Edirne'deki birinci basamak hekimlerinin defansif tıp uygulamaları hakkında bilgi ve tutumları ve bunun klinik pratiklerine etkisi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Defansif tıp; öncelikle dava edilmeyi önlemek amacı ile kanıta dayalı tıp kuralları çerçevesinde yapılan tıbbi uygulamalardan sapma durumudur. Sağlık hizmetlerinin maliyetlerini, hasta bakımının kalitesini ve güvenliğini negatif yönde etkileyen hekimler arasında yaygın olan bir yaklaşımdır. Çalışmamızda birinci basamak hekimlerinin defansif tıp uygulamaları hakkındaki bilgi, tutum ve bunların klinik pratiklerine etkisiyle birlikte bu tutuma neden olan faktörleri incelemeyi amaçladık. Çalışmamız 01.09-01.11 2019 tarihleri arasında birinci basamakta görev yapan ve çalışmaya katılmayı kabul eden hekimlere yapılmıştır. 126 aile hekiminin 116’sı çalışmaya katılmayı kabul etmiştir. Çalışmada araştırmacılar tarafından hazırlanan sosyodemografik bilgiler, bilgi soruları, neden sorularını ve ek olarak “Defansif Tıp Uygulamaları Tutum Ölçeği” ni içeren 58 soruluk anket kullanılmıştır. Edirne Halk Sağlığı Müdürlüğü’nden alınan veriler de çalışmaya eklenmiştir. Kruskal-Wallis testi, Mann-Whitney U testi, Ki-Kare (Fisher’s exact) testi, Pearson korelasyon testi kullanılmış ve p<0,05 değeri anlamlı kabul edilmiştir. Çalışmamızda hekimler %94,8 oranında orta ve yüksek düzeyde defansif tıp uygulamalarına başvuruyordu. Defansif tıp tutumları ile sosyodemografik veriler, uzmanlık durumu, kayıtlı nüfus, muayene edilen hasta sayısı ve istenilen tetkik sayısı arasında anlamlı ilişki saptamadık. Hekimlerin çoğu defansif tıp kavramını duymuş olmasına rağmen bu konuda bilgi sahibi değildi. Defansif tutumları yüksek olan hekimlerin medyadan (p=0,004), şiddete maruz kalmaktan (p<0,001), hastaları memnun etme kaygısından (p<0,001), iletişim problemlerinden (p=0,001) etkilenme oranı anlamlı derecede yüksekti. Hekimlerin mesleki geleceği, sağlık harcamalarının maliyeti, hastalara daha bilinçli bir şekilde yaklaşabilmek için defansif tutumların azaltılması gerektiğini düşünmekteyiz. Bunu da hekim- hasta iletişiminin her iki taraf için de arttırarak sağlayabiliriz. Defansif tıp kavramıyla birlikte dördüncül koruma kavramının da daha iyi kavranabilmesi için bilgi seviyesinin yükseltilmesi ve eğitim programlarının arttırılması gerektiğini düşünmekteyiz.
Defensive medicine; is the diversion of medical practices performed within the framework of evidence-based medical rules primarily to prevent being sued. It is a common approach among physicians that negatively effect healthcare costs, patient care quality and safety. In our study, we aimed to examine the knowledge and attitudes of primary care physicians about defensive medicine practices and the factors that causes this attitude along with their effects on 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 58 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, 94.8% of the doctors was applying to medium and high level defensive medicine practices. We did not find a significant relationship between defensive medical attitudes and socio-demographic data, specialty, registered population, number of patients examined, and the number of examinations requested. Although most of the physicians had 56 heard about the concept of defensive medicine, they did not have any information about this subject. The rate of physicians with high defensive attitudes being influenced by the media (p = 0.004), exposure to violence (p <0.001), anxiety to please patients (p <0.001), communication problems (p = 0.001) was significantly high. We think that the defensive attitudes should be reduced for the sake of the doctors' professional future, the cost of healthcare expenses and in order to be able to approach patients more consciously. We can achieve this by increasing the physician-patient communication for both parts. We think that the level of knowledge and education programs should be increased in order to better understand the concept of quaternary prevention along with defensive medicine.
Defensive medicine; is the diversion of medical practices performed within the framework of evidence-based medical rules primarily to prevent being sued. It is a common approach among physicians that negatively effect healthcare costs, patient care quality and safety. In our study, we aimed to examine the knowledge and attitudes of primary care physicians about defensive medicine practices and the factors that causes this attitude along with their effects on 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 58 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, 94.8% of the doctors was applying to medium and high level defensive medicine practices. We did not find a significant relationship between defensive medical attitudes and socio-demographic data, specialty, registered population, number of patients examined, and the number of examinations requested. Although most of the physicians had 56 heard about the concept of defensive medicine, they did not have any information about this subject. The rate of physicians with high defensive attitudes being influenced by the media (p = 0.004), exposure to violence (p <0.001), anxiety to please patients (p <0.001), communication problems (p = 0.001) was significantly high. We think that the defensive attitudes should be reduced for the sake of the doctors' professional future, the cost of healthcare expenses and in order to be able to approach patients more consciously. We can achieve this by increasing the physician-patient communication for both parts. We think that the level of knowledge and education programs should be increased in order to better understand the concept of quaternary prevention along with defensive medicine.
Açıklama
Anahtar Kelimeler
Savunma Tıbbı, Tıbbi Uygulama Hatası, Aile Hekimliği, Dördüncül Koruma, Defensive Medicine, Malpractice, Family Practice, Quaternary Prevention
