Sổ tay Thực hành cộng đồng 1: Phần 2

Chia sẻ: Thị Huyền | Ngày: | Loại File: PDF | Số trang:79

Thêm vào BST

Báo xấu

160
lượt xem 32
download

Download Vui lòng tải xuống để xem tài liệu đầy đủ

Mời các bạn cùng tìm hiểu Tài liệu Thực hành cộng đồng 1: Phần 2 xoay quanh các vấn đề về việc tổ chức hoạt động của trạm y tế xã; phân tích hệ thống sổ Tài liệu báo cáo tại trạm y tế xã; thực hiện các chương trình sốt rét và tiêm chủng mở rộng tại tuyến y tế xã; chẩn đoán cộng đồng; lập kế hoạch truyền thông giáo dục sức khỏe;... Hy vọng Tài liệu là nguồn thông tin hữu ích cho quá trình học tập và nghiên cứu của các bạn.

Chủ đề:

Bình luận(0) Đăng nhập để gửi bình luận!

Lưu

Nội dung Text: Sổ tay Thực hành cộng đồng 1: Phần 2

TO CHlfc HOAT DONG CUA TRAM Y TE XA MUC TIEU . Sau khi hoc xong bai nay, sinh vien co khd nang: 1. Phan tich diidc tinh hinh nhan liic va thiic hien nhiem vu cua tram y te ndi sinh vien den thUc tap. 2. So sanh diidc thiic trang cd sd ha tang va trang thiet bi chu yeu cua tram y te xa vdi chuan quoc gia ve y te xa. 3. Phan tich diidc cac nguon kinh p h i va sii dung kinh p h i cho hoat dong cua tram. 4. N han xet diidc cong tac quan ly diidc d tram y te xa. 1. Nhan lire va nhiem vu cua tram y te xa/phudng 1.1. Bwdc 1: gidi thieu ve nhan liic va nhiem vu cua tram Sinh vien se difdc nghe can bo tram gidi thieu ve nhan life va nhiem vu cua tram y te xa. - Tinh hinh nhan life cua tram y te bao gom: + S6' lifdng can bo. + Trinh do va sii tham gia cac ldp dao tao nghiep vu chuyen mon. + Chute nang va nhiem vu cua tifng nhan vien y te. + Moi quan he cong tac cua cac thanh vien vdi cong dong va cac nhan vien khac cua tram. - Tinh hinh thiic hien nhiem vu cua tram y te xa: + Ke hoach hoac nhiem vu cua tram y te va ke hoach cong tac nam ve cham soc sifc khoe cho ngifdi dan trdng cdng dong. + Cac loai dich vu y te dang cung cap cho cong dong bao gom kham chifa benh va cac dich vu dii phdng. + Tinh hinh siic khoe chung cua cong dong d thdi diem hien tai. + So lifdng va dac diem doi tifdng sii dung cac dich vu y te cua tram (vi du dan so trong cong dong, mot sd dac diem nghe nghiep, van hoa, phong tuc tap quan cua cong dong cd anh hiidng den sdc khoe va hanh vi sii dung dich vu v te) 79
1.2. Bifdc 2: quan sat cac hoat dong cua tram y te va cua tiing can bo trong thdi gian thac hanh. - Dia diem lam viec: tram y te, cong dong dan cii, triidng hoc.... - Thdi diem tien hanh cac hoat dong, vi du truyen thong giao due siic khoe to chiic vao buoi toi hoac sau gid an trifa ; tiem chung tien hanh vao mot ngay co dinh trong thang, chiidng trinh nha hoc diidng tien hanh 2 buoi/1 tuan triidc gid vao 16p.... - Hoat dong chinh cua tiing nhan vien y te, vi du bac si cung cap cac loai dich vu lien quan den kham va chiia benh hang ngay ; can bo phu trach tiem chung md rong quan ly cac loai sd sach co lien quan den tiem chung, dii tru vacxin, linh vacxin tif Trung tam Y te, phan cong nhiem vu cho cac can bo khac de chuan bi cho tiem chung, td chiic buoi tiem chung, ghi chep va bao cao buoi tiem chung ; can bo phu trach chiidng trinh dinh diidng thiidng ket hdp vdi cong tac vien dinh diidng d cong dong de td chiic theo doi can nang cho tre, truyen thong ve dinh diidng cho cong dong, quan ly cac loai sd sach va bao cao lien quan den chiidng trinh dinh diidng.... - Xac dinh vai tro, nhiem vu, sii dong gop cua can bo tram trong viec dap ling nhu c lu cham soc siic khoe cho ngiidi dan cua tram y te xa. 1.3. Biroc 3 Neu danh sach cua can bd tram y te, phan tich ro nhiem vu cua tiing chiic danh theo bang: nhan liic va thiic hien nhiem vu cua Tram y te Trinh do NhCmg Ho va Churc Nhiem Hoat dong Hoat dong TT chuyen diem can ten danh vu cu the hoan thanh mon cai thien 1 Tran A BS Tram pho -Kham - Kham, ke - Ke ddn Lap ke benh ddn - Da dii tru hoach -Phu Dii tru vacxin trach vacxin nhi/ng chiia TCMR - LTnh Vaccin du - To chiic buoi tiem chung md rong - Bao cao tiem chung md rong... 2 3 4 5 6 7 80
1.4. Budc 4: sinh vien thao luan nhom cac cau hoi sau: - Bien che cua tram y te ve so' liidng va thanh phan co gi giong va khac so vdi bien che quy dinh cua Nha nifdc? Can dieu chinh, bo sung khong? Neu phai dieu chinh co tinh kha thi khong? - Viec sap xep va phan cong cong viec co phu hdp k h 'n g ? Tai sao? Sinh vien tim hieu cach thiic hien nhiem vu chung cua tram gom bai phan chinh kham chiia benh tai tram va trien khai cac chiidng trinh y te quoc gia. Dua tren sii phan tich ve: cO sd phan cong nhiem vu cho tiing thanh vien, trinh do chuyen mon, kha nang lam viec, khoi liidng cong viec cua moi thanh vien ma de thao luan ve ti'nh phu hdp khi giao nhiem vu cua triidng tram y te. - Tram y te co hoan thanh nhiem vu theo quy dinh khong? B^ng chiing la gi? De tra ldi phan nay sinh vien do'i chieu ket qua dat diidc vdi muc tieu cua cac chiidng trinh/hoat dong y te va nhiem vu chung cua tram. - Tram y te co thuan ldi va kho khan gi khi thiic hien nhiem vu? Tram da lam gi de kh&c phuc nhiing kho khan? Nhiing diem nao ho can cai thien de lam viec co hieu qua hdn? Nen phan tich den khia canh nhan liic cua tram, kinh phi hoat dong, sii tham gia cua cac thanh vien trong tram vao cac hoat dong y te, sii ung ho cua chinh quyen dia phifdng va ngifdi dan khi thiic hien cac chiidng trinh y te, cac chinh sach lien quan den y te dang trien khai tai dia phifdng, dieu kien dia ly, kinh te va xa hoi cua cong dong... 2. C a s a ha tang va trang thiet bj 2.1. So sanh thuc trang co so ha tang va trang thiet bi vdi chuan quoc gia v e y te xa Danh muc Co Khong Cd sd ha tang Tram d gan true giao thong, trung tam xa Dien tich dat tren 500 m2 Tong the cong trinh: - Khoi nha chinh, cong trinh phu trd - San phdi, vi/dn mau trong cay thuoc - Cay xanh bong mat chiem tren 30% dien tich khu dat - Co hang rao bao ve, co cong, bien tram Khoi nha chinh: - Cap cong trinh toi thieu cap III - Dien tich toi thieu: tren 90m2 - So phong chiic nang chinh 8-9 phong: + Tuyen truyen tii van + Don tiep va quay/tu thuoc + Kham benh va so cuu + Dich vu ke hoach hoa gia dinh 81
+ Dd de + Sau de + Liru benh nhan + Rira, tiet trung + Kham chCra benh bang y hoc co truyen Khoi phu trd bao g6m: nha bep, nha kho, be nifdc, nha ve sinh, nha de xe He thong ky thuat ha tang: - Difdc noi vdi dien lifdi hoac co may phat dien - Co mot thue bao dien thoai trifc tiep - Co ngucn nude sinh hoat dam bao ve sinh va on djnh Duy tu, bao difdng: cd sd ha tang di/dc duy tu, bao difdng djnh ky m6i nam 1 lan vao quy IV hang nam Trang thiet bj Trang thiet bj cd ban cho can bo y te de thifc hien kham, dieu tri benh nhan d tuyen dau tien: ong nghe, huyet ap, nhiet ke, bdm kim tiem va cac trang thiet bj cap cifu thong thifdng ban dau. Bo dung cu kham chuyen khoa cd ban: mat, tai mui hong, rang ham mat Tai cac tram y te co bac sT lam viec: may khi dung, kinh hien vi, may xet nghiem ddn gian Trang thiet bj chc kham, dieu trj san phu khoa, ke hoach hoa gia dinh, dd de, cap cCru sd sinh va cham soc tre Trang bj ve sd che, bao quan thuoc dong y: chao sao thuoc, can thuoc, tu thuoc dong y, dao cau, thuyen tan, kim cham cifu Trang thiet bj phuc vu cho chifdng trinh y te quoc gia, chong mu loa, cham soc rang mieng, nha hoc dudng va cac chifdng trinh CSSK khac Trang thiet bj de thifc hien cong tac truyen thong giao due sifc khoe trong cong dong Thiet bj va dung cu tiet khuan: noi hap, tu say, noi luoc dung cu Thiet bj noi that: tu, ban ghe, giifdng benh, tu dau giifdng Thiet bj theng dung: den dau, den pin, may bdm nifdc Tui y te thon ban: moi thon tif 1-2 tui de thifc hien cac djch vu cd ban nhif: tiem , sd cifu, truyen thong giao due sifc khoe Tui de sach doi vdi cac xa mien nui, vung sau, vung xa. 2.2. Thao luan nhom Sinh vien thao luan nhom de tra ldi cac cau hoi sau: - Cd sd ha tang va trang thiet bi co dap ilng difdc yeu cau thifc hien nhiem vu cua tram khong? - Loai trang thiet bi nao can bo sung de dam bao chu&n quoc gia? 82
- Nguon kinh phi nao de nang cap tram y te xa? - Sinh vien phan tich khi'a canh kinh te trong viec sii dung trang thiet bi, tram y te co nhat thiet phai bo sung mcfi trang thiet bi khong hay chi can sda chda va nang cap thiet bi, sii tiidng xdng ve mdc do sd dung trang thiet bi so vdi nhu cau kham chiia benh cua ngifdi dan trong cong dong. - Tram y te sd dung cd sd vat chat va trang thiet bi co hieu qua khong? Neu khong thi lam the nao de sd dung tot hdn? - Sinh vien thao luan, phan tich ve tan suat sd dung cac loai trang thiet bi lien quan den cung cap dich vu so vdi so lifdng ngifdi dan den sd dung de tim ra cau tra ldi. 3. Kinh phi hoat dong cua tram y te 3.1. Budc 1 Lang nghe can bo y te trinh bay ve nguon kinh phi va sd dung kinh phi cua tram y te, bao gom so liiOng cua cac nguon thu va so lifdng cua cac khoan chi cho hoat dong cua tram y te. 3.2. Budc 2 Liet ke theo bang kinh phi cua Tram y te xa Cac nguon kinh phi So tien /nam Ghi chu - Trung tam Y te - Lifdng can bo - Phu cap dien nifdc - Kham, chCfa benh - Cac chifdng trinh y te - Chifdng trinh a,b... - Thu phi kham benh - Ngan sach cua xa - Cac nguon thu khac.... 3.3. Budc 3: thao luan nhom Sinh vien thao luan nhom de tra ldi cac cau hoi sau: - Ngan sach Nha nifdc cap co dam bao cho cac hoat dong cua tram y te xa khong? - Cac nguon kinh phi bo sung cho hoat dong cua tram la gi? - Co dap dng difdc cho hoat dong cua tram khong? - Tram y te sd dung kinh phi co hdp ly khong? co hieu qua khong? - Chinh sach tai chinh ap dung cho ngifdi ngheo, dien chinh sach, che do hifdng ldi cua nhan vien y te cong dong la nhdng gi va lam nhii the nao? 83
- De thao luan pnan nay dtfdc de dang sinh vien nen phan tich ve cac nguon thu, so liidng so vdi cac khoan muc, so' ludng chi cua tram y te xa hang ky. 4. Cong tac quan ly duoc tai tram y te 4.1. B udc 1 L in g nghe can bo phu trach diidc gidi thieu ve cong tac diidc cua tram y te: - Nguon kinh phi de mua thuoc va quay vong von thuoc tai tram - Cd sd de liia chon thuoc de mua thuoc cho tram - Nguon cung cap thuoc cho tram y te xa va phiidng thiic thanh toan. - Danh muc thuoc hien co cua tram v te xa - Bao quan thuoc tai tram - PhiiOng thiic cap phat va ban thuoc cua tram y te xa - Cac loai so sach iien quan tdi cong tac diidc cua tram. 4.2. BUOC 2 Sinh vien thao luan n’n ung van de sau: - Tram co quay thuoc khong? - Co du thuoc theo danh muc thuoc thiet yeu khong? - Thuoc co diidc bao quan theo yeu cau ghi tren nhan khong? - Tu thuoc co ngan chua thuoc doc va thuoc gay nghien rieng theo quy che khong? - Co du thuoc cap ciiu n en g tai piiong Kham va iuon co du cd so thuoc cap ciiu thong thiidng tren dia ban va thuoc chong soc khong? - Thuoc co dap ling nhu cau chiia benh cua nhan dan trong xa? co tinh trang thuoc thiia. thieu hoac qua han khong? - Nhiing diem can bo sung, dieu chinh de dam bao ch u ln quoc gia ve thuoc thiet yeu va sii dung thuoc an toan hdp ly tai tram v te xa la gi ? TL/LirO NG GIA 1. Cau hoi luong gia 1. Nhan liic cua tram y te co dat so vdi tieu chuln quy dinh cua Bo Y te khong9 2. Sii phan cong cong viec cho cac thanh vien co phu hdp khong9 tai sao9 3. Nhiing nhiem vu nao tram y te da hoan thanh? Nhung nhiem vu nao chiia hoan thanh? 4. Nhiing diem thuan ldi va kho khan cua tram v te khi thuc hien nhiem vu la gi? 84
5. Cd sd ha tang va trang thiet bi y te co dat chuan quoc gia khong? Nhiing diem can bo sung de dat diidc chuan quoc gia? 6. Cac nguon kinh phi cung cap cho tram y te xa hoat dong? Cac khoan chi cua tram y te la gi? Viec sti dung nguon kinh phi co hieu qua khong? 7. Quan ly thuoc cua tram co dat chuan quoc gia khong? Nhiing giai phap nao can dUdc thuc hien de k h lc phuc nhiing diem con ton tai cua tram y te ve quan ly thuoc? 8. Danh gia hoat dong cua Tram y te xa theo cac phan sau: - Quan ly nhan liic: + So vdi thong tii lien bo so 08/TTLB ngay 20/4/1995 hiidng dan mot so" van de ve to chiic va che do chinh sach doi vdi y te cd sd bien che va cd cau co phu hdp khong ? + Tram co du phong lam viec can thiet khong ? + Tram co phong cho benh nhan san khoa va phu khoa khong ? + Tram co phong lam viec hanh chinh, phong diidc khong ? + Moi thon co it nhat mot y te thon ban lam viec khong ? + Y te thon ban co hoat dong deu dan khong ? - Xa hoi hoa cong tac y te + Co ban chi dao cham soc siic khoe khong ? + Ban nay hoat dong co deu dan, co hieu qua khong ? + Co ke hoach y te diia vao nghi quyet Dang Uy khong ? - Hieu qua cua chiidng trinh + Giao due va nang cao siic khoe + Xay diing goc truyen thong va nang cao siic khoe + To chiic noi chuyen, tii van siic khoe + Noi chuyen qua he thong truyen thanh cua xa may thang/1 lan - Hoat dong ve sinh phong benh + Co phat hien sdm cac vu dich, ngo doc thiic pham kip thdi khong? + Co bien phap de phong va khong che kip thdi khong? + Ty le ho gia dinh co ho xi hdp ve sinh? + Ty le ho gia dinh xii ly rac va phan xuc vat dung cach? - Kham chiia benh: + Binh quan so liidt ngiidi den kham tren 0,6 lan/ngiidi/nam khong? + Hoc sinh co diidc kham siic khoe hang nam tren 80% khong? + Ty le ngiidi tan tat diidc hudng dan va phuc hoi chiic nang tren 20% khong? 85
- Y hoc co truyen: + Ty le kham chiia benh b&ng y hoc co truyen tren 20%/nam khong? + Co ap dung cac bien phap chiia benh khong dung thuoc khong? - Cham soc siic khoe tre em: + Ty le tiem chung dat tren 95% khong? + Tre em diicfi 2 tudi diidc theo doi tang triidng hang nam tren 90% khong? + Chan doan dung va dieu tri dung phac do cho tre diidi 5 tudi va nhiem khuan ho hap dat tren 90%)/ nam khong? - Cham soc siic khoe sinh san + Tat ca cac phu nii co thai diidc kham thai it nhat 1 lan triidc khi sinh khong? + Ty le phu nii kham thai du 3 lan trong thdi ky thai nghen dat tren 75% khong? + Ty le san phu khi sinh co can bo y te dd co dat tren 95% khong? + Ty le sii dung bien phap tranh thai dat tren 65%> khong? + Ty le phu nii trong do tudi sinh de diidc kham phu khoa tren 35%? - Thuoc diidc quan ly dung quy che va co it nhat tren 60% loai thuoc thiet yeu? - Thu chi dung quy dinh, ngiidi ngheo va doi tiidng chinh sach dtfdc kham chiia benh mien phi tai tram y te? 9. Truong tram y te co hoan thanh nhiem vu khong? Phan nay sinh vien tirtra ldi qua cac bang kiem sau? Nhiem vu Co Khong Nam ro tinh hinh kinh te, vSn hoa, xa hoi, dan sd Co cac chi so tinh hinh siic khoe va benh tat d thdi diem hien tai Trao doi vdi chinh quyen, doan the ve benh tat Xac dinh van de iru tien de giai quyet Xay dung ke hoach giai quyet van de siic khoe Lap ke hoach djnh ky cho toan tram y te Phan cong cong viec cu the cho cac thanh vien va uy quyen khi can thiet Quy dinh hop tram va bao cao dinh ky Thu’c hien cac hoat dong de tao nguon kinh phi, kiem soat thu chi tai tram Co theo doi vat tu’, trang thiet bi, hi/dng dan kiem tra, tong hdp, dii tru thuoc men... Phan cong trifc tai tram y te xa va kiem tra Co di xuong cac thon va tham ho gia dinh Co triic tiep hiidng dan, giam sat, kiem tra y te thon ban lam viec Co ke hoach djnh ky danh gia hoat dong cua Tram y te Co ke hoach tap huan chuyen mon, nghiep vu cho can bo tram va y te thon ban Huy dong sir tham gia cua cong dong thong qua chinh quyen dja phifdng Thiet lap cac mdi quan he cua Tram vdi chinh quyen dja phudng To chiic lull trufva quan ly hd sd tai Tram 86
2. Hudng dan sinh vien tu luong gia Qua ket qua thao luan nhom, sinh vien tim ra cau tra ldi. Trinh bay nhiing diem chua ro hoac khong the tii tra ldi vdi can bo tram hoac giao vien de difdc giai dap (khong co dap an chung cho tat ca cac tram y te) HUONG DAN TU HOC, TU NGHIEN CLTU, VAN DUNG THUC TE 1. Phuong phap hoc B u d c 1: sinh vien on tap cac p h ln ly thuyet co lien quan den quan ly nhan life, vat tif, trang thiet bi, kinh phi, thuoc va nhiem vu cua tram y te xa, chuan quoc gia ve y te xa giai doan 2001-2010 bang cach on tap cac tai lieu co lien quan. Budc 2: thu thap nhiing thong tin lien quan den cac van de sinh vien quan tam b in g cach quan sat, phong van, xem xet sd sach bao cao lien quan...de co difdc thong tin can thiet. Budc 3: so sanh giiia ly thuyet va thifc te de co nhan xet cua ca nhan, sau do thao luan nhom de tra ldi cac cau hoi/hifdng dan thao luan. Budc 4: tra ldi cac cau hoi liidng gia; do'i chieu nhiing kien thutc/ky nang da hoc difdc vdi muc tieu bai hoc de ra tii do rut ra nhiing kinh nghiem/bai hoc thiic te ve td chdc hoat dong cua tram y te xa. 2. Van dung thuc te Qua nhiing nhan xet ve tram y te xa ndi sinh vien thiic tap, rut ra nhiing bai hoc kinh nghiem ve td chifc hoat dong cho mot tram y te xa; phan dau de tram y te ndi sinh vien se lam viec dat diidc chuan quoc gia b in g cach sii dung co hieu qua nguon liic (con ngifdi, kinh phi, cd sd vat chat, trang thiet bi...). 3. Tai lieu tham khao 1. Bo Y Te. C huan quoc gia ve y te xa giai doan 2001-2010. Ban hanh kem theo quyet dinh so' 370/2002/Q D -B Y T , ngay 7 thang 2 nam 2002 cua Bo trifdng Bo Y te. 2. Pham Tri Dung. Quan ly y te. Bo Y te, To chiic Y te The gidi, Dii an phat trien he thong y te. Y hoc. 2001. 125-131. 4. Tai lieu dpc them 1. Bo mon Y Xa Hoi Hoc. To chdc va quan ly y te. Trifdng Dai hoc Y khoa Thai Nguyen. 2004. 2. Trifdng Dai hoc Y khoa Thai Nguyen. Tai lieu hifdng dan thiic hanh CBE. 2004 87
PHAN TICH HE THONG SO SACH, BAO CAO TAI TRAM Y TE XA MUC TIEU Sau khi hoc xong bai nay, sinh vien co khd nang: 1. Mo td ditdc he thong so sach bao cao tai tram y te cd sd 2. Thitc hanh ghi chep thong tin y te tai cd sd 3. Thong ke ditdc thong tin deviet bao cao dinh ky tai cd sd Sinh vien thiic hanh theo cac bii6c sau: 1. Budc 1: gidi thieu cac d lu sd sach, bang bieu, bao cao Sinh vien se diidc nghe va quan sat cac quyen sd chinh dang stf dung de quan ly thong tin tai tram y te, bao gom: - Cac loai sd theo quy dinh cua Bo Y te: tii sd A l den sd A12 - Cac sd theo quy dinh cua Sd y te + Kham phu khoa + Kiem nhap thuoc + So nhap thuoc ngiidi ngheo + Theo doi benh nhan tam than: cap phat thuoc, cap nhat thuoc + Theo doi phat trien the chat tre em
4. Budc 4: tien hanh thong ke cac thong tin cho bao cao dinh ky Phan nay sinh vien tien hanh theo yeu cau cua can bo tram, thong thiidng tram tien hanh lam bao cao tong hdp hoat dong cua tram theo thang de liiu trii va bao cao den trung tam y te huyen. Cac bao cao chiidng trinh y te diidc tien hanh theo qui dinh rieng cua tiing chiidng trinh va theo bieu mau quy dinh. 5. Budc 5: thao luan nhom Noi dung thao luan nhii sau: - To chiic va s&p xep cac dau sd co liu va nhiidc diem gi? lam the nao de khac phuc diidc nhUdc diem? - Noi dung thong tin trong cac cuon sd co cap nhat khong? chinh xac? Chong cheo giGa cac cuon sd? Cac giai phap de khac phuc ton tai? - Lam the nao de thong ke sd lieu thii cap nhanh va chinh xac nhat tii nguon so sach bao cao cua tram (theo yeu cau cua giao vien diia ra mot sd vi du cu the ve nhiing thong tin can lay tai tram, vi du so tre trong dien tiem chung tiing loai vacxin, sd tre diidc tiem du, so' tre tiem dam bao an toan...)? - He thong chiing tii ghi chep ban dau (chiing tii goc) ap dung cho tuyen y te cd sd diidc bao quan bang cach nao? - Dinh ky gom nhiing loai bao cao nao, bao cao co kip thdi khong? dap ling yeu cau khong? - Cac thong tin trong bao cao co dam bao tinh chinh xac va trung thiic khong? - Thong tin co diidc ghi chep ngay tai ndi, tai thdi diem phat sinh theo dung quy dinh - Cac bao cao giii triic tiep t6i cd quan c6 tham quyen khong? - Nhiing diem tram y te can cai thien de dam bao yeu cau quan ly thong tin tai tram cd sd cua Bo Y te? TU LUONG GIA 1. Cau hoi lifdng gia 1. So sanh quan ly thong tin y te d cd sd so vcfi quy che ve tho"ng ke y te (ban hanh kem theo quyet dinh cua Bo triidng Bo Y te so 379/2002/QD-BYT ngay 8/2/2002)? tii do diia ra cac nhan xet ve quan ly thong tin d cd sd? 89
2. Danh gia cac loai so sach cua tram y te qua bang sau Co Ten sd sach Khong Tot Trung binh Kem So kham benh So tiem chung So kham thai So de So ke hoach hoa gia dinh So tuf vong So theo doi sot ret So theo doi Lao So theo doi phong va da lieu So theo doi m lt hot va mu loa So theo doi tam than, nghien hilt, HIV/AIDS So theo doi budu cd Cac loai sd khac cua tram Cac tieu chi' danh gia sd sach: - Chat lifdng: ghi chep day du, ro rang, khong bo sot - Cap nhat thong tin: khoa hoc, tin cay, de tim kiem - Bao quan: giuf gin va liiu truf tot 3. Tinh toan cac chi sd tu: cac cuon sd: - So kham benh: + So' ngiidi kham benh binh quan/ngiidi/thang + Ty le benh nhan theo gidi,tudi, chinh sach (ngheo, bao hiem ,...) + Ty le benh nhan dieu tri noi tru, ngoai tru. + Ty le benh nhan cap ciiu, benh nhan chuyen tuyen. + Ty le mac tiing loai benh - So tiem chung: + So" tre trong dien tiem chung theo tudi, gidi. + Ty le tra diidc tiem,uong du cac loai vacxin.... - So kham thai + Ty le phu nii co thai/ phu nii tii 15 den 49 tudi 90
+ Ty le phu nut difdc kham thai + So lan kham thai trung binh cho moi thai phu + Ty le thai phu diidc tiem phong uon van 4. Viet bao cao thang ve hoat dong cua tram y te cd sd theo bieu mau quy dinh ma tram y te dang ap dung. 2. Hudng dan sinh vien tulucfng gia Qua ket qua thao luan nhom, sinh vien tim ra cau tra ldi. Trinh bay nhiing diem chiia ro hoac khong the tii tra ldi vdi can bo tram hoac giao vien de diiOc giai dap (khong co dap an chung cho tat ca cac tram y te). HUCJNG DAN TL/ HOC, TL/ NGHIEN CLfU, VAN DUNG THUC TE 1. Phucfng phap hpc Budc 1: sinh vien doc cac phan ly thuyet co lien quan den quan ly thong tin y te va quy che ve thong ke y te (ban hanh kem theo quyet dinh cua Bo triidng Bo Y Te so' 379/2002/QD-BYT ngay 8/2/2002) tii do diia ra cac nhan xet ve quan ly thong tin d cd sd. Budc 2: thu thap nhiing thong tin lien quan den viec quan ly thong tin 6 tram y te cd sd quan sat, phong van/ thao luan v6i can bo tram, xem xet so sach bao cao lien quan...de co diidc thong tin can thiet. Budc 3: so sanh giiia ly thuyet va thiic te de co nhan xet cua ca nhan, sau do thao luan nhom de tra ldi cac cau hoi/hii6ng dan thao luan. Budc 4: tra ldi cac cau hoi liidng gia; doi chieu nhiing kien thiic/ky nang da hoc diidc vdi muc tieu bai hoc de ra tii do rut ra nhiing kinh nghiem/bai hoc thiic te ve quan ly thong tin y te d cd sd. 2. Van dung thuc te Qua nhiing nhan xet ve quan ly thong tin y te d cd sd , sinh vien rut ra nhiing bai hoc kinh nghiem de van dung trong viec quan ly thong tin y te d cac cd sd y te mot cach co khoa hoc, tii khau cap nhat so lieu ban dau, cach sap xep so lieu, liia chon nguon thong tin, thong ke so lieu tii so sach hay bao cao, ... cho cong tac quan ly y te noi chung. 3. Tai lieu tham khao 1 . Bo Y Te. Chuan quoc gia ve y te xa giai doan 2001-2010. Ban hanh kem theo quyet dinh so 370/2002/QD-BYT, ngay 7 thang 2 nam 2002 cua Bo triidng Bo Y te. 2. Quy che ve thong ke y te (ban hanh kem theo quyet dinh cua Bo triidng Bo Y Te so 379/2002/QD-BYT ngay 8/2/2002. 3. Pham Tri Dung. Quan ly y te. Bo Y te, To chiic Y te The gi6i, Dii an phat trien he thong y te. Y hoc. 2001. 125-131. 91
THI/C HIEN CHUDNG TRINH SOT RET, TIEM CHUNG MD RONG TAI TUYEN Y TE XA MUC TIEU Sau khi hoc xong bai nay, sinh vien co khd nang: 1. Nhan xet diidc thitc trang hoat dong cua chiictng trinh phong chong sot ret tai tuyen xa. 2. N han xet diidc thiic trang hoat dong cua chiidng trinh tiem chung md rong tai tuyen xa. 1. Bi/dc 1: gi6i thieu cac chiidng trinh muc tieu y te quoc gia hien dang trien khai tai xa, muc tieu va dinh hii6ng cua cac chiidng trinh. 2. Bi/dc 2: sinh vien thiic hanh theo cac bii6c sau 3.1. Sinh vien lang nghe can bo phu trach chiidng trinh phong chong sot ret trinh bay cach to chiic trien khai chiidng trinh, gi6i thieu cach ghi chep cac so sach, bieu mau, bao cao cua chiidng trinh. Trong khi thiic hanh sinh vien can chu y quan sat, tim hieu nhiing noi dung ve to chiic thiic hien chifOng trinh phong chong sot ret nhii sau: - Lap ke hoach phong chong sot ret tai xa: co phu hdp v6i muc tieu dinh hiidng cua chiidng trinh khong? co can cii vao tinh hinh benh sot ret cua dia phiidng? Sinh vien nen tim hieu cac yeu to" khach quan va chu quan co the tac dong den tinh hinh sot ret cua xa trong nam nhii giao liiu, bien dong dan cii, kha nang nhan liic, tai chinh,... cua xa. - Cong tac phat hien dieu tri. quan ly m lm benh: so" ngiidi phai dieu tri cat cdn tai xa9 So lam mau ma tram y te da xet nghiem ? So" ngiidi phai dieu tri chong tai phat,... - Cong tac phong chong va diet vec td: thiic te d xa da thiic hien phun hoa chat nhii the nao? So dan diidc bao ve trong xa la bao nhieu? Co phu hdp vdi muc tieu cua chiidng trinh khong? Van de tam man d xa co diidc thiic hien khong9 Thiic hien nhii the nao? - Nhan liic de thiic hien chiidng trinh phong chong sot ret d xa ra sao ? Du hay thieu? Co can bo sung khong? 92
- Cong tac truyen thong giao due ve phong chong sot ret cho nhan dan tai xa co dude trien khai tot hay khong? Nhiing kho khan va thuan ldi trong cong tac nav? Cach khac phuc kho khan de hoan thanh nhiem vu? - Cong tac tham miiu chi dao trien khai chiidng trinh cua tram v te veil chinh quven dia phiidng: co thanh lap Ban chi dao khong? Ban chi dao hoat dong nhii the nao? co deu dan va hieu qua khong? - Cong tac quan ly cac dung cu, vat tii, thuoc men, hoa chat, kinh phi phuc vu cho chiidng trinh co day du khong? Cach quan ly va sii dung thiic te tai xa nhii the nao? - So sach bieu mau bao cao thong ke cua chiidng trinh: sinh vien can xem cac so nhii kham benh va dieu tri benh nhan sot ret, so quan ly benh nhan sot ret, danh sach ngiidi lay lam mau giii di xet nghiem. sd nhap thuoc. vat tii, hoa chat phong chong sot ret cua tram y te,... 3.2. Sinh vien lang nghe can bo phu trach chiidng trinh tiem chung md rong trinh bay cach td chiic trien khai chiiOng trinh, gidi thieu cach ghi chep cac sd sach, bieu mau, bao cao cua chiidng trinh. Trong khi thiic hanh sinh vien can chu y quan sat, tim hieu nhiing noi dung ve td chiic thiic hien chiidng trinh tiem chung nhii sau: - Dia diem td chiic: co gan dan, theo 1 chieu, khong un tac khong? Co kham phan loai dung khong? Co hiidng dan cho ba me ve chi dinh tiem chung khong? Thdi gian chd ddi tiem nhii the nao? - Phiidng tien tiem chung: co phich lanh tot, sach, nhiet ke? Co du bdm kim tiem khong? - Khau vo trung: can bo y te tiem co ao, mu, khau trang, riia tay sach bang xa phong, niidc sach triidc khi tiem khong? Vo trung dung cu dam bao theo dung quy dinh khong? Co thiic hien tiem 1 bom tiem, 1 kim tiem cho 1 mui tiem khong? Can bo y te co thao tac gon, sach khi tiem hay khong? - Ky thuat tiem: Tiem BCG: noi da cam 7 mm: d cd Delta trai: Tiem BH-HG- UV3; UV2? Tiem bap co dung ky thuat khong? Du lieu khong? Tiem Sdi: Tiem dii6i da dung ky thuat? Du lieu? Uong Sabm 3: Uong dung ky thuat? Du lieu? Sinh vien triic tiep kiem tra ngau nhien tre da tiem BCG xem co seo khong? - Tre trong do tudi tiem chung co diidc tiem dung theo dung lich khong? - Bao quan vacxin co thiic hien theo dung quy dinh khong? (sinh vien doc nhiet ke kiem tra thiic te) - Thong ke bao cao: ghi chep day du, dung theo quy dinh khong? De tong ket khong? So theo ddi benh truyen nhiem tre em: ghi chep du. dung? Ro va sach se? So quan ly vacxin: ghi chep du, dung? Ro va sach se? Bao cao tiem chung: sd lieu day du khong? So lieu chinh xac? Tram y te co lap bang hay bieu do tiem chung khong? 93
- Dieu hanh tiem chung: co thanh lap Ban chi dao TC khong? Hop deu co chiidng trinh cu the? Tinh hinh hoat dong cua Ban chi dao co deu dan khong? - Thai do CB tiem chung: niem nd, nhiet tinh hay khong? - Co long ghep TCMR vdi cac cong viec khac nhu uong vitam in A. can do, kham chiia benh cho tre khong? Sinh vien lin g nghe, quan sat va ghi chep nhiing thong tin c ln thiet trong khi can bo tram y te gidi thieu, hiidng dan. - Sinh vien thiic hanh quan sat cac bien ban ma tram y te da trien khai chiidng trinh, tham khao cach ghi chep cac sd sach, bieu m lu , bao cao ve cac chiidng trinh muc tieu y te quoc gia. 3. Budc 4: thao luan nhom Sinh vien thao luan theo cac noi dung sau: 1. Hien co bao nhieu chiidng trinh muc tieu y te quoc gia dang diidc trien khai tai xa? Ten cua cac chiidng trinh? 2. Cach td chiic trien khai hoat dong chiidng trinh sot ret tai xa ra sao? Cach ghi chep sd sach, bieu mau, bao cao cua chiidng trinh nhii the nao? Ket qua dat diidc cua chiidng trinh trong cong tac phong chong sot ret tai xa so vdi muc tieu dinh hiidng cua nganh Y te de ra cd hoan thanh tot khong? Nhiing khd khan, thuan ldi khi thiic hien chiidng trinh? Cach khac phuc nhiing khd khan de thiic hien chiidng trinh cd hieu qua hdn? 3. Cach td chiic trien khai hoat dong chiidng trinh tiem chung md rong tai xa ra sao? Cach ghi chep sd sach, bieu mau, bao cao cua chiidng trinh nhii the nao? Ket qua dat diidc cua chiidng trinh tai xa so vdi muc tieu dinh hiidng cua nganh Y te de ra cd hoan thanh tot khong? Nhiing khd khan, thuan ldi khi thiic hien chiidng trinh? Cach khac phuc nhiing khd khan de thiic hien chiidng trinh cd hieu qua hdn? 4. So sanh giiia thiic te va ly thuyet ve cach td chiic thiic hien chiidng trinh. tii dd rut ra nhiing kinh nghiem de cd the giup cho viec td chiic thiic hien chiidng trinh y te quoc gia tai tuyen y te cd sd dat hieu qua hdn. Trong qua trinh thao luan sinh vien ghi lai nhiing cau hoi cdn chiia ro de hoi can bo tram y te hoac de nghi giao vien giai dap. TL/LLfONG GIA 1. Cau hoi lupng gia 1. Nhiing cong viec cu the trong viec td chiic trien khai chiidng trinh phdng chong sot ret tai xa la gi? So sanh giiia thiic te va ly thuyet cd gi giong va khac nhau? 2. Nhiing cong viec cu the trong viec td chiic trien khai chiidng trinh tiem chung md rong tai xa la gi? So sanh giiia thiic te va ly thuyet cd gi giong va khac nhau? 3. Nhiing thuan ldi va khd khan cua tram y te khi thiic hien chiidng trinh? Nhiing giai phap nao c ln diidc thiic hien de k h lc phuc khd khan? 94
f , O 0 x 4. Cach tham mifu cua tram y te xa vdi cap Uy Dang, chinh quyen. sii phoi hop vdi cac ban nganh, doan the de huy dong nguon liic, kinh phi cho hoat dong cua cac chUdng trinh muc tieu y te quoc gia dat ket qua tot ra sao? 2. Hudng dan sinh vien tu ludng gia Qua ket qua thao luan nhom, cac y kien thao luan diiOc thong nhat ngay sau buoi hoc chinh la phan dap an cho cac cau hoi tii liiOng gia cua sinh vien. Trinh bay nhiing diem chiia ro, cdn thac mac de nghi vdi can bo tram y te hoac giao vien de diidc giai dap. HUClNG DAN T ii HOC, TL/ NGHIEN CL/U, VAN DUNG THL/C TE 1. Phudng phap hoc Sinh vien doc tai lieu phan ly thuyet cd lien quan den cac noi dung hoc tap trong bai giang, danh dau nhiing diem cdn khd hieu hoac chiia ro de thao luan vdi cac ban sinh vien khac trong khi hoc hoac hoi giao vien de diidc giai dap. Sinh vien nen chu dong hoc hoi va de nghi vdi can bo Trung tam giup dd khi can thiet. 2. Van dung thuc te Qua thiic hanh tai tram y te xa, sinh vien tim hieu diidc ve thiic trang td chiic va quan ly chiidng trinh muc tieu y te quoc gia phdng chong sot ret va chiidng trinh tiem chung md rong dang diidc trien khai tai tram y te xa, tii dd sinh vien cd kha nang doi chieu so sanh giiia nhiing kien thiic diidc hoc trong bai ly thuyet vdi thiic te diidc chiing kien, diia ra nhiing nhan xet ve thiic trang viec thiic hien cac chiidng trinh muc tieu y te quoc gia, van dung diidc nhiing kinh nghiem thiic te de cd the giup cho viec td chiic chi dao va quan ly chiidng trinh y te quoc gia tai tuyen y te cd sd diidc tot hdn. 3. Tai lieu tham khao 1. Bo Y te. Cac van ban hiidng dan thiic hien chiidng trinh muc tieu quoc gia phdng, chong mot so benh xa hoi, benh dich nguy hiem va HIV/AIDS giai doan 2001-2010. Ha Noi, 8/2002. 2. Bo Y te. Cac chinh sach va giai phap thiic hien cham soc siic khoe ban d lu . Ha Noi, 2002. 3. Bo Y te. Hoi nghi toan quoc Y te dii phdng 10 nam doi mdi 1991-2000, dinh hiidng chien liiOc 2001-2010. Vu Y te dii phdng, 11/2001. 4. Bo Y te ■ Vien Ve sinh Dich te Trung lidng - Dii an tiem chung quoc gia. Tong ket cong tac tiem chung md rong nam 2001. Ha Noi, 12/2001. 5. Bo Y te - Vien Ve sinh Dich te Trung liOng - Dii an tiem chung md rong quoc gia. Bao cao tong ket cong tac tiem chung md rong 2002 va ke hoach tiem chung md rong nam 2003 khu viic mien Bac. Ha Noi, 2002. 6. Bo mon Y xa hoi hoc. To chiic va quan ly y te. Triidng Dai hoc Y khoa Thai Nguyen. 2006. 7. Triidng Dai hoc Y khoa Thai Nguyen. Tai lieu day/hoc mon hoc cong dong 1. 2006. 95
CHAN DOAN CONG DONG MUC TIEU Sau khi thiic hanh xong bai nay sinh vien co khd nang: 1. Thiic hien diidc cac biidc chan doan cong dong de ph at hien ra van de siic khoe cdn can thiep d cong dong ndi sinh vien thiic te. 2. N han thiic diidc tam quan trong cua chan doan cong dong la mot ky nang cdn thiet cua ngiidi cdn bo y te cong dong. 1. Sd do qua trinh thi/c hanh chan doan cong dong 96
2- Tien hanh cac bi/dc chan doan cong dong 2.1. Chuan bj: sinh vien can chuan bi nhiing noi dung sau: - Cac kien thiic can xem lai: cac budc chan doan cong dong, ky thuat chon m iu , co m lu , cac phifdng phap thu thap thong tin, mot so" test thong ke de xii ly so' lieu. - Lap ke hoach cho cac budc chan doan cong dong (Xem phan Hudng dan sinh vien tu hoc, tu nghien cUu va van dung thiic te) 2.2. Thut hanh chan doan cong dong B u d c 1: thu thap chi so Tuy theo muc dich, quy mo cua chan doan cong dong d dia phudng ma sinh vien thuc tap (thong thudng theo noi dung ma nha trudng dinh hudng), can xac dinh cac loai so lieu can thu thap, cac phudng phap thu thap cac so' lieu dd, nguon cua cac sd lieu cd the lay tti dau, tti dd len ke hoach thu thap so' lieu. Cd hai loai so' lieu: - So lieu sd cap: la cac so' lieu thu thap lan dau phuc vu cho muc dich cuoc chan doan cong dong nay. PhUdng phap thu thap cac loai so' lieu nay cd the la dinh lUdng (phdng van dieu tra ho gia dinh), ket hop dinh tinh (phdng van cac can bo y te, lanh dao dia phUdng, ngUdi dan; thao luan nhom; quan sat; kham hay xet nghiem sang loc... ) - So' lieu thii cap: la cac so lieu thu thap tti cac nguon san cd nhu so sach, bao cao, ho so lUu trti tai dia phudng. Tien hanh thu thap so' lieu: + So' lieu thti cap: xem xet cac ho sO, so sach san cd tai tram y te va Uy ban nhan dan xa theo tting nhom chi so'. Vi du: cac chi so've dan so', kinh te, *» . 0 van hoa, xa hoi cua ngudi dan trong xa: xem sd sach tai Uy ban nhan dan xa hoac mot so' bao cao tong ket tai tram; Cac chi so've siic khoe benh tat va chi so' phuc vu cua y te: Xem cac so kham chiia benh, sd de, sd ghi chep cac chUdng trinh y te da va dang thiic hien tai tram y te xa... + So lieu sd cap: . Dieu tra ho gia dinh theo phieu: can lien he vdi tram y te de giup lap danh sach cac ho gia dinh theo cd mau da chon va xuong ho gia dinh de thu thap thong tin. Sii dung bo cau hoi dUdc xay diing san de thu thap thong tin. . Quan sat: cd the quan sat trong khi di dieu tra, trong khi song va hoc tai cong dong ve tat ca cac hien tUdng xay ra trong cong dong cd lien quan den muc tieu chan doan cong dong. Nhiing thong tin cd the thu thap dUOc qua quan sat nhU: tinh hinh ve sinh moi trUOng (xii ly phan. nUdc, rac...); Nguon o nhiem; Thdi quen sinh hoat cua ngUdi dan trong cong dong, thdi quen cham soc stic khoe cua ngudi dan, thiic hien nhiem vu cua can bo y te .... 97
. Phong van / thao luan vdi mot sd can bo y te, lanh dao dia phudng. ngifdi dan trong cong dong ve nhUng van de ma thong tin thu difdc qua cac phifdng phap khac (dieu tra, so lieu s in cd) tra ldi chua ro. Sd lieu sau khi thu thap difdc can difdc xii ly theo mot sd thuat toan thong ke ddn gian de tif dd cd the rut ra difdc cac thong tin can thiet cho xac dinh van de siic khoe va lua chon ifu tien. B iid c 2: xac dinh van de siic khoe Sau khi thu thap difdc day du cac thong tin phuc vu cho chan doan cong dong, cac thong tin nay can difdc tong hdp va xii ly theo cac phifdng phap thong ke y hoc. Tii ket qua phan tich, xii ly thong tin, nhom chan doan cong dong rut ra difdc cac chi so’. Chon ra mot so' van de cd cac chi so' ndi bat ndi len mot tinh trang khong tot nao dd ve siic khoe. Sii dung bang tieu chuan xac dinh van de stic khoe de xac dinh van de nao thifc sif la van de siic khoe. Lifu y: de tien hanh cho diem xac dinh van de stic khoe difOc chinh xac, nhom chan doan cong dong can thao luan cung vdi dai dien can bo y te, lanh dao va ngifdi dan dia phifdng. Diem difdc xac dinh difa tren y kien tan thanh cua da so' ngifdi trong nhom. Phudng phap thong dung nhat la sii dung bang xac dinh van de siic khoe Bang tieu chuan xac djnh van de siic khoe Diem Diem Van Van Van Tieu chuan xac dinh VOSK ~~~— -— de 1 de 2 de 3 1. Cac chi sd bieu hien van de ay da vifdt qua miic binh thifdng. 2.Cong dong da biet ten cua van de ay va da cd phan ling rd rang. 3. Da cd dii kien va hanh dong cua nhieu ban nganh, doan the. 4. Ngoai sd can bo y te, trong cong dong cd mot nhom ngudi kha thong thao ve van de dd. Tong so Cach cho diem: 3 diem: rat rd rang; 2 diem: rd rang; 1 diem: cd the khong rd Cach nhan dinh ket qua: Tif 9-12 diem: cd van de siic khoe dd trong cong dong; Difdi 9 diem: van de chifa rd. Biiofc 3: liia chon van de siic khoe uu tien: 98