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

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

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

- 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



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


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)


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


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

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

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

cic

resistance

use

in

Vietnam:

An

of

inefficiency

and

health

resources,

in:

EE

Efficiency, equity - oriented stragegies for health".

Summary