Edirne'de birinci basamak sağlık hizmetlerinde döndüncül koruma uygulamalarının yeri
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Date
2020
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Trakya Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Dördüncül koruma hastaya gereksiz tedavinin önlenmesi ve hastaya aşırı tıbbi işlem yapılmasının önlenmesidir. Sözlükteki tanımıyla dördüncül koruma “aşırı medikalizasyon riskindeki hastayı ve toplumu tanımlamak, medikal istilalardan onları korumak ve onlara bilimsel ve etik olarak kabul edilebilir bakım prosedürlerini sağlamak için yapılan eylemdir”. Çalışmamızda birinci basamakta dördüncül koruma uygulamalarını etkileyebilecek faktörleri incelemeyi ve bu faktörlerin klinik pratikteki etkisini değerlendirmeyi amaçladık. Çalışmamız 01.09-01.11.2019 tarihleri arasında birinci basamakta görev yapan ve çalışmaya katılmayı kabul eden hekimlere yapıldı. 126 aile hekiminin 116’sı çalışmaya katılmayı kabul etti. Çalışmada; araştırmacılar tarafından hazırlanan sosyodemografik bilgiler, bilgi soruları, neden sorularını ve ek olarak “Defansif Tıp Uygulamaları Tutum Ölçeği” ni içeren, 61 soruluk anket kullanıldı. Edirne Halk Sağlığı Müdürlüğü’nden alınan veriler de çalışmaya eklendi. Kruskal-Wallis testi, Mann-Whitney U testi, Ki-Kare (Fisher’s exact) testi, Pearson korelasyon testi kullanıldı ve p<0,05 değeri anlamlı kabul edildi. Çalışmamızda hekimlerin birincil koruma kapsamında olan aşı uygulamalarına katılımlarını yüksek (%93,9) saptanırken, ikincil koruma kapsamında olan kanser taramalarına katılımlarını (%78,5) ve üçüncül koruma kapsamında olan kronik hastalıkların komplikasyonlarının takibine katılımı (%81) daha düşük saptandı. Defansif tıp puanı orta ve üzerinde olan katılımcıların oranı %94,8 olarak yüksek saptandı. Tanı kaçırma korkusunun nedenleri incelendiğinde, hekimlerin defansif tıp tutumları (p=0,018) ile anlamlı ilişki mevcuttu. Dördüncül korumanın daha iyi uygulanabilmesi için hasta- hekim iletişimini daha da geliştirilmelidir. Bunun sağlanması için de hekimlerin dava korkusunun azaltılması, makalelere güvenin artmasının sağlanması, özellikle pratik eğitimde yenilikler ve gezici nüfus uygulamasında düzenlemeler gerekmektedir.
Quaternary prevention is the prevention of unnecessary treatment or the prevention of overmedicalisation. The definition of quaternary prevention in the dictionary is ‘‘action taken to identify patient at risk of over medicalization, to protect patient from new medical invasion, and to suggest interventions that are ethically acceptable’’. In our study, we aimed to examine the factors that may affect quaternary prevention practices in primary care and to evaluate the effects of these factors in clinical practice. Our study was conducted between 01.09-01.11.2019 on physicians working in primary care and who agreed to participate in the study. 116 of 126 family physicians agreed to participate in the study. In the study, a questionnaire is used composed of 61 questions, including socio-demographic information prepared by the researchers, knowledge questions, cause questions and additionally "Defensive Medicine Practices Attitude Scale”. The data received from Edirne Public Health Directorate were also included in the study. Kruskal-Wallis test, Mann-Whitney U test, Chi-Square (Fisher's exact) test, Pearson Correlation test were used and p <0.05 was considered significant. In our study, we found that the participation of physicians in vaccine applications under primary prevention was high (%93,9), while participation in cancer screenings under secondary prevention (%78,5) and in the follow-up of complications of chronic diseases under tertiary prevention (%81) were lower. We found the rate of participants with moderate or higher defensive medicine scores as 94.8%. When we examined the causes of fear of missing disease, was examine there was a significant was highes relationship with the defensive medical attitudes of physicians (p=0,018). Further improve ment is needed inpatient-physician communication so that quaternary prevention can be better applied. In order to achieve this, it is necessary to reduce the fear of litigation of physicians, to increase trust in articles, innovations especially in the practical education of medical faculties and arrangements in the application of mobile services.
Quaternary prevention is the prevention of unnecessary treatment or the prevention of overmedicalisation. The definition of quaternary prevention in the dictionary is ‘‘action taken to identify patient at risk of over medicalization, to protect patient from new medical invasion, and to suggest interventions that are ethically acceptable’’. In our study, we aimed to examine the factors that may affect quaternary prevention practices in primary care and to evaluate the effects of these factors in clinical practice. Our study was conducted between 01.09-01.11.2019 on physicians working in primary care and who agreed to participate in the study. 116 of 126 family physicians agreed to participate in the study. In the study, a questionnaire is used composed of 61 questions, including socio-demographic information prepared by the researchers, knowledge questions, cause questions and additionally "Defensive Medicine Practices Attitude Scale”. The data received from Edirne Public Health Directorate were also included in the study. Kruskal-Wallis test, Mann-Whitney U test, Chi-Square (Fisher's exact) test, Pearson Correlation test were used and p <0.05 was considered significant. In our study, we found that the participation of physicians in vaccine applications under primary prevention was high (%93,9), while participation in cancer screenings under secondary prevention (%78,5) and in the follow-up of complications of chronic diseases under tertiary prevention (%81) were lower. We found the rate of participants with moderate or higher defensive medicine scores as 94.8%. When we examined the causes of fear of missing disease, was examine there was a significant was highes relationship with the defensive medical attitudes of physicians (p=0,018). Further improve ment is needed inpatient-physician communication so that quaternary prevention can be better applied. In order to achieve this, it is necessary to reduce the fear of litigation of physicians, to increase trust in articles, innovations especially in the practical education of medical faculties and arrangements in the application of mobile services.
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Keywords
Dördüncül Koruma, Aile Hekimliği, Tıbbi Uygulama Hatası, Defansif Tıp, Quaternary Prevention, Malpractice, Family Practice, Defensive Medicine
