
207,38 143,00 83,97
152,30 742,62
Nam 2015 {
TT
22,15
27,07
17,88 7,06
9,11 33,06 776,33
SD
28,38
46,15
29,44 - 9,3 -
6,52
47,88 767,67
TyldSD/TT
(%)
128,13
170,48 164,65 1 131,73 1
71,57 144,83 1 744,73 1
Nhdn xit: Cac n h d m thudc khao sat deu cd g i i tri sU d u n g cao hdn so vdi gia tri t h u d c t r t i n g t h a u . Nam 2014, n h d m thudc t i m mach cd gia tri sU d u n g cao gap ddi g i ^ trj t r u n g thau (13,01/26,98 t i ddng), chiem t J le cao nh^t 207,38%. Nam 2015, n h d m thudc ung t h u va dieu hda mien djch co gia trj sU d u n g cao n h ^ t (46,15 t i ddng), chiem 170,48%.
Trong ca hai nam, chi cd n h d m t h u d c giam dau ha sdt, chdng viem khdng steroid, t h u d c dieu tri gOt va cac benh xUdng khdp cd gia tri sU d u n g thap hon g i i trj t r u n g thau, dat 83,97% nam 2014 va 71,57%
nam 2015.
4 . Ban luan
T^y' le sU d u n g cac thudc t r o n g danh muc t h u d c t r u n g t h a u d cS hai gdi t h I u biet dupc va Generic
cCia hai nam deu chi khocing 70% nhung t y le gia trj SLT d u n g cac thudc do deu chiem t ^ le cao (tU 96% den 100,07% cCia gdi bl^t dupc va tU 89,46% d^n 96,71%
cCia gdi Generic). Nghidn cUu cCia tac gia N g u y i n Trung Ha va cdng su [5], t y le sU d u n g cac tliudc trong danh muc trOng thau so vcri thUc te sU d u n g trung binh cac nam 2007 - 2010 tU 48,0 - 64,2%, t y le nay thap hdn ket q u ^ nghien cUu cOa d e t a i .
Can cd t h e o Quyet d i n h sd 4824/QD-BYT ngay 03/12/2012 cua Bd t r u d n g Bd Y t e ve phe d u y M de an "Ngudi Viet Nam Uu tl§n d u n g t h u d c Viet Nam"
quy d i n h t y le t a n g t r u n g b i n h t h u d c V i ^ t Nam d cac Benh vien t u y ^ n t r u n g Udng la 1-3% [2]. B&nh vien da cd ke hoach sd 803/KH-BV108 thUc hien de ^n tai Benh vien t r o n g do phan dau kinh p h i t h u d c Viet
TAP CHlY DLTOC LAM SANG 108 Tap 11-564/2016
Nam sOf d u n g tai Benh vien t d i thieu 22% [1]. Vdi t y le sU d u n g t h u d c Viet Nam tai B§nh vi§n nam 2014 v i 2015 lan lUpt la 22,88% va 18,08%, chUng t d B&nh vien da quan t a m sU d u n g t h u d c ndi cd ch^t lUpng.
Thudc cd n g u d n gde nude ngoai sU d u n g tai Benh vien chCi yeu la cac t h u d c dat tieu PICs-GMP, EU- GMP thudc cac nude ICH chiem tdi 61,95% tSng kinh phi sU d u n g cho t h ^ y Benh vi§n lUa chpn t h u d c cd chat lUdng t d t , tU nhUng nha sSn x u a t cd uy t i n de dap Ung nhu c l u d i l u tri cua Benh vien tuyen cudi.
So sanh gia trj sd d u n g cCia 6 n h d m t h u d c chiem t i trpng cao nhat t r o n g c d cau t h u o c sU d u n g t h e o nhdm tac d u n g dupc I;? cho t h a y cac n h d m diu cd gia tri sCf d u n g cao hdn gia trj trying t h a u . Bac biet, ba nhdm thudc dieu t r i Ic/ sinh trCing, chdng nhiem khu^n; n h d m t h u d c dieu trj ung t h U va i^eu hda mi^n dich; n h d m thudc t i m mach da cd gia tri sU dung chi^m khoang 50% t o a n b d gia trj sU d u n g cCia c i hai nam 2014va nam 2015, d i l u nay phu h p p vdi nghien cUu cua tac gia Nguyen Sdn Nam va cdng sU [6]. Trong d d n h d m thudc dieu trj ung thU va dieu hda ml^n dich la n h d m thudc cd gia tri Idn nhat (39,92 t! d6ng/150,84 t i d d n g nam 2014, chiem 26,47% va 46,15 t i ddng/167,67 t i d d n g nam 2015, chiem 27,52%).
5. Ket l u i n
Ty le sU d u n g cac thuoc biet dUdc t r o n g danh muc thudc t r u n g thau chiem ty'lS 75,17% nam 2014 va 71,67% nam 2015. T^ le sU d u n g cac t h u d c generic cua nam 2015 cao hdn nam 2014 (71,27%/66,50%).
Thudc cd ngudn goc ngoai nhap chl^m t i t r g n g Idn trong t o n g gia tri sU d u n g t h u d c cCia 2 nam (89,68% nam 2014 va 93,43% nam 2015).
N h d m t h u d c dieu trj ky sinh trCing, chdng n h i l m khuan, n h d m t h u d c c h d n g ung t h U va n h d m t h u d c t i m manh c h i l m t i t r o n g Idn (61,99% t d n g gia t n sU d u n g nam 2014 va 72,77% nam 2015) t r o n g c d cau sU d u n g t h u d c tai Benh vien 6 ca hai n a m . N h d m t h u o c dieu t n ung t h u v& d i l u hda mien djch chiem tJ- I& sU d u n g Idn nhat 6 ca hai nam (28,04% va 28,70%).
Tai lieu t h a m khSo
1. B§nh v i l n Trung Udng Quan ddi 108 (2013) Ki hogeh sd 803/KH-BV108 ngdy 8/5/2013 thUe hien de dn "NgUdi Viet Nam M tiin ddng thude Viet Nam".
2. Bd Y t l (2012) Quyit dinh so 4824/QD-BYT ngdy 03/12/2012 phi duyet de dn "Ngudi Viit Nam Uu tien ddng thudc Viet Nam".
3. Bo Y te - Bd Tai chinh (2012) HUdng dan ddu thdu mua thudc trong cdc ea sdy te; Thdng tu tiin tich so 01/201Z/TTLT-BYT-BTC ngdy 19/01/2012.
4. Bd Y te - Bd Tai chinh (2013) Sda ddi, bo sung mot so dieu cOa Thong tU lien tich sd 01, Thong tU Hen tich so 36/2013/TrLT-BYT-BTC ngdy n/n/2013.
5. Nguyen Trung Ha va cac cdng sU (2012) Phdn tich kit qud ddu thdu thudc vd thUe ti sd dung mdt s6 nhom thudc tgi Benh viin Trung uang Qudn ddi 108 ndm 2007 - 2010. Tap chi Y hpc thUc hanh. Sd 7/2012(829), tr. 16-18.
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