Khó khăn trong thực hành kê đơn thuốc và nhu cầu đào tạo về sử dụng thuốc hợp lý an toàn của cán bộ y tế thuộc một số bệnh viện ở miền bắc, việt nam

TCNCYH 65 (6) - 2009
prevalence cf Pterigyum in one eye is 12.9%, and in both eyes is 4.85%. The bilateral aphakia rate is
3.04%, monocular aphakia rate is 2.99%. The cataract surgical coverages are 80.0% (per persons) and
55.2% (per eye). The successful surgical rate is 74.53%. Main barriers for cataract services are
unawareness (29.5%), fear of loosing sight (15.9%) and poverty (11.4%). Conclusion: Main cause of
blindness in Hanoi in 2007 is still cataract. The CSSR is good but the successful surgical rate is not
high. Strategies for blindness prevention are promotion of health education and improvement of surgical
quality to achive the goal "Vision 2020".
Keywords: assessment of blindness, cataract surgical services

KHO KHAN TRONG THL/C HANH KE DON THUOC VA NHU CAU
DAO TAO VE SL/ DUNG THUOC HOP LY AN

TOAN

CUA CAN BO Y

TE THUOC MOT SO BENH VIEN 5 MIEN BAC, VIET NAM
Hoang Van Minh, Nguyen Tran Thj Giang Hffdng, Vu Thj Vffng,
Kim Bao Giang, Le Thi Hoan, Tran Thanh Tung,
Trddng Dal hgc Y Ha Noi

(J Viet Nam, hldn cdn thieu cic nghien cdu ve mde do khd khan trong qua tnnh ke dan ciia cin bd d
cic tuyen dieu trj khic nhau. Muc tieu: md ti nhdng khd khan chinh trong qui tnnh ke dan cua cic bic sy
thudc mgt sd khoa/don vj tai mdt sd benh vidn cic tuyen d mien Bac Viet Nam vi xic djnh nhu cau dio tao
ctia hg ve cic van de cd lien quan den sd dung thudc hgp ly, an toin.

Boi tugng va phuang phap nghien

cdu: md ta dt ngang sd dung phuang phip tu dien phieu thUc hien vdi cic cin bd dieu trj mdt sd khoa/ dan
vi Ndi, Nhi, Lay d 10 benh vien thudc 3 tuyen d mien Bac. Ket qua: khd khan chinh cua cic can bg tuyen

huyen khi thuc hanh ke dan bao gam: thieu thdng tin ve thudc (68,5%o), thieu kie'n thdc dugc lim

sing

(47,5%o); thieu xet nghiem ho trg (59%o). Nhu ciu dio tao ve cic vi'n de cd lien quan den sd dung thudc hgp
ly an toin ciia cin bg d tuyen trung uang: 80,0%o; tuyen tlnh 92,4%o; tuyen huyen: 95,2%o. Ket luan: cin bg y
te tuyen huyen gap nhieu khd khan trong qui trinh ke dan vi cd nhu cau cao han ve dao tao sd dung thudc
hgp ly an toin so vdi cin bg y te tuyen dnh vi tuyen trung uang.
Tff khoa: ke ddn, sff dung thudc hdp ly an toan
I DAT VAN DF

nhflng cd I n h hfldng den sflc khce ca n h i n ngfldi
sfl dung bdi hien tfldng tfldng tac thud'c va p h l n

6 Viet Nam tlnh trang sfl dung thud'c khdng

,jng khdng mong mud'n cua thud'c ma cdn lam

hdp ly - an t o l n dang I I mdt v i n d l dang bao

tang nguy cP khang thud'c cung nhfl gay ra tdn

ddng khdng chl trong cdng ddng ma ngay c l d

kem cho ban than ngfldi benh va he thd'ng y t l .

c i c Cd sd y t l . Da cd mdt sd b i o c l o dieu tra d l

H I U qua cua viec sfl dung khang sinh khdng hpp

cap d i n viec sfl dung thud'c khdng hpp ly tai cac

|^ da d i n den tlnh trang khang thud'c gia tang d i n

cd sd y te', n h i t la dd'i vdi thud'c khang sinh [ 1 , 2].

rnde bao dpng d cac chung vi khuan gay benh

Sfl dung thud'c khdng hdp ly - an toan khdng

thfldng gap [5]. Cd nhieu nguyen nhan cd the d i n

96


TCNCYH 65(6)

- 2009

Ket-noi.com kho tai lieu mien phi
ph
den tlnh trang sfl dung thudc khdng hpp ly - an

mdi d i n hdi trfldng de d i i n p h i i u t r i Idi difdi sfl

t o l n tai cac co sd y t l , vf du nhfl cac can bd d i i u

hfldng d i n cua cac nghien cflu vien.

trj t h i i u kien thflc, thieu thdng tin, cd sd y t l t h i i u

thud'c, benh nhan khdng tuan thu d i i u tri, anh
hfldng cua q u i n g cao thud'c... Tuy nhien, d Viet
Nam, hien cdn thieu c i c nghien cflu ve mflc dp

6. Quan If va phan tich sd lieu: sd' lieu dfldc
nhap vao may tfnh bang p h l n m i m Epi - info vdi
cac tep Check de ban che sai so. Phan mem Stata
10 dflpc sfl dung trong xfl ly v l phan tfch sd lieu.

khd khan trong q u i trinh ke ddn cua c l n bd d cac

III. KETQuA

tuyin d i i u trj k h l c nhau.
VI cae ly do tren, chung tdi tie'n hanh d l tai
nghien cflu vdi muc tieu:

Tdng sd cd 137 c l n bd tham gia d i i n p h i i u ,
bao gdm 44 c l n bd tuyin trung fldng (32.1%), 58

trinh

c l n bd tuye'n tinh (42,3%) va 35 c l n bd tuye'n

kboa/dan

huyen (25,5%). Cd 56 can bd nam (40.9%) v l 81

vi Ngi, Nhi va Lay d mgt sd benh vien cac tuyen

c l n bd nfl (59,1%). Chu yeu c i c c l n bd difpc d i i u

Mo ta nhifng khd khan chinh trong qua
ke dan cua can bg y te thugc mgt sd

d mien

Bac Viet Nam, nam 2008 va xac

dinb

nbu cau dao tao ciia cac can bg duac dieu
ve cac van de co lien quan den sif dung

tra

thudc

tra cd dd tudi dfldi 50 tudi (83,2%). Phln Idn c i c
c l n bd d i i u tra cd trinh dp b i c sy (42,3%). So c l n
bd cd trinh dp sau dai hpc tai tuye'n trung flpng la
tflpng dd'i cao (thae sy: 45,5%; t i i n sy: 1 5,9% v l

help ly an toan.

phd g i l o sfl: 4,6%). T"/ le c l n bd cd trinh dp sau dai

II. DOI TUONG vA

PHUONG PHAP

hpc d tuyen tlnh cung dat gan 50% (chu ye'u la

,

chuyen khoa 1) va tuyen huyen la 14.3% (tit c l

NGHIEN CL/U

deu I I chuyen khoa 1). Tai tuyin huyen, 34,3% sd
1. Bdi tuang nghien cdu: C I c can bd dieu trj
mdt sd khoa/ddn vj Npi, Nhi, Lay d mdt sd' benh
vien eac tuye^n d mien B i c
2. Thief ke nghien cii'u: Nghien cflu md t l c i t

chpn vao d i i u tra vl cung trflc t i i p tham gia vao
cdng tac d i i u trj. Tai tuyin trung flpng, Xy le can bd
cd tren 30 nam cdng t i c la tfldng dd'i cao (36,4%).
Tai tuyin tlnh va tuye'n huyen, p h l n Idn c i c c l n bd

ngang
3. Bia diem nghien

c l n bd difdc dieu tra cd trinh dp y sy. Hp dflpc Ifla

ciifu:

dflpc d i i u tra cd dfldi 10 nam cdng t i c (55,2% d
tuyen tinh va 50% d tuyen huyen).

- Tuyen trung fldng: benh vien Bach Mai
- Tuye'n tinh: 3 benh vien (benh vien tinh Ha

B l n g 1 trinh bay nhflng khd khan chfnh m l

Nam - vung Ddng bang sdng Hong, benh vien

c i c c l n bd d i i u trj thfldng gap trong qua trinh ke

tinh Viet Tri - vung Ddng Bac, benh vien tinh Hoa

don. 1 8,3 % c l n bp dfldc d i i u tra cho r i n g hp

Binh - vung Tay Bac)

t h i i u kil'n thflc chan doan va d i i u trj (tuyen trung
fldng: 18,2%; tinh: 10,3% va huyen 31,4%). Cd

- T u y i n huyen: Tai mdi tlnh difpc Ifla chpn, 2
benh vien huyen dfldc d i i u tra

32,9% c l n bd dflpc d i i u tra (trung fldng: 18,2%;
tlnh: 22,4% va huyen 68,5%) cho rang hp t h i i u

4. C6 miu va chgn mau: t i t ca c l n bd d i i u trj

thdng tin ve thud'c trong qua trinh ke ddn. Ty le

(bic sy, y sy) thudc cac khoa/ddn vj ndi, nhi, lay

can bd dflpc d i i u tra cho rang hp thieu k i l n thflc

tai c i c benh vien nghien cflu dflpc d i i u tra

v l dflpc lam sang la 40,9%. Ty le n l y cao d c l 3

5. Ky tbuat va cong cu tbu thap thong tin: sfl

tuye'n, dac biet d t u y i n tuyen huyen (45,7%). Cd

dung be cau hdi tfl dien. Cae can be d i i u tri dflpc

19% can bd dflpc d i i u tra cho rang hp cd khd

97


TCNCYH 65 (6) - 2009

khan trong qua trinh ke ddn do benh-.vien t h i i u

tuyen huyen (60%) so vdi tuyen tlnh (29,3%) va

thud'c. Ty

huyen

tuyen trung fldng (25%). Mdt sd khd khaQ khac

(28,6%), tiep theo I I d tuye'n tinh (17,2%) va

trong q u i trinh ke ddn lien quan dfldc cac can

le

nly

cao

nhit

d tuye'n

cud'i cung la t u y i n trung fldng (10,7%). C a n 3 5 %

bd dfldc d i i u tra ke d i n bao gdm sfl tuan thu cua

c l n bd difpc d i i u tra cho rang hp cd khd khan

benh nhan kem (ty le chung la 50,4%) va viec

trong q u i trinh ke ddn do benh vien thieu cac

b i o hiem y te khdng che tran thanh toan (Trung

xet nghiem hd trp. Ty le nay dac biet cao d

fldng: 29,5%, tlnh: 4 1 , 3 % ; va huyen: 54,3%).

Bang 1. Kho khan cbinb trong qua trinh ke dan cua cac can bg dugc dieu tra

Trung ffdng

Tfnh

Huyen

Chung

n (%)

n (%)

n (%)

n(%)

Thieu kie'n thfle c h i n d o l n , d i i u trj

8 (18,2)

5(10,3)

11 (31,4)

25(18,3)

Thie'u thdng tin v l thud'c

8(18,2)

13 (22,4)

24 (68,5)

45 (32,9)

Thie'u k i l n thflc dflpc l l m sang

19 (43,2)

21 (36,2)

16(45,7)

55 (40,9)

Benh vien thie'u thud'c

6(13,5)

10(17,2)

10(28,5)

26(19,0)

Benh vien thie^u xet nghiem hd tro

11 (25,0)

17(29,3)

21 (50,0)

49 (35,8)

Benh nhan tuan thu kem

22 (50,0)

28 (48,3)

19 (54,3)

69 (50,4)

Bao hiem khdng c h l tran thanh toan

13 (29,5)

24 (41,4)

19 (54,3)

55 (40,9)

Tdng sd

44 (100)

58(100)

35 (100)

137 (100)

Cac kho khan

B l n g 2 t h i hien ty le c l n bd dfldc dieu tra da tham gia c i c khda dao tao lien quan den ke ddn trong 3
nam trd lai day. Nhin chung, cac can bd tuye'n tinh va huyen cdn it dfldc d i e tao ve sfl dung thud'c hdp
ly, an toan cung nhfl c l e v i n d l dflpc l l m s i n g (T'/ le dfldc dao tao d i u dfldi 50%). Rieng dd'i vdi khda
dad tad ve d i i u trj tieu c h l y thi sd' c l n be tuyen huyen dfldc d i e tao n b i l u hdn sd vdi can bd cua cac
t u y i n tren.
Bang 2. Cac khda dao tao lien quan den ke dan ma cac ddi tUgng dieu tra da tbam gia trong 3 nam trd lai day
Cac khoa dao tao

Trung ffdng (%)

Tinh (%)

Huyen(%)

Sfl dung thud'c hpp ly, an toan

80

50

50

Dflpc l l m s i n g

70

30

40

D i i u tri viem phe quan

40

30

10

Dieu trj viem loet da day - t l trang

60

30

20

D i i u trj ly trflc trung

40

10

10

D i i u trj benh viem phdi tre em

30

30

20

D i i u trj tieu c h l y tre em

30

30

50

B i i u dd 1 t h i hien k i t qua d i i u tra v l nhu cau dao tao v l cac v i n d l cd lien quan den ke ddn tai cac
benh vien nghien cflu. Phan Idn c l n bd dflpc dieu tra d i u the hien mong mudn dfldc tham gia cac khda

98


TCNCYH 65

(6)-2009

Ket-noi.com kho tai lieu mien phi

ph
dao tao v l cac v i n d l cd lien quan den ke ddn, dac biet I I c i c c l n bd tuyen huyen. Ty le p h l n tram c l n
bd tuyen huyen mong mud'n dfldc dao tao v l sfl dung thud'c hop ly, an toan la 9 5 , 2 % (trung fldng: 80%,
tlnh: 92,4%) ); v l dfldc lam s i n g la 88,3% (trung fldng: 86,2%, tlnh: 79,7%); va ve c i c phac dd dieu trj
lam s i n g chuan la 9 0 . 1 % (trung fldng: 74,0%, tlnh: 82,4%).

95,2%

Q Trung udng B Tinh D Huyen '•

92,4%
80,0% ^^

90,1%

88,3%

86,2%

82,4%

79,7%
74,0<

a

! •

Su dung thudc hop ly, an toan

Dupc iam sang

. Cac phac dd dieu tri lam sang chuan

Bieu dd 1. Nhu ciu dao tao cua cac can bo duac dieu tra

IV. B A N L U A N

can bd y t l tuyen tlnh va t u y i n trung fldng. C I c
khd khan chfnh cua c i c c l n bd tuye'n huyen bao

Trong nghien cflu nay, phan ldn cac can bd

gdm thieu thdng tin v l thud'c (68,5%), thidu kie'n

thudc cac khoa phdng d i i u trj dfldc lfla chpn da

thflc dflpc l l m s i n g (47,5%); thie'u xet nghiem

tham gia dien phieu. Cd the t h i y cd sfl chenh

hd trd (59%). Nhfl vay, de cd the n l n g cao viec

lech gifla cac tuyen ve so Ifldng cung nhfl trinh dp

sfl dgng thud'c hdp ly, an t o l n tai tuye'n huyen,

chuyen mdn cua dpi ngu can bd. Tuyen cao hPn

c l n cd n h i i u bien phap can dflpc trien khai nhfl

thi ed so Ifldng c l n bd ddng hPn, n h i i u c l n bd cd

cung c i p c i c thdng tin cap n h l t cd lien quan

trinh dp chuyen mdn cao va nhieu kinh nghiem

de'n ke ddn (ban tin thfldng k'/ v l thud'c, p h i c dd

cdng t i c . Dieu nay p h l n anh dung thflc trang

d i i u trj...), thflc hien c i c xet n g h i l m hd trd khi

ngudn nhan Iflc trong he thd'ng y te nfldc ta hien

ke ddn (nhfl khang sinh dd, xet nghiem chflc

nay va d l y cung la yeu to quan trpng cd anh

nang gan than)... Ket qua nay cung n h i t quan

hfldng de'n viec ke ddn thud'c cho benh nhan.

vdi k i t qua nghien cflu cua Pham Huy Dung va

Cac can bp y te tuye'n huyen neu len n b i l u
khd khan trong qua trinh ke ddn hdn so vdi cac

cdng sfl nam 1999 [4] va cua N g u y i n M i n h Hieu
nam 2005 [3].

99


TCNCYH 65 (6) - 2009
Ke't q u i nghien cflu v l thflc trang dao tao v l

v i n de cd lien quan d i n sfl dung thud'c hdp ly

cac v i n d l cd lien quan.de'n ke ddn cua cac c l n

an toan cua can bd d t u y i n trung fldng: 80,0%;

bd dflpc d i i u tra trong nhflng nam qua cung

t u y i n tlnh 92,4%; tuye'n huyen: 9 5 , 2 % . Nhfl v l y ,

phan I n h thflc te la cac c l n bd d tuyen cao cd

can bd y te tuye'n huyen gap n h i i u khd khan

n b i l u cP hpi tham gia c i c khda dao tao hdn so

trong qua trinh ke ddn va cd nhu cau cao hdn v l

vdi c l e c l n bd tuye'n dfldi. K i t qua nghien cflu

dao tao sfl dung thud'c hdp ly an toan so vdi can

v l nhu cau dao tao k h i phu hpp vdi k i t qua ve

bd y te' tuyen tlnh va tuye'n trung flpng.

thflc trang dao tao. Nhu cau dao tao v l cac v i n

T A I L I E U THAM KHAO

d l cc lien quan d i n sfl dung thud'c hdp ly an
toan cua can bd d c l 3 tuyen I I kha cao, v l nhu

1. Dffdng Le Quyen (2005), "Tim hieu viec sfl

cau cua can bd tuyen huyen la cao n h i t . Ke't q u i

dung thud'c cho benh nhan ndi tru tai benh vien

nay gpi y den viec tang cfldng dao tao va d i o

Huyen Ba Vi - Ha Tay," Khda luan td't nghiep

tao lai cho c l n bd y te cac tuyen, dac biet la

B I c s'/ da khoa - Dai hpc Y Ha Ndi

c i p t h i i t dd'i vdi can bd tuyen huyen ve c i c v i n
2. Bo Y te' (2005), "Tai lieu tap h u i n : Hfldng

d l cd lien quan de'n thflc hanh ke don. Viec cd

difpc nhflng p b l e dd d i i u trj chuan cho cac

dan sfl dung thud'c hdp ly trong dieu trj," 268.

benh thdng thfldng cung la met trong c i c bien

3. Nguyin Minh Hie'u (2006), " K i l n thflc,

p h i p nang cao sfl dung thud'c hop ly, an toan

thflc hanh ke ddn k h l n g sinh cua c l n bd tram y

trdng benh vien. K i t q u i nay cung n h i t q u i n vdi

te xa trong d i i u tri tre dfldi 5 tudi mac n h i i m

k i t q u i nghien cflu cua Pham Huy Dung va CS

khuan hd h i p c i p tfnh tai huyen Binh Xuyen

nam 1999 [4].

tlnh VTnh Phuc nam 2 0 0 3 " .
4. Pham Huy Dung, va cong sff (2000), "Bao

V. KET LUAN

cao thflc h i n h ke ddn thud'c td't nam 1999," T i i

Sfl dung ky thuat phdng v i n tfl d i i n phieu

cho 1 37 c l n bd y t l chuyen nganh ndi, nhi, lay

lieu hdi thao sfl dung thud'c hpp ly, Vien Chie'n
Iflpc va Chfnh s i c h y te'. Ha Ndi

thudc t u y i n trung fldng, tuyen tlnh, tuyen huyen

5. Sam, I. Tomquist, Bjorn Wenngren, Nguyen

tai 10 benh vien cho t h i y : cac khd khan chinh

Thi Kim Chuc, Mattias Larsson, et al. (2000),

cua cac c l n bd tuyen huyen khi thflc h i n h ke

"Antibiotic

ddn bao gdm t h i i u thdng tin v l thud'c (68,5%),

epidemiological

indicator

inequitbale

of

thieu k i l n thfle dflpc lam sang (47,5%); thie'u xet
nghiem hd trd (59%). Nhu cau dao tao v l

cic

resistance

use

in

Vietnam:

An

of

inefficiency

and

health

resources,

in:

EE

Efficiency, equity - oriented stragegies for health".

Summary

DIFFICULTIES ASSOCIATED WITH DRUG PRESCRIPTION PRACTICE AND
TRAINING NEEDS REGARDING RATIONAL USE OF DRUG OF HEALTH STAFFS FROM
SELECTED HOSPITALS IN THE NORTH OF VIETNAM
In Vietnam, there remains very little information on difficulties associated with drug prescription
practice of health professionals. This study aims to describe the drug description's difficulties encountered
by health staffs from selected hospitals in the North of Vietnam while and to assess their training needs
regarding rational and safe use of drug. This was a cross - sectional study using self - administered

100