Kiến thức, thái độ về tuân thủ điều trị thuốc kháng virus của người bệnh viêm gan b mạn tính phòng khám ngoại trú bệnh viện đa khoa tỉnh nam định

BQ YTE
TRIOAG DAI HOC DIEU DtfONG NAM DINH

19 6 0

BAO CAO TONG KET DE TAI NGHIEN CUU KHOA HOC CAP CO SO

KIEN THUG, THAI DQ VE TUAN THU DIEU TRI THUOC KHANG
VIRUS CUA NGlTdl BENH VIEM GAN B MAN TINH PHONG KHAM

s•

NGOAI TRU BENH VIEN
DA KHOA TtNH NAM DINH
Chu nhiem
de tai: MAI THI• YEN
•

Nam Dinh, thang 11 nam 2019


BOYTE
TRUONG DAI HOC DIEU DUONG NAM DINH

19 6 0

BAO CAO TONG KET DE TAI NGHIEN CUE KHOA HOC CAP CO SO

KIEN THUG, THAI DO VE TUAN THU DIEU TRI THUOC KHANG
VIRUS CUA NGtTCH BENH VIEM GAN B MAN TINH PHONG KHAM
NGOAI TRU BENH VIEN

DA KHOA TINH NAM DINH
Chu nhiem de tai: MAI THI YEN
Nhung nguoi tham gia:
TS. Nguyen Thi Minh Chinh
Ths. Bui Chi Anh Minh
Ths. Vu Thi Minh Phuong
n?(/ONG DAI HOC DIFU DUONG
Ths. Vu Thi Thuy Mai
nam dinh

THWvi^n
So:...... '

Nam Dinh, thang 11 nam 2019


X

-

X

z

•

2.10. Van de dao due nghien cun.....................................................................

19

Chiro ng 3. KET QUA NGHIEN CUXJ.........................................................

20

• A

• ?%

z

z

3.1. Dac diem cua doi tuong nghien cuu.........................................................

20

3.2. Kien thuc tuan thu dieu tri thuoc khang virus viem gan B...................

21

3.3. Thai do NB doi voi tuan thu dieu tri thuoc khang virus........................

26

Chuang 4. BAN LUAN...................................................................................

29

•A

*>

• Z\

' •

z

. 29

4.1. Dac diem cua doi tuong nghien cuu
I

z

z

'

•

A

4.2. Kien thuc chung cua nguoi benh doi voi tuan thu dieu tri dimg thuoc
khang virus viem gan B.................................................
r

\

30

*

4.2.1. Hieu qua cua thuoc dieu tri........................................................................31

4.2.2. Nhung nguyen tac dieu tri viem gan B man tinh.................................... 32
4.2.3. Tac hai cua viec khong tuan thu dieu tri thuoc khang virus..................32

4.2.4. Xet nghiem can thuc hien dinh ky............................................................. 33
4.2.5. Tac dung phuc cua thuoc khang virus........................................................ 34
4.2.6. Thuoc khang virus co chua khoi benh VGB man tinh............................ 34

4.2.7. Kien thuc tuan thu ve each su dung thuoc, theo doi dinh ky trong dieu
tri viem gan B truoc va sau can thiep................................................................... 34
4.2.8. T6ng diem kien thuc noi chung................................................................... 36
4.3. Thai do ve tuan thu dieu tri thuoc khang virus viem gan B truoc va sau
can thiep giao due.................................................................................................... 36

Ket luan.................................................................................................................... 40
Kien nghi.............................................................

41 .

TAI LIEU THAM KHAO............................. 1
PHU LUC.......................................5
PHU• LUC
1...
5
•
PHU LUC2..................................... 11

DANH MUC CAC CHLJ VIET TAT

HBV
NUC
NB
DTNC
VGB
HCC
n
%

Viem gan virus B man tfnh
Thuoc khang virus
Ngirai benh
Doi tuong nghien cmi
Viem gan B
Ung thu bieu mo te bao gan
So lurang ngudi benh
Ty le phan tram
r

*>

z


DANH MUC CAC BANG
Bang 3.1. Mot so dac diem nhan khau hoc cua doi tuong nghien cuu..

20

Bang 3.2. Kien thuc tuan thu thuoc dieu tri Viem gan B truoc va sau can

thiep...........................................................................................................................21
Bang 3.3. Kien thuc tuan thu ve each su dung thuoc, theo doi dinh ky trong
dieu tri viem gan B trade va sau can thiep........................................................... 24

Bang 3.4. T6ng diim kitin thuc chung ve tuan thu. dieu tri viem gan B......... 25
Bang 3.5. Thai do tuan thu su dung thuoc dieu tri viem gan B trudc va sau can

thiep...........................................................................................................................26
Bang 3.6. Thai do cam nhan ve qua trinh dung thuoc truve va sau can thiep 28


DANH MUC CAC BIEU DO VA HINH
•

/

a

X

•

.................................................

11

Hinh 2.2. So do quy trinh kham benh
Bieu do 3.1. Dac diem lien quan den gidi tinh ngubi benh viem gan B

16

20

Bieu do 3.2. Ly do quen uong thuoc trade can thiep

27

Hinh 2.1. Cac bien so nghien ctru
A

■»

• A

/

A

X

/

A

A

A

• A

Bieu do 3.3. Ly do quen uong thuoc sau can thiep

27


1
DAT VAN DE
Viem gan sieu vi B (VGSV B) man tinh la tinh trang nhiem sieu vi viem gan
B keo dai, dien ra o ben trong te bao gan. Berth lay nhiem qua: dubng xuyen qua
da (tiem chich, truyen mau, phau thuat, vet tray xuac...), quan he tinh due khong
an toan voi nguai nhiem benh, me nhiem benh truyen sang con.
Viem gan B man tinh la nguyen nhan dan den xo gan, ung thir gan.Theo
uoc tinh, tai Viet Nam co khoang 7,8 trieu trubng hop nhiem viem gan B man
tinh. Ben canh do, trong do co hon 13.000 bi xo gan mat bit (tiic la berth xo gan
da buoc vao giai doan cuoi), gan 6.000 ca bi ung thu te bao gan va hon 6.400 ca
tir vong lien quan den gan. Dac biet, uoc tinh chi cd 74.000 nguoi dupe dieu tn
truoc do. Viet Nam la mot trong nhung nude co san cac loai thuoc khang vi nit
dubng uong de dieu tri viem gan B man tinh tai cac benh vien va da dupe bao
hiem y te chi tra. Tuy cac loai thuoc khang virus nay khong chua dupe nhiem
viem gan virus B (HBV), nhung dieu tri co the lam cham su tien trien cua xo
gan, giam ty le mac benh ung thu gan va cai thien su song con lau dai [13]
Hien nay, tren toan the gioi uoc tinh cd it nhat 2 ty nguoi (mot phan ba
dan so the gioi) da bi nhiem HBV; khoang 240 trieu nguoi (tuong duong voi 6%
dan so the gioi) nhiem HBV man tinh [30], [31]. Su phat trien tu nhien cua
nhiem HBV man tinh la tir trang thai khong hoat dong den viem gan B man tinh

tien trien (CHB), cd the tien trien thanh xo gan va ung thu bieu mo te bao gan
(HCC) [21]. Benh gan giai doan cuoi co lien quan den HBV gay ra hon 0,5-1
trieu ca tu vong moi nam va hien chiem 5-10% so ca ghep gan. Cac nghien cuu
theo chieu doc cua nhung benh nhan khong dupe dieu tri CHB cho thay rang:
sau khi chan doan, ty le mac benh xo gan tang tu 5% len khoang 8 - 20%. Ty le
HCC tren toan the gioi da tang, chu yeu la do nhiem HBV va/hoac HCV. Ty le
HCC cd lien quan den HBV rat cao, dao dong tir 2% den 5% khi xo gan xay ra
[21]; 82% trubng hop cd lien quan den viem gan virus, 55% o viem gan loai B
(HBV), 89% o nhung vung cd HBV. Phan Ion cac trubng hop HCC (ung thu
bieu mo te bao gan) cd xo gan (70 - 90%), tuy nhien, vi HBV la mot virus gay
ung thu, nd cd the gay ra HCC ca khi khong cd xo gan £23}. Nhu vay, viem gan
B man tinh tro thanh ganh nang benh tat doi voi he. thdng y td cung nhu sue
khoe nguoi dan la rat Ion.
/V

***

Z

Z

z

'

Z

7

Z

Z

z

e

e

z

Z

•

Z

\

Z

Z

7

7

Z

7

7

e

Z

z

z

Z

e


2
z

'

'

e *

e

Tuy nhien, tai Viet Nam mac du rat nhieu co so y te dieu tri cho nguoi benh

benh viem gan B man tinh nhung nghien ciru str tuan thu dieu tri thuoc khang

virus con han che. Cac ket qua cua cac nghien curu deu cho thay ty le tuan thu

con han che, dieu nay doi voi mot so thuoc dieu tri khang virus tro nen kh6
khan, dac biet ty le khang thuoc o benh nhan dieu tri thuoc khang virus o ngtroi

benh viem gan B man tinh ty le tucmg doi cao nhu trong nghien curu cua Bui
Phan Quynh Phuong va cong su nam 2017 cho thay co 16 tniong hop khang
thu6c chiSm 22,2% [8], nghien cuu cua Nguyen Minh Ngoc va Bui Huu Hoang
Z

/

nam 2012 cho thay ty le tuan thu su dung thuoc b viem gan B man tinh tai TP

H6 Chi Minh la 63,8%[7], Theo nghien cuu cua Nguyen Thi Phuong cho thay
co den 75,8% benh nhan viem gan B man tinh tuan thu dieu tri thuoc khang

virus 6 muc do kern, chi co 24,2% tuan thu tot. Tir nhung ket qua cua nhung

nghien cuu tren cho thay rang ty le khang thuoc cao va tuan thu dieu tri thuoc

con han che [9].

Trong khi do hien tai tren dia ban tinh Nam Dinh co 1 co so duy nhat cung cap

diSu tri thu6c khang virus voi hon 367 nguoi benh viem gan B man tinh dang
duoc dieu tri tai khoa truyen nhiem benh vien da khoa tinh Nam Dinh. Tuy
nhien, chua co de tai nghien cuu nao ve kien thuc, thai do tuan thu dieu tri

thuoc khang virus cua nguoi benh viem gan B man tinh. Vi vay chiing toi tien

hanh nghien cuu d6 tai “Kien thuc, thai do ve tuan thu di6u tri thuoc khang virus

cua nguoi benh viem gan B man tinh phong kham ngoai tni Benh vien Da khoa
tinh Nam Dinh” voi 2 muc tieu sau:

1. Mo ta thuc trang kien thuc, thai do ve tuan thu dieu tri thuoc khang

virus cua nguoi benh viem gan B man tinh tai phong kham ngoai tni Benh vien
Da khoa tinh Nam Dinh.
2. Danh gia su thay d6i kien thuc, thai do ve tuan thu dieu tri thuoc khang

virus cua nguoi benh viem gan B man tinh trudc va sau can thiep giao due sue
khde tai phong kham ngoai tni Benh vien Da khoa tinh Nam Dinh.


3

Chirang 1

TONG QUAN TAI LIEU

1.1. SO LUOC VE VIEM GAN B

Viem gan vi nit B la mot berth pho bien toan cau, do vi rut viem gan B

(HBV) gay ra. Benh co th£ lay truyen qua duong mau, duong tinh due, tu me
truyen sang con. Neu me nhiem HBV va co HBeAg (+) thi kha nang lay cho

con la hon 80% va khoang 90% tre sinh ra se mang HBV man tinh. Viem gan

vi rut B co the dien bien cap tinh, trong do hon 90% so truong hop khoi hoan
toan, gan 10% chuyen sang viem gan man tinh va hau qua cuoi ciing la xo gan

hoac ung thu gan [1].

Nhiem HBV man tinh khong the dupe xu ly hoan toan do bo gen cua HBV
tich hop vao bo gen cua vat chu, DNA vong kin (cccDNA) cua virus lien ket
cong hoa tri trong hat nhan cua te bao gan bi nhiem, dieu nay co the giai thich
A

sir tai hoat tinh HBV [21], Muc tieu chinh cua dieu tri viem gan virus B la lam

giam su tien trien cua ton thuomg gan, lam cham su phat trien thanh xof gan va
HCC [13], £19]. Muc tieu nay co the dat dupe neu sao chep HBV dupe ngan

chan mot each ben vung. Mot so benh nhan khong dat dupe dap ung virus keo

dai, dieu tri keo dai nhieu nam, lam tang kha nang phat trien cac dong virus
khang thuoc. Hau qua la cac lua chon dieu tri se giam xuong. Cac yen to nhu
dpt bien virus, giam rao can di truyen cua mot so loai thuoc, va su thieu tuan
thu dieu tri khang virus la nhung nguyen nhan gay ra khang thuoc [9]. Hien

nay, khang genotyp khong dupe xac nhan a bat ki benh nhan nao co dpt bien
virus khi tiep nhan cac NUC co rao can di truyen cao nhu tenofovir va

entecavir nen nguyen nhan chinh cua dpt bien virus chinh la tinh trang tuan thu

kem, dieu nay co the do kien thuc ve tuan thu kem dan den [13].

1.1.1. Chan doan xac dinh:
- HBsAg (+) > 6 thang hoac HBsAg (+) va Anti HBc IgG (+).
- AST, ALT tang tung dpt hoac lien tuc tren 6 thang.
•>

a

* r

- Co bang chung ton thuemg mo benh hoc tien trien, xo gan (dupe xac dinh

bang sinh thiet gan hoac do dp dan hoi gan hoac Fibrotest hoac chi so APRI)
ma khong do can nguyen khac.

1.1.2. Dieu tri:
A

a) Chi dinh dieu tri khi:

1


4

- ALT tang tren 2 lan gia tri binh thuong hoac co bang chung xac nhan co

xo hoa gan tien trien/xo gan bat ke ALT o mire nao. va - HBV-DNA >105
copies/ml (20.000 lU/ml) neu HBeAg (+) hoac HBVDNA >104 copies/ml

(2.000 lU/ml) neu HBeAg (-).

b) Dieu tri cu the:
- Thuoc dieu tri: + Tenofovir (300mg/ngay) hoac entecavir (0,5 mg/ngay).
+ Lamivudine (lOOmg/ngay) su dung cho ngirbi benh xo gan mat bu, phu nu
mang thai.

+ Adefovir dung phoi hop voi lamivudine khi co khang thuoc. + Peg-IFNa,

IFNa (Peg-IFNa-2a lieu 180mcg/tuan; Peg-IFNa-2b lieu l,5mcg/kg/tuan;
IFNa lieu 5 trieu lU/ngay hoac 10 trieu lU/lan -3 lan/tuan, tiem duoi da tir 6-12
thang.

- Can theo doi tac dung khong mong muon cua thuoc de xu tri kip thoi) tru
tien str dung trong truong hop phu nu muon sinh con, dong nhiem viem gan vi

nit D, khong dung nap hoac that bai dieu tri voi thuoc uc che sao chep HB V'
duong u6ng. - Xem xet ngimg thuoc uc che sao chep HBV uong khi: + Truong

hop HBeAg (+): sau 6-12 thang co chuyen doi huyet thanh HBeAg va HBV­
DNA duoi nguong phat hien. + Truong hop HBeAg (-): HBV-DNA duoi
nguong phat hien trong 3 lan xet nghiem lien tiep each nhau moi 6 thang va can
Z

’

. X

e

e

theo doi tai phat sau khi ngimg thuoc de dieu tri lai.

1.1.3. Theo doi dieu tri:
- Tuan thu dieu tri: can tu van cho benh nhan ve loi ich cua viec tuan thu
dieu tri va cac bien phap h§ trp tuan thu dieu tri (phuong tien nhac uong

thuoc). Thang ddu tien sau khi bit dau dieu tri: theo doi AST, ALT, creatinine
mau. Sau mSi 3-6 thang trong qua trinh dieu tri: theo doi AST, ALT, creatinine

mau, HBeAg, Anti-HBe, HBV-DNA, c6 the dinh lupng HBsAg.

- Neu dieu tri IFN hoac Peg IFN: theo doi cong thuc mau, glucose mau, ure

mau, creatinin mau, chuc nang tuyen giap de phat hien tac dung khong mong

muon cua thuoc. - Sau khi ngimg dieu tri: + Theo doi cac trieu chung lam sang.
+ Xet nghiem sau moi 3-6 thang: AST, ALT, HBsAg, HBeAg, anti-HBe,
HBV DNA de danh gia tai phat.

- Can danh gia tuan thu dieu tri va do tin cay cua xet nghiem HBV DNA
trade khi ket luan that bai dieu tri. (Trong truong hop chua lam dupe xet


5
f

r

x

z

nghiem HBV DNA neu thay ALT khong giam hoac tang len can danh gia van
de tuan thu dieu tri neu benh nhan tuan thu tot can chuyen benh nhan len tuyen

tren de xet nghiem HBV DNA) [1].
1.2. KIEN THLfC VE TUAN THU DIEU TRI

1.2.1. Dinh nghia tuan thu dieu tri

Tuan thu che do thuoc da dupe theo doi tir then Hippocrates, khi cac dau
hieu dung thuoc dupe ghi lai cho biet benh nhan da dung chung hay khong
[25]. Tuan thu thuoc la mot phan quan trong trong cham soc benh nhan va la

dieu khong the thieu cho viec dat dupe cac muc tieu lam sang. To chuc Y te
The gioi (WHO), trong bao cao nam 2003 ve tuan thu dieu tri, tuyen bo rang
“viec tang hieu qua cua cac can thiep tuan thu co the c6 tac dong 16m den sue

khoe cua dan so horn bat ky cai thien cu the nao trong dieu tri y te” [34].

Theo WHO, “tuan thu” la mure do hanh vi cua con ngubi (bao gom ca
viec uong thuoc, che do dinh duong) phii hop vbi nhung khuyen cao tu cac
chuyen gia cham soc sure khoe [34]. Tuan thu can phai dupe theo doi, danh gia

trong mot khoang thbi gian dai, ke tir khi benh nhan bat dau dieu tri. Hai tir

trong tiSng anh dune sir dung trong nghien cuu va thuc hanh lam sang vbi
nghia “tuan thu” la “adherence” va “compliance”. “Compliance” bieu thi

nhung hanh vi dung thubc cua benh nhan triing khop voi Ibi khuyen cua cac

bac si [28]. no ngu y su thu dong cua benh nhan va khong co su phoi hop giua
benh nhan va bac si trong viec trien khai ke hoach dieu tri [25]. Con

“adherence” yeu cau su dong y cua benh nhan voi cac khuyen cao, benh nhan

trb thanh ngubi chu dong, dong hanh ciing voi bac si trong viec cham soc sue

khoe cua chinh ho va moi quan he bac si — benh nhan la can thiet cho hieu qua
tren lam sang [27].

1.2.2. Tinh hinh tuan thu dieu tri tren the gioi theo bao cao cua WHO
Khoang 50% benh nhan dieu tri benh man tinh b cac nubc phat trien dupe
X

z

♦

z

danh gia la tuan thu dieu tri. Con sb nay b cac nubc dang phat trien thap horn
rat nhieu do thieu ngubn luc kinh te, nhung han che trong kha nang tiep can vbi

cac dich vu cham soc sue khoe va nhieu benh nhan gap kh6 khan de tuan theo

nhung khuyen cao dieu tri [27]. Vi du, voi benh tang huyet ap, neu benh nhan

tuan thu >80% thi kha nang phat trien thanh benh dong mach vanh, benh mau

nao va suy tim sung huyet la rat thap [22], Tuy nhien theo khao sat, b My co


6

51% berth nhan dieu tri tang huyet ap tuan thu che do dung thuoc ha ap, con so

nay o Trung Quoc, Gambia va Seychelles tuong ung la 43%, 27% va 26%. O
Uc, chi c6 43% berth nhan hen phe quan dung thuoc theo chi dinh, va 28%

benh nhan su dung cac thuoc du phong. Trong dieu tri HIV-AIDS, tinh hinh
tuan thu cac thuoc khang virus cua berth nhan rat khac nhau, dao dong tir 37%
den 83% tuy thuoc vao loai thuoc nguoi benh dang su dung va dac diem nhan
khau hoc cua cac nh6m benh nhan [27].

Theo mot so bao cao, ty le benh nhan tuan thu dieu tri thubng cao hon o
nhung benh nhan co tinh trang cap tinh, so vdi nhung nguoi co tinh trang man
tinh [25]. Tinh trang benh nhan khong tuan thu lam keo dai thoi gian dieu tri,
gay ra tarn ly lo lang cr nguoi benh [20], [27] tang kinh phi, tang nguy co benh
tien trien va nhap vien [26].

1.3. MOT
SO NGHIEN CUT! TUAN THU DIEU TRI• VIEM GAN B
•
A

Ar/\

A

a

•>

A

a

•a

•

•

a

1.3.1. Kien thirc lien quan den tinh trang tuan thu dung thuoc dieu tri viem

gan B
A

Tinh trang benh nhan khong tuan thu lam keo dai thoi gian dieu tri, gay ra
tarn ly lo lang o nguoi benh [20], [28] tang kinh phi, tang nguy co benh tien

trien va nhap vien [26]. Hon nua, no co the dan den su phat trien cua cac chung
khang thuoc, han che cac lua chon dieu tri va bo sung them nguy cor sue khoe
A

•

'

'

cong dong cua viec truyen cac chung virus khang thuoc sang nguoi khong
mien dich trong cong dong, hoac cho nhung nguoi tiem chung truoc do khong
A

con bao ve [18]. Voi ganh nang toan cau cua can benh nay, su lay lan rong rai

cua cac chung khang thuoc co the co hau qua nghiem trong va rong Ion. Vi
vay, viec tuan thu dung thuoc dong vai tro rat quan trong, nhung co nhung

nguoi benh bo lo lieu phap chong virus cua viem gan B man tinh, hay anh
z

r

a

huong den ket qua dieu tri. Theo nghien cuu cua Ford N [15], cac rao can pho
bien nhat lien quan den tuan thu la quen thuoc, kien thuc ve su tuan thu dieu tri

thuoc khang virus va thay doi thoi quen hang ngay, chi phi chain soc, li do ban
viec khac, het thuoc va khong cai thien tinh trang sue khoe. Theo nghien cuu

cua Giang, Leesa [16], trong so cac benh nhan bao cao bo qua thuoc, ly do pho
bi£n nhSt dupe vien ddn la "su quen lang" ( n = 27, 56,25%). Cac ly do ph6
bi£n khac bao g6m: h6t thu6c ( n = 5, 10.42%), qua ban ( n = 4, 8.33%) va do
thay d6i thoi quen hang ngay (n = 5, 10.42%). Benh nhan bao cao tuan thu

4

7
z

*

X

f

thap cac thuoc ke toa khac cung co nhieu kha nang bo lo viec su dung cac

NUC (P = 0,04).
•»

Z

Z

Z

e

X

X

Nhu vay, co the thay cac van de tuan thu dieu tri thuoc khang virus va cac

yeu to lien quan den benh nhan viem gan B man tinh dang la van de dang quan
tarn hien nay tren toan the giai.

1.3.2. Mot so nghien ciru ve tuan thu dieu tri HBV
Tai Viet Nam: Tai Viet Nam theo nghien cuu cua Nguyen Thi My hanh
x

z

z

z

nam 2010 ve tuan thu dung thuoc doi voi benh nhan tang huyet ap la 49,5%

[4], theo nghien cun cua Nguyen Thi My Tien va cong sir nam 2016 ty le tuan

thu dieu tri chung vdi thuoc khang HIV la 71% [10], cua Nguyen Thanh Tri va
cong sir nam 2018 ve tuan thu dieu tri thuoc khang lao la 79,8% [1]. Cac ket
\

r

z

z e

X

qua cua cac nghien cuu deu cho thay ty le tuan thu con han che, dieu nay doi
Z

Z

X

voi mot so thuoc dieu tri khang virus trd nen kho khan, dac biet ty le khang
x

Z

z

thuoc d benh nhan dieu tri thuoc khang virus d ngudi benh viem gan B man
z

tinh ty le tuong doi cao nhu trong Nguyen Thi Nha Doan nam 2011 va cong su
nghien cuu tren 60 benh nhan viem gan B man thi co tai 20 truang hap xuat
z

z

z

z

hien dot bien khang thuoc chiem 33,3% [3], nghien cuu cua Ngo Viet Loe nam
z

e

'

2012 cho thay ty le nhiem Viem gan B la 16,4% va nghien cuu chi ra rang
nhom co tiep can thong tin ve viem gan B co ty le nhiem va tien trien benh thap
Z

X

X

hon so vdi nhom khong tiep can thong tin ve viem gan B trong d6 bao gom ca
thong tin ve str dung thuoc dieu tri viem gan B [5].

Tren the gioi: Dau tien la hai nghien cuu danh gia tuan thu dieu tri cua

benh nhan viem gan virus B tai My qua hai nghien cuu cua tac gia
z

X

Chotiyaputta va cong su. Mot nghien cuu hoi cuu duoc dng tien hanh tren
•»

z

11.100 benh nhan (69% benh nhan tren 45 tudi) dung cac loai thuoc NUCs

(ADV, LAM, ETV, TDF) thuc hien nam 2010; nguon du lieu thong qua cac

cong ty duoc pham. Theo so lieu thu thap duoc co 55% benh nhan duoc danh
gia la tuan thu dieu tri va mot so yeu to co lien quan thi khong tuan thu duoc

ghi nhan gom co: tuoi cua benh nhan (<45 tudi); su dung LAM va benh nhan
moi mac [14], Nghien cuu con lai duoc dng thiet ke theo mo hinh tidn cuu,
thuc hien nam 2011, tren 111 benh nhan co tudi trung binh la 48 tudi. Cong cu
nghien cuu duoc su dung la bo cau hoi vdi ket qua la 74% benh nhan va 84%

bac si hoan thanh bang cau hoi, Trong nghien cuu nay, thdi gian theo doi la 1


8

nam, tuan thu dupe danh gia moi 3 thang va du lieu trong 30 ngay cuoi ciing
dupe su dung nhu la mot su uoc lupng ve hanh vi cua benh nhan. Nhung benh
nhan khong bo lo bat ki mot lieu thuoc nao trong 30 ngay dune coi la tuan thu
9

hoan toan. Ket qua co 74% benh nhan dugc bao cao la tuan thu hoan toan.
Dong thoi nghien cuu cung chi ra moi lien quan tori viec khong tuan thu dieu tri
9

\

gom co tuoi benh nhan con tre, nu gioi, thu nhap thap horn [13], [20].
9

9

9

e

Co 2 nghien cuu dugc thiet ke theo phuong phap mo ta cat ngang. Nghien
ciru dugc Sogni va cong su thuc hien tren 190 benh nhan a Phap, co tuoi trung

binh la 50 tuoi cung su dung bo 5 cau hoi (cau cuoi cung danh gia theo thang
VAS) lam cong cu nghien cuu, ket qua danh gia c6 61%, 32% va 7% benh

nhan dugc phan loai theo 3 muc: tuan thu hoan toan, tuan thu tuong doi va
khong tuan thu. Va nghien cuu cung ghi nhan viec tuan thu dieu tri cua benh

nhan khong co moi lien quan tai nguon goc dia ly cua benh nhan, tai lugng

virus ban dau, loai phac do hay che dp dung thuoc [20], [29]. Mot nghien cuu
mo ta cdt ngang khac dua ra bp cau hoi gom 32-cau de benh nhan tra loi, dong

thoi bac si dieu tri cua hp cung tham gia tra loi mot bp cau hoi. Ket qua dupe
tinh dua van thang do VAS (visual analogue scale). Voi 80 benh nhan hoan
9 *

9

thanh bang hoi, 66% trong so hp dugc danh gia la tuan thu toi uu (VAS - 10
diSm) va 92% bac si dilu tri cua hp cho ring benh nhan cua hp da tuan thu dieu
tri toi uu. Nghien cuu ghi nhan khong co moi lien quan nao giua muc dp tuan
thu voi gioi tinh, tuoi, noi dugc sinh ra cua ngubi benh [16].

Theo ket qua diSu tra ganh nang benh tat toan cau nam 2010, nguyen nhan
tit vong co lien quan den vi nit viem gan dung hang thu 3 trong so cac nguyen
nhan do benh truySn nhiem gay ra. Theo uoc tinh cua To chuc Y te the gioi,
khoang 240 trieu ngurai tren toan cau da nhiem vi rut viem gan B man tinh va

ganh nang benh tat do viem gan B gay ra doi voi he thong y te cung nhu sue
9

y

* e

B

khoe nguai dan la rat Ion. Dieu tri khang virus cho benh viem gan B c6 -hieu
qua va lam giam nguy co tien trien xo gan va ung thu gan nhung thuong dugc
yeu cau trong mot thoi gian khong xac dinh. Tuan thu dieu tri la dieu quan

trong de ngan chan su phat trien khang thuoc va toi uu h6a ket qua. Hien tai c6
rat nhieu de tai nghien cuu nude ngoai nghien cuu su tuan thu dieu tri thuoc
khang virus va cac yeu to lien quan den su tuan thu dieu tri dung thuoc nhu

nghien cuu Ford N, Allard N,.. Sogni va epng su cho thay muc dp tuan thu


9

thap han 65% se dan den 2,6 trieu ca tu vong them trong khoang then gian 15
nam va cac rao can pho bien nhat lien quan den tuan thu [15] la quen thuoc,
kien thuc ve su tuan thu dieu tri thuoc khang virus va thay doi thoi quen hang

ngay, chi phi cham soc, li do ban viec khac , het thuoc va khong cai thien tinh
trang sue khoe.
Nhu vay, co the thay cac van de tuan thu dieu tri thuoc khang virus cua
benh nhan viem gan B man tinh dang la van de dang quan tarn hien nay tren
toan the giai. Cac mo hinh nghien cuu khac nhau nhu thu nghiem lam sang
ngau nhien co doi chung, mo ta cat ngang, tien cuu hay hoi cuu; cac cong cu
ducrc su dung nhu bo cau hoi, dem lieu, dinh luomg thuoc trong mau; co mau
benh nhan dao dong tu 47 den 11.100 nguoi; phan tram benh nhan tuan thu
dune danh gia dao dong trong khoang tir 35% den 92%. Mot so yeu to duoc
danh gia la co lien quan toi viec kern tuan thu cua benh nhan la tuoi (tuoi cao
hon kha nang tuan thu dieu tri tot hon), gioi tinh (nu gioi tuan thu kern hon
nam gioi), tai luomg virus ban dau, hay thu nhap thap.
•9

r

f

\

f

X

f

\

X

F

e


10
Chirtfng 2

PHUONG PHAP NGHIEN CUU
2.1. Doi tiro’ng nghien cuu
Ngudi benh dirge chan doan viem gan virus B man tinh dang dieu tri tai

phong kham ngoai tru benh vien da khoa tinh Nam Dinh
2.1.1. Tieu chuan lira chon

- NB co thoi gian dieu tri it nhat la 3 thang tinh tdi thoi diem phong van.
- NB tir du 18 tuoi tra len tir nguyen tham gia nghien curu

2.1.2. Tieu chuan loai trir
z

- Ngubi benh khong tbi kham va linh thuoc theo dung hen
- Ngubi benh suy gan hay ghep gan tir trubc.
- Ngubi benh co benh than doi hoi phai chinh lieu thuoc khang virus
(NUC).
- Ngubi benh mac kem viem gan C hay HIV.

- Nguai benh khong co kha nang giao tiep, khong nghe dupe, khong nbi

dupe.

- Ngubi benh khong on dinh ve tam than.
2.2. Thcri gian va dia diem nghien cuu

Thin gian: Thang 01/2019 den thang 11/2019
Dia diem: Phong kham ngoai tru - khoa Truyen nhiem - BVDK tinh Nam

Dinh

2.3. Thiet ke nghien cu-u
Nghien cuu can thiep co so sanh trubc sau.

Lua chpn doi
tuong nghien
cuu: cung cap
thong tin, muc
dich nghien
cuu

Ddnh gia ki£n
thuc ,th£i dp
tuSn thu dieu
tri thudc
> khang virus
cua NB viem
gan B man
tinh lan 1

Can thi^p gtao
due: tu van true

tiep tai khoa,
t& lieu phat tay

>

Danh gia sir thay d6i
Hinh 2.1. So* do nghien ciru

Danh gia kien
thuc ,thai dp
tuan thudiSu
tri thudc
> khang virus
cua NB viem
gan B man
tinh lan 2


11
2.4. Mau va phuo’ng phap chon mau

- Phiro’ng phap lay mau.
Chon mau toan bo theo danh sach ngiroi benh bi viem gan B man tinh dang
dieu tri ngoai tru tai khoa truyen nhiem benh vien da khoa tinh Nam Dinh phu

hop vai tieu chuan lira chon trong thdi gian lay so lieu nghien ciru.

- Co* mau.
Chon toan bo ngubi benh bi viem gan B man tinh dang dieu tri ngoai tni tai

khoa truyen nhiem benh vien da khoa tinh Nam Dinh tu thang 03/2019 den

thang 06/2019.
Cd mau thu dugc: 50 ngubi

2.5. Bien so nghien ciru
Doi vdi cac bien so nay lien quan den danh gia kien thuc, thai do lien quan

den hanh vi tuan thu vi vay de danh gia trong nghien cuu dirge phu hgp va co y

nghia thi chung tbi tien hanh danh gia 2 lan each nhau 4 tuan de ngubi benh co
thdi gian thuc hien thay doi hanh vi dira tren nhan thuc cua NB ve benh va che

do tuan thu dieu tri: trudc can thiep (LI), can thiep (L2) khoang 4 tuan, sau do
*>

9

y

x

r

z

so sanh de danh gia hieu qua su thay doi ve kien thuc cua NB. Phan kien thuc

dugc danh gia vdi 16 cau hoi tu cau 7 den cau 23 theo muc do dat hay khong dat
vdi moi cau, vdi cau tra Ibi “dat” se dugc 1 diem, “khong dat” dugc 0 diem.

z

f

- Nhom 1: Thong tin chung (nhan khau hoc), cac thong tin lien quan den
X

z

dieu tri thuoc khang virus.
\

r

z

z

- Nhom 2: Kien thuc cua ngubi benh doi vdi tuan thu dieu tri dung thuoc
z

\

z

z

z

khang virus viem gan B (so lan uong thuoc, thbi diem va each su dung thuoc va

z

z

thuc hanh tuan thu uong thuoc)

- Nhom 3: Thai dp cua ngubi benh doi vdi viec tuan thu dieu tri thuoc

khang virus

Bang 2.1. Cac bien so nghien ciru

TT

Bien so

Dinh nghia bien - Cac chi

Phan

so nghien ciru

.-x

PP, Ky
loai thuat
x

bien so

thu thap
TT

I

Bien so chung


I

12
Tinh tron theo nam durang

1

2

lich, lay nam 2019 trir di nam

Tuoi

tir

ho

so

sinh cua DTNC

benh an

La giai tinh cua DTNC, bao

Lay

tir

ho

so

Nhi phan

gom: nam, nu

Giai

Rai rac

Lay

benh an
La cong viec chinh dang lam

3

hoac mang lai thu nhap chu

Nghe nghiep

Dinh danh

Trinh do hoc La cap hoc cao nhat cua

DTNC

van

tir

ho

so

benh an

yeu cho ban than nguai benh
4

Lay

Thur hang

Phong

van

La tinh trang hon nhan hien
5

Tinh trang hon tai cua nguai benh: chua ket
z

hon, ly than, ly hon, song

nhan

Nhi phan

Phong
van

Thur hang

Phong
van

Rai rac

Phong
van

cung vq/chong
La

thu

nhap

chia theo

Thu nhap binh quan/nguai/thang
6

gia cac mure: ngheo,khong ngheo

cua

quan

dinh nguai benh

(Quyet

Dinh-59-2015-QD-

TTg)

So lan dieu tri
7

binh

________________

So lan dieu tri benh viem

benh viem gan gan B man tinh dune tinh
z

e

>

B man tinh cua den lan hien tai
nguai benh

II

Kien thirc ve tuan thu dieu tri cua ngiriri benh
z

8

Dung

thuoc

•\

dung lieu luong

La lieu luong thuoc dung

duqc sir dung cho moi nguai
*

benh cu the
f

9

Dung

thuoc

z

10

Dung
dung each

thuoc

phan

La dung thuoc hang ngay
(tiem, uong) cung mot luc xa

bua an

*

z

Phong van

X

La dung thuoc deu dan hang Nhi

ngay theo mot gia nhat dinh

deu dan

Nhi

phan

Nhi

phan

*

z

Phong van

Phong van


I

13

11

Dung thuoc du

12

dieu tri theo phac do dieu tri.

thai gian
Tac

cua

hai

viec khong tuan
thu NTDT

Thai

La dung thuoc du thai gian

tuan thu cac nguyen tac dieu

Danh

tri (khang thuoc, khong khoi, muc

7

Phong van

7

gian

khoi

F

La nhung tac hai khi khong

it
x

tri

*

Phong van

bien chung...)

nhat can de dieu
13

Rai rac

r

7

La thai gian can thiet it nhat

benh de dieu tri khoi benh viem Rai rac

Phong van

viem gan B man gan B man tinh theo phac do
tinh

in

Thye hanh tuan thu dieu tri cua ngiroi benh

Thai gian den La thai gian nguai benh
7

14

linh thuoc trong viem gan B linh thuoc theo Danh muc

qua trinh dieu tri chi dinh cua bac si
Huong dan cua

15

CBYT ve dung

thuoc

Phong

van

La cac huang dan nguai
x

7

benh ve each dung thuoc, cac
tac

dung

phu,

thai

gian

Nhi phan

Phong

van

ubng,...

2.6. Cong cu va phtrong phap thu thap dir lieu

2.6.1. Cong cu thu thap dir lieu
Bo cong cu se dugc nha nghien cuu xay dung va phat trien. Bo cau hoi

dugc xin y kien chuyen gia va truac khi thu thap so lieu nha nghien cuu se thu

thap thu tren 20 nguai benh tu do se cho thay do tin cay cua bo c6ng cu.
X

Bo cau hoi gom:

Phan I: Thong tin chung cua doi tuang nghien cuu bao gom: ma benh
nhan (lay trung vai ma so benh an), ten, tuoi, giai tinh, dia chi nai a, trinh do

hoc van, benh ly mac kem, tien su gia dinh, thai diem chan doan benh va
khoang thai gian nguai benh da dugc dieu tri bang thuoc khang virus...

Phan II: Bp cau hoi v& kiSn thuc cua nguai benh doi vai tuan thu dung

thuoc khang virus cua nguai benh viem gan B man bao gom 16 cau hoi ( cau 7

den cau 23) ve thuoc khang virus, each su dung thuoc, tac dung phu cua thuoc,


I

14
f

f

ã

ã

ôx

X

1

zx

X

each xii tri khi xuat hien tac dung phu, viec quen uong thuoc, ly do quen uong
thuoc..

Phan III: Thai do cua ngubi benh voi viec dung thuoc khang virus cua
ugiich benh viem gan B man bao gbm 6 cau hoi (cau 24 den cau 29) ve cam
z

r

\

x

nhan chung, khi dung thuoc qua lieu, ke hoach dieu tri...

2.6.2. Phirong phap thu thap thong tin/dir lieu

Ky thuat thu thap so lieu
Ket hop voi 5 dieu tra vien (DTV) la giang vien Truong Dai hoc Dieu

X

Z

f

/

duong Nam Dinh tham gia de tai se tien hanh phong van true tiep ngubi benh du
tieu chuan dua vao nghien cuu bang phieu khao sat chuan bi trudc (Phu luc 1).

Cac CTV durgc tap huan truoc khi tham gia nghien cuu trong hai buoi.
Phieu khao sat nay dupe xay dung tren co so “tdz lieu hicomg dan chan doan,
phong va dieu tri benh viem gan virus B man tinh” cua Bo y te ban hanh nam
2015 [1] va tham khao nghien cuu “Khao sat tuan thu dieu tri cua benh nhan
viem gan B man tinh dupe quan ly tai phong kham ngoai tru benh vien Bac
Thang Long nam 2017” cua tac gia Bui Phan Quynh Phuong va CS [8]. Phieu
khao sat tiep tuc dupe chinh sua, bo sung cho phu hop voi nghien cuu .
Phieu khao sat trudc khi su dung de thu thap so lieu da dupe dieu tra thu
nghiem cho 20 ngubi benh rbi tiep tuc chinh sua cho phu hop voi muc tieu nghien
cuu.
- Cac buoc thuc hien nghien cuu:
+ Buoc 1: Nghien cuu hb so benh an va so sach quan ly ngubi benh mac viem
gan B tai phong kham ngoai tru de lua chon nguoi benh du tieu chuan dua vao
nghien cuu.
+ Buoc 2: Ngubi benh trong danh sach nghien cuu dupe gui giay moi theo
dia chi hb so benh an va gpi dien true tiep de hen den phong tu van cua khoa
kham benh. Dbi voi nhung ngubi benh co lich tai kham tai phong kham trong
thbi giam lay sb lieu lan 1 thi lich phong van trung voi lich tai kham, thbi gian
phong vSn va tu van la thbi gian ngubi benh chb ket qua xet nghiem tai kham.

Nhung ngubi benh khbng co lich tai kham thi thbi gian phong van tai phong
kham dupe sip xbp phii hop voi thbi gian va ebng viec nhat cho ngubi benh. Co
12 ngubi benh vi li do sue khoe va ebng viec khbng the den phong kham de.
phong van va khbng tham gia nghien cuu. Sb ngubi con lai tham gia nghien cuu
la 52 ngubi. Truoc khi phong van, ngubi benh dupe gidi thieu muc dich, y
nghia, phuong phap va quyen loi cua ngubi tham gia vao nghien cuu. Neu dong
y ngubi benh ky vao ban dong thuan va dupe pho bien ve hinh thuc tham gia
z

z


15
•

'

•f

•

nghien cun, sau do dirge hiromg dan ve each tra loi cac thong tin trong phieu
khao sat.
+ Bude 3: Dieu tra vien se danh gia kien thuc va thuc hanh tuan thu dieu tri cua
nguoi benh (lan I) bang phuong phap phong van true tiep thong qua phieu khao
sat chuan bi truoc (phu luc 1) tai phong tu van khoa kham benh hoac tai nha
nguoi benh.
+ Bude 4: Can cu ket qua thu dirge tu phieu khao sat ( lan 1) nhom nghien
cuu biet dupe kien thuc va thai do tuan thu dieu tri con thieu hut cua doi tuong
nghien cun. Tu do bo sung kip thai noi dung kien thuc va thai do con thieu hut

cho nguoi benh. Moi doi tuong nghien cuu se dune tu van true tiep va phat to
rai ve noi dung cac nguyen tac tuan thu dieu tri, huang dan de noi de quan sat
khi ve nha nhu mot cong cu nhac nha nguoi benh thuc hien dung. Noi dung can
thiep bao gom cac nguyen tac dieu tri va hau qua cua viec khong tuan thu dieu
tri (phu luc 2). Hen nguai berth 1 thang sau quay lai de phong van lan 2.
+ Bude 5: Nguoi benh dupe goi dien de nhac nhd lich hen phong van lan 2,
lich phong van duoc sap xep tuong tu lan 1. Co 50 nguoi benh den va dupe
phong van bang phieu khao sat chuan bi truoc giong lan 1 (Phu luc 1) tai phong
tu van cua khoa kham benh khoa truyen nhiem benh vien da khoa tinh Nam
Birth, 2 nguai con lai khong den dugc phong kham va tu choi tham gia vi ly do
ca nhan.
2.7. To chii-c thuc hien de tai (Chirong trinh can thiep)
9

>

f

r

/

/

2.7.1. Doi tuffng can thiep:
Doi tugng la nguai berth viem gan B dieu tri ngoai tru tai khoa truyen
,

y

e

>

nhiem tham gia nghien cuu

2.7.2. Nguffi thuc hien can thiep:
Nghien cuu vien la nguai giao due sue khde

2.7.3. Noi dung can thiep: (Phu luc 2,3)
Giao due sue khde cho nguai benh viem gan B man tinh dang dieu tri ngoai
tru tai khoa truyen nhiem co kidn thuc ve cac nguyen tic phai tuan thu khi dieu
A

tri viem gan B man tinh va hau qua cua viec khong tuan thu dieu tri (phu luc 2).

+Binh nghta va hau qua ve benh viem gan B man tinh
+Cac thuoc didu tri benh viem gan B

+Lgi ich cua viec tuan thu dieu tri thuoc khang virus
+Tac dung phu hay gap trong qua trinh dung thuoc khang virus

- Tai lieu va cac vat lieu phuc vu budi tu van: Cac to roi, ap phich dong quyen


I

16
z

z

z

•

X

•

z

theo tung khuyen cao cua Bo y te. Cac vat lieu khac nhu poster kho Al in cac

noi dung can can thiep, giay, but, ban in cac phieu khao sat, so ghi chep.
- Hinh thirc: Tu van ca nhan hoac nhom nho 3-5 nguoi duoc thuc hien true
tiep tai phong tu van khoa truyen nhiem benh vien da khoa tinh Nam Dinh hoac

tai nha cua nguoi benh.
2.7.4. To chuc can thiep:
Ket hop voi 5 dieu tra vien (DTV) la giang vien Truong Dai hoc Dieu
duong Nam Dinh tham gia de tai se phong van thu thap so lieu true tiep bang

each hoi nguoi benh ve cac cau hoi san co.
z

i

r

Ket hop voi quy trinh kham benh cua phong kham de dua tu van GDSK
z

thanh mot buoc truoc trong quy trinh kham viem gan B, ITnh thuoc.
NB den kham xep
sox

♦

*

NB se nghi ngoi va
cho kham 15 phut

^z

Lua chon va Phong van

Phong BS kham

Phong tu van GDSK
Noi linh thuoc

<

Hinh 2.2. Sa do quy trinh kham benh

Nguoi benh nop so va dupe dang ky so kham benh tai khoa truyen

nhiem, trong thoi gian cho d6 kham nguoi benh se ngoi nghi ngoi khoang

10 phut. Luc nay 4 cong tac vien la cac giang vien tham gia de tai lua chon

DTNC va phong van nhanh nguoi benh khoang 10 phut. Sau do nguoi benh
dupe vao phong bac sy kham va tai phong kham bac sy se hudng dan nguoi

benh sau khi dupe kham xong sang phong tu van, giao due sue khoe ve
benh viem gan B (la phong tu vdn cua khoa).
Cac nghien cuu vien (NCV) chinh la cac dieu tra vien tham gia

nghien cuu se co trach nhiem huong dan nguoi benh vao phong tu van,
trong phong tu vdn chung toi chuan bi hai ban tu van voi can bp tu van la


17

giang vien da dirge tap huan ve noi dung tu van theo tai lieu viem gan B

cua bo y te, tai day nguoi benh se dupe cac can bo tu van se tu van theo cac
noi dung viem gan B cua bo y te voi khoang thoi gian cho moi nguoi benh

khoang 10—15 phut, trong khoang thoi gian nay nguoi benh se dupe phat
z

z

z

to noi dung GDSK doc khoang 7 phut. Sau khi tu van xong can bo tu van

hoi nguoi benh co con cau hoi thac mac gi ve benh, che do dieu tri viem

gan B man khong? Trong qua trinh tu van khuyen khich nhung nguoi benh

co kien thuc va thuc hien tot che do dieu tri chia se cho nhung nguoi benh
z

az

con lai ve kien thuc, tro ngai cua ho trong viec thuc hien tuan thu che do
z

a

dieu tri thuoc khang virus viem gan B.
z

z

z

Tiep theo sau khi hoan thanh tu van NCV phong van danh gia lai
A

Z

A

Z

ngay sau can thiep bang bo cau hoi phong van ve kien thuc trudc can thiep

A

(Ghi chu: trudc khi NB tham gia nghien cuu se duoc giai thich ve quy trinh

cac buoc can tham gia cua nguoi benh, neu NB dong y moi tien hanh de
tranh tinh trang sau 4 tuan co NB khong den, ngoai ra NCV ghi lai so dien

thoai, dia chi de tien lien lac voi NB). Sau 4 tuan khi nguoi benh den kham
theo lich hen cua bac sy se duoc phong van lai lan 2 bang cung bo cau hoi
Z

A

A

phong van lan dau (truoc can thiep).

Trong nghien cuu nay chung toi thu thap so lieu trudc va sau can thiep giao
due sue khde str dung bo cong cu danh gia chia lam 3 giai doan voi thoi

gian du kien cho mot NB la 30 phut cho lan dau phong van va 10 phut cho

danh gia lan 2 va tra loi thac mac khoang 20 phut.
2.7.5. Cac buffc can thiep:

- On dinh

----- —^±DINh

- Gioi thieu

- Nhic lai ket qua phong van lan 1

b

THuviKrn
S6:..
*
/

- Giai thich tung noi dung
- Tom tat

2.8. Tieu chuan danh gia

*Danh gia kien thirc ve tuan thu dieu tri thuoc khang virus
Danh gia ve kien thuc
- Nguoi benh tham gia tra loi phong van 17 cau hoi ve kien thuc tuong
duong voi 34 tieu chi danh gia, voi moi tieu chi tra loi dung dupe 1 diem, tra loi


18
sai hoac khong biet 0 diem (Xac dinh tieu chi dung/sai dua tren nhung nbi dung

ve tuan thu dieu tri thuoc khang virus do Bo Y te ban hanh [1]
- Tinh tong diem kien thuc va lay diem cat 50% de phan loai kien thuc cua

ngubi benh viem gan B cu the nhtr sau:
Ngubi benh dugc coi la tuan thu dieu tri thuoc khang virus khi ngubi benh
hieu ve loai thuoc, so lan uong thuoc, thbi diem uong thuoc, each su dung thuoc.
/

z

*

Doi vbi cau hoi 1 lua chon duy nhat thi cau tra Ibi dung dupe 1 diem, cau

tra loi sai hoac khong biet dupe 0 diem.
Doi vdi cau hoi co nhieu lua chon thi vdi moi dap an dung se dupe cong 1

diem, chon sai hoac khong biet dugc 0 diem.,
z

*>

z

> Vdi 16 cau hoi (cau 7 den cau 23), diem tbi da la 34 diem, ngubi benh dat
•>

z

z

9

tu 17 diem trb len thi kien thuc dat, dudi 17 diem dupe cho la kien thuc chua

dat
*Danh gia thai do ve tuan thu dieu tri thuoc khang virus [1]

z

z

•>

Doi vdi cau hoi 1 lua chon duy nhat thi cau tra Ibi dung dupe 1 diem, cau
z

*>

tra loi sai hoac khong biet dupe 0 diem.

Doi vdi cau 28, 29 la thang do 3 mure dp diem cao nhat la 3 diem, thap nhat

la 1 diem

>

Vdi 6 cau hoi (cau 24 den cau 29) , diem toi da la 9 diem, ngubi benh dat

tu 4,5 diem trb len la cd thai dp tot, dudi 4,5 diem la co thai dp chua tot.
*

z

- Cach tinh. diem va phan loai kien thuc, thai do dat va khong dat truoc va sau

can thiep la giong nhau.
- Darth gia su thay dbi sau can thiep giao due so vdi truoc can thiep dua

X

Z

/w

tren su chenh lech ve ty le tra loi dung dbi vdi moi nbi dung danh gia.
2.8. Thir nghiem triarc bo cong cu nghien cuu
e

z

X

z

Thu nghiem bo cong cu nghien cuu se dugc thuc hien 2 tuan truoc khi bat
x

z

x

z «

dau thu thap du lieu. Tien hanh dieu tra thu dbi tupng phu hop tieu chuan lua
chon (nhung dbi tupng nay se khong tham gia vao dbi tupng nghien cuu se dupe
dieu tra sau do nham tranh d6i tugng da biet truoc noi dung cau hoi lan danh gia

kien thuc ve sau se thieu khach quan) de xac dinh tinh kha thi cua bp thu thap du

lieu, va de danh gia dp dai, su phu hop cua bb cong cu. Sau do chiing tbi tibn

hanh chinh sua va cap nhat bb cong cu cho phu hop bang each dieu chinh cac .
cau hoi va nhung lua chon cua cau tra loi.


20
Chircng 3
KET QUA NGHIEN CUT
3.1. Dac diem cua doi tuong nghien ciru

BiBu dd 3.1. Dac di6m lien quan den gioi tfnh nguoi benh viem gan B
Nhan xet: Nhin bieu do 3. 1 cho thay ty le nam mac benh rat cao chiem 76%, n£r
chi chiem % so doi tuong nghien cuu (chiem 24% )
Bang 3.1. Mot so dac diem nhan khau hoc cua doi tuong nghien cuu
n
Ty le
STT Bien
(%)
(ngiroi)

1

2

Tuoi
< 30 tuoi
30- 39tu6i
> 40 tuoi
Nghe nghiep

Can bo, vien chuc
Cong nhan
Nong dan
Noi tro
Khac (nghi him, tu do)

2

4

IT

12

42

84

10
7~

20

16

14

2~

32

4~

15

30