UY BAN NHAN DAN TINH KHANH HOA SOf Y TE BAO CAO KET QUA D^ TAI NCKH CAP TiNH DANH GIA HOAT DQNG CUA CAC PHONG CHAN TRI Y HOC CO TRUYEN TiNH KHANH HOA Cd quan quan ly: Sd KHOA HQC & CONG NGHE KHANH HOA Cc^ quan chu tri: SCf Y TE KHANH HOA Cd quan thrfc hien: HQI DONG Y KHANH HOA Chu nhiem de tai: TSDK. NGUYEN THl/CfNG Nha Trang, thang 07 nm 2009 UY BAN NHAN DAN TINH KHANH HOA sd Y TE BAO CAO KET QUA DE TAI NCKH CAP TINH DANH GIA HOAT DONG CUA CAC PHONG CHAN TRI Y HOC CO TRUYEN TINH KHANH HOA OC Cd quan chu tri S^i?;fST^ANH HOA Mai Thi Thanh Cg quan thrfc hien ,Y KHANH HOA 'HO CHU TICH 1 Xuan Minh sdK Cd quan quan ly & CONG NGHE KHANH HOA iC "/ MUC LUC • • MUCLUC i NHUNG CHLT VIET TAT iv MUC LUC CAC BANG vi MUC LUC CAC BIEU DO viii DAT VAN DE 1 CHVONGI 3 TONG QUAN TINH HINH HOAT DONG YHCTTU^ NHAN 3 1.1. Tinh hinh hoat dgng YHCT tu nhan tren the gidi 3 1.2. Tinh hinh hoat dgng YHCT tu nhan tai Viet Nam 4 1.3. Tinh hinh hoat dgng YHCT tu nhan tai Khanh Hda 8 1.4. "Phdng chdn tri YHCT" theo Phap lenh hanh nghi y, dugc tu nhan 16 1.4.1. PCT-YHCT la mgt hinh thirc to chirc hanh nghi YDHCTtunhan 16 1.4.2. Dieu kien va pham vi hanh nghe ddi vdi mgt PCTYHCT 17 1.5. Dao dire hanh nghi YHCT Viet Nam 20 CHVONGII DOI TlTgnVG VA PHU'ONG PHAP NGHIEN CUtJ 21 2.1. Dia ban nghien ciiu 21 2.2. Doi tugng nghien ciin 21 2.3. Thilt ke nghien ciiu 21 2.4. Cd mdu va phuong phap chgn mau 22 2.5. Cac ky thuat ap dung trong nghien cim 28 2.6. C6ng cu sir dung 28 2.7. Xir ly va phan tich s6 lieu 28 u CHVONGIII KET QUA NGHIEN CUtJ 29 3.0. Khai quat ve cac mau khao sat 29 3.1. Ket qua khao sat mang ludi to chiic ciia cac PCT YHCT tinh Khanh Hda 30 3.1.1. Kit qua thu thap tir mau "Cac PCT" 30 3.1.2. Ket qua thu thap tir mau "Nhung ngudi hanh nghl"36 3.1.3. Kit qua thu thap tir mau " Cac chuyen gia" 38 3.1.4. Ket qua thu thap tir mau "Nhung ngudi dan sdng tren dia ban nghien ciiu" 40 3.2. Danh gia thuc trang hoat dgng cua cac PCT - YHCT Tinh Khanh Hda 42 3.2.1. Kit qua thu thap tir mau "Cac PCT" 42 3.2.2. Ket qua thu thap tir mau "Nhimg ngudi hanh nghe"51 / OH 3.2.3. Ket qua thu thap tir mau " Cac chuyen gia" 53 3.2.4. Ket qua thu thap tir mau "Nhiing ngudi dan sdng tren dia ban nghien ciiu" 57 CHVONGIV BAN LUAN 69 4.1. Mang ludi t6 chirc cac PCT-YHCT tinh Khanh Hda 69 4.1.1. Su thanh lap he thing cac PCT - YHCT tinh KH 69 4.1.2. Dac dilm he thong PCT - YHCT tinh KH 70 4.1.3. Nhan xet chung ve s6 lugng cac PCT va dgi ngu cac thdy thuoc YHCT tinh Khanh Hda 72 4.2. Danh gia thuc trang hoat dgng cua cac PCT ! 74 4.2.1. Su chgn lua noi dieu tri ctia ngudi dan khi dau 6m. 74 4.2.2. Ly do ngudi benh chgn den PCT 76 4.2.3. Nhimg phuong phap dieu tri tai PCT 77 4.2.4. Nhirng loai benh dugc dieu tri tai PCT 78 Ul 4.2.5. Nhirng bien chiing trong qua trinh dieu tri 80 4.2.6. Thai do cua thay thu6c va nhan vien PCT d6i vdi benh nhan 80 4.2.7. Gia djch vu YHCT tai PCT 80 4.2.8. Vai trd cua PCT trong cdng ding 81 4.2.9. Viec chap hanh cac qui dinh vl pham vi hanh nghl.82 4.2.10. M6i quan he giira PCT vdi Tram y tl ciing dia ban xa/phudng 83 4.3. Nhirng van de can uu tien giai quyet 83 CHVONG V KET LUAN 87 5.1. vl mang ludi to chirc cac PCT- YHCT tinh Khanh Hda 87 5.2. Ve thuc trang hoat ddng cua cac PCT- YHCT tu nhan tinhKhanhHda 88 HAN CHE CUA DE TAI 90 KIEN NGHI Nhung giai phap kha thi nham nang cao hieu qua hoat ddng cua cac PCT - YHCT tinh Khanh Hda 91 A. Nhdm giai phap nham giai quyet nhirng van de can uu tien thuc hien 92 B. Nhdm giai phap mang tinh chien luge lau dai 94 DE XUAT HU6NG NGHIEN CUtJ TIEP THEO 96 TAI LIEU THAM KHAO 97 PHU LUC 100 IV NHUNG CHCT VIET TAT F F Chir viet tat CR, DK, NT, NH, VN, CL ND- 103 PCT PKS PL-07 PL-1993 SL TL TT-01 TT-07 Cum tir dtfcJc thay the Thi xa Cam Ranh, Huyen Dien Khanh, Thanh pho' Nha Trang, Huyen Ninh Hoa, Huyen Van Ninh, huyen Cam Lam. Nghi dinh so 103/2003/ND-CP ngay 12 thang 9 nam 2003 ciia Chinh phii quy dinh chi tie't mgt so'dieu cua Phap lenh hanh nghe y, dggc tg nhan. Phdng chan tri Phieu khao sat Phap lenh s6 07/2003/PL - UBTVQH ngay 25 thang 02 nam 2003 ciia Uy ban Thudng vu Qudc hgi quy dinh vl hanh nghe y, dugc tu nhan. Phap lenh hanh nghe y, difdc tg nhan nam 1993 S6 lugng Tile Thong tu^ s6'01/2004/TT-BYT ngay 06 thang 01 nam 2004 ciia Bg Y te'hgdng dan ve hanh nghe y, dgdc tif nhan Thong tu* so' 07/2007/TT-B YT ngay 25 thang 5 nam 2007 ciia Bg Y te' hu'dng dan ve hanh nghe y, y hoc co truyen va trang thiet bi y te' tg nhan ChCr viet tat WHO YDHCT YHBT&TT YHCT YHHD Cum tir dxidc thay the World Health Organization : T6 chiic Y te Thi gidi. Y dugc hgc c6 truyen Y hgc b6 trg va thay the Y hgc c6 truyen Y hgc hien dai vi MUC LUC CAC BANG Bang Bang I Bang 2 Bang 3 Bang 4 Bang 5 Bang 6 Bang 7 Bang 8 Bang 9 Bang 10 Bang 11 Bang 12 Bang 13 Bang 14 Bang 15 Bang 16 Bang 17 Bang 18 Bang 19 Bang 20 Bang 21 Tieu de Phan bo cac PCT trong tinh Ket qua kham va dieu tri ciia he tho'ng hgi Dong y Phan bo so' Iifdng mlu cac PCT Phan bd so' lUdng mlu nhiing nggdi hanh nghe Phan bo so'lu'dng mlu ciia ngudi dan (16 1) Phan bd so' lufdng mau ciia ngudi dan (16 2) t F fv Phan bd s6 lugng cac mau khao sat Th6ng tin ca nhan ve nhirng ngudi dimg dau cac PCT F S6 lugng ngudi giiip viec cd trong 1 PCT Trinh do chuyen m6n cua nhiing ngudi giiip viec Qui md t6 chiic cac PCT F S6 lugng PCT dugc thanh lap theo thdi gian Viec hgc tap nang cao trinh do chuyen mdn tai PCT. / F Mdi quan he giira PCT vdi Tram y te Thdng tin ca nhan ve nhiing ngudi hanh nghe F F \ F Trac nghiem kien thiic phap luat cua thay thude YHCT \ r \ F Nhan xet ve s6 lugng cac PCT va thay thu6c YHCT F F Y kien chuyen gia so sanh cac PCT tu nhan vdi cac co sd dieu tri bang YHCT ctia Nha Nude. Su chgn lua each dieu tri bang Ddng y cua ngudi dan Cac loai benh dugc dieu trj tai PCT Nhirng loai benh ma PCT chira cd hieu qua II 9 12 24 25 26 27 29 31 31 32 33 34 35 35 36 37 38 39 40 42 44 Vll Bang Bang 22 Bang 23 Bang 24 Bang 25 Bang 26 Bang 27 Bang 28 Bang 29 Bang 30 Bang 31 Bang 32 Bang 33 Bang 34 Bang 35 Bang 36 Bang 37 Bang 38 Bang 39 Tieu de Tr Nhung bien chimg trong qua trinh dilu tri tai PCT Ket qua khao sat viec chdp hanh cac qui dinh vl hanh nghi F , So lugng benh nhan den kham tai 01 PCT qua cac nam F S S6 tien lam tir thien tai 01 PCT qua cac nam. Cac nhdm benh din vdi PCT ciia ngudi hanh nghi Nhiing phuong phap dieu tri sd trudng Y kien ngudi hanh nghi vl cac vdn de cdn uu tien giai quyet Y kien chuyen gia ve ly do ngudi benh chgn din kham Nhan xet ciia chuyen gia ve chat lugng kham chira benh va thai do phuc vu benh nhan tai PCT Y kien cac chuyen gia ve vai trd xa hdi ciia PCT F F \ F •>. \ F Y kien ciia chuyen gia ve cac van de can uu tien giai quyet Ly do ngudi dan chgn den PCT tu nhan Nhiing loai benh khien ngudi dan tim den cac PCT Nhirng phuang phap dieu tri tai PCT Thai do ciia thay thude va nhan vien PCT Y kien cua ngudi benh ve vai trd cham sde sire khoe cdng ddng cua PCT Y kien ciia ngudi benh ve gia dich vu kham chira benh tai PCT Tai bien gap phai khi dieu tri tai PCT F F S W \ -S. F Bang 40 Y kien ciia ngudi benh ve cac van de can uu tien giai quyet 46 47 49 50 51 52 53 54 55 56 56 58 59 61 62 66 66 67 67 j Tong cong: 40 bang Vlll MUC LUC CAC BIEU DO •> > Bieu do t \ Biiu do I Bieu do 2 Bieu do 3 7 > Biiu do 4 Biiu do 5 9 \ Biiu do 6 •7 \ Bieu do 7 Tieu de Trang Trinh do chuyin mon ciia nhimg nguoi hdnh nghi Su chgn lua cdeh diiu tri bdng Ddngy ciia nguoi ddn Cdc nhom binh dugc diiu tri tgi PCT (theo khao sat tai PCT) Cdc nhdm benh chira co hiiu qud tgi PCT So lugng binh nhdn din khdm tgi 01 PCT qua cdc ndm F \ So tiin Idm tic thien tgi 01 PCT qua cdc ndm F F Cdc nhom binh khiin ngudi ddn tim den PCT (theo phong van benh nhan) •9 f -y Tdng cpng: 7 biiu do 37 41 43 45 50 51 60 [...]... khdng cd can bg chuyen trach theo ddi hoat dgng kham chiia benh bang YDHCT Nhan Iiic YDHCT ca tinh ve YHCT cd 01 bac si chuyen khoa 2 YHCT, 05 thac s i , bac si chuyen khoa 1 YHCT, 19 bac si YHCT, 43 y sT YHCT, 07 dieu diTdng YHCT va 172 lirdng y thi trong dd mang hanh nghe YDHCT tiT nhan ddng gdp 10 bac sT YHCT, 16 y si YHCT va 160 * Ten cac huyen, xem bang NHCTNG CHlT VIET TAT 10 liTdng y - Toan tinh... chuyen mdn" tai Chuang II - Thdng tu so 13/1999/TT-BYT cua Bd Y tl ban hanh ngay 06 thang 7 nam 1999 hudng dan thuc hien Phap lenh hanh nghe y dugc tu nhan thugc ITnh vuc y, dugc cd truyen [1] ' Tai lieu Imi trd tai Hoi Dong y tinh 16 1.4 "Phong chin trj YHCT" theo Phap lenh hanh nghe y, dw(yc tw nhan 1.4.1 Phong chan tri YHCT la mgt hinh thifc td chii'c hanh nghe YDHCT tif nhan Hien nay, hoat dgng YHCT... nghien cii^ mang YHCT trong he tho'ng y te Nha nifdc, chga phan biet rach rdi giu'a 2 mang YHCT trong y te cong lap vdi mang YHCT ngoai c6ng lap; chua tha 'y cdng trinh nao nghien cii^ chuyen vetd chii'c So lieu do Phong nghiep vu Y - So Y te cung cap va hoat dgng ciia cac PCTYHCT, ma cd the noi do la hinh thi?c hanh nghe YHCT tg nhan tieu bieu d Khanh Hda hien nay Do vay cac c6ng trinh ay chga danh gia... he tho'ng y te'nha ngdc va he tho'ng y te'tu* nhan, ngubn nhan Igc y te YHHD chiem da so' tai cong dbng (92,58%) nhgng viec cung cap dich vu YHCT chii ye'u do y te'tg nhan dam trach Tai cac Tram y te dich vu YHCT dggc suf dung rat it, hinh thu'c cdn ngheo nan, chii ye'u do cac can bg YHHD ke't hdp them vao dieu tri tai cong dbng, cac can bg y te d day khong dii kha nang de cung cap dich vu YHCT phuc... 5,53% Nhg vay cac ti le nay cdn rat thap so vdi chi tieu tai Quyet dinh 222/2003/QQDTTg yeu cau ti le KCB bang YHCT tai tuye'n tinh la 20%, tuye'n huyen la 25% va tuye'n xa la 40% tdng Iggt nggdi dggc kham va dieu tri [15] Song hanh ciing nganh y te, ve phia Hdi Ddng y, tinh de'n 31 thang 12 nam 2007, so' liTdng hgi vien la 656 nggdi, trong dd cd 165 * nggdi cd dang ky hanh nghe du'dc Sd y te' cap phep... viec sir dung YHCT cua dan chiing tai ITnh vuc y tl tu nhan dang cd khuynh hudng phat trien 1.2 Tinh hinh hoat dgng YHCT tw nhan tai Viet Nam Ve mat lich sti, cac PCTYHCT cd tiln than tir Tap doan Ddng y dugc thanh lap ngay sau khi cd Quylt dinh thanh lap Hdi nghien cim Nam dugc ngay 27 thang 8 nam 1946, try sd tai s6 nha 75 pho Hang B6 - Ha ngi [19] Sau khi Hgi D6ng y dugc thanh lap theo Quylt dinh s6... dung Ddng y dam nhan viec kham chira benh bang D6ng y Trong qua trinh chuyen d6i ca che quan ly cua Nha nude, ngay 06 thang 9 nam 1989 Bd Y tl ban hanh Quylt dinh so 508/BYT/QD vl Dilu le Phdng chdn tri YHDT Cdng vdi tir khi cd ca che khoan 10 va thuc hien cd ^ F phan hoa cac doanh nghiep Nha nude thi he thdng cac PCT trong ca nude Cling dugc thay ddi hinh thirc quan ly va bat dau cd xu hudng suy giam... nang tap hgp, tuyen truyen, bdi dudng chuyen mdn va doan ket hdi vien Nam 2008, Hdi hanh nghi y tl tu nhan tinh Khanh Hda ra ddi, da va se thu hiit mgt s6 chii PCT gia nhap vao hgi mdi nay Sd Y te' thiTdng xuyen td chiJc tap huan va thanh kiem tra cac hoat ddng YHCT trong khudn khd quan ly hanh nghe y dgdc tg nhan ndi chung Theo Bao cao ngay 22 thang 5 nam 2006 cua Doan kiem tra Sd Y te [11], thi nhin... can bg y te ndi chung, YHCT ndi rieng cho tinh la Trudng Cao dang Y te, cho den nam 1998 da dao tao 2 ldp luong y, tdng cdng 52 hgc vien ^ Tir dd den nay, 2008, chua dao tao them Hdi Ddng y cd chiic nang bdi dudng chuyen mdn YHCT, tinh den thang 7/2007 da md tdng cdng 51 ldp, bdi dudng cho 1.796 hgc vien [8], nhung F y cac Giay chirng nhan bdi dudng chuyen mdn cua Hdi la khdng dii tinh phap ly de hgc... Phdng chan tri y hgc cd truyin (PCTYHCT) la mdt trong cac hinh t \ t \ thirc td chiic hanh nghe y dugc hgc c6 truyen tu nhan dugc qui dinh trong Phap lenh so 07/2003/PL - UBTVQHI1 ngay 25 thang 02 nam 2003 cua F •> > , Uy ban Thudng vu Qu6c hgi (PL- 07) quy dinh ve hanh nghe y, dugc tu nhan Qua viec ban hanh PL- 07, Nha nude da khuyen khich viec phat trien y, dugc tu nhan ndi chung, YHCT tu nhan ndi . WHO YDHCT YHBT&TT YHCT YHHD Cum tir dxidc thay the World Health Organization : T6 chiic Y te Thi gidi. Y dugc hgc c6 truyen Y hgc b6 trg va thay the Y hgc c6 truyen Y hgc hien. khoa 1 YHCT, 19 bac si YHCT, 43 y sT YHCT, 07 dieu diTdng YHCT va 172 lirdng y thi trong dd mang hanh nghe YDHCT tiT nhan ddng gdp 10 bac sT YHCT, 16 y si YHCT va 160 * Ten cac huyen,. nhg tuyen huyen khdng cd can bg chuyen trach theo ddi hoat dgng kham chiia benh bang YDHCT. Nhan Iiic YDHCT ca tinh ve YHCT cd 01 bac si chuyen khoa 2 YHCT, 05 thac si, bac si chuyen