İstanbul ilindeki şehir hastanelerinde görev yapmakta olan uzman hekimlerin sevk sistemi hakkındaki düşünceleri (öngörüleri, kaygıları ve önerileri) üzerine tanımlayıcı çalışma
A descriptive study on the opinions (predictions, concerns, and suggestions) of specialist physicians working in city hospitals in İstanbul regarding the referral system
- Tez No: 859191
- Danışmanlar: DOÇ. DR. HİLAL ÖZKAYA
- Tez Türü: Tıpta Uzmanlık
- Konular: Aile Hekimliği, Family Medicine
- Anahtar Kelimeler: Family Medicine, Healthcare System, Referral Chain, Medical Specialization
- Yıl: 2024
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Başakşehir Çam ve Sakura Şehir Hastanesi
- Ana Bilim Dalı: Aile Hekimliği Ana Bilim Dalı
- Bilim Dalı: Aile Hekimliği Bilim Dalı
- Sayfa Sayısı: 99
Özet
AMAÇ: Sevk zinciri, hastaların ihtiyaçlarına göre birinci basamaktan başlayarak uygun sağlık hizmetlerine adım adım yönlendirilmesini sağlayan, sağlık sisteminin etkin kullanımını amaçlayan bir yönlendirme sistemidir. Sevk zincirinin temel hedefi, ikinci ve üçüncü basamakta hizmet veren hastaneleri, alt basamaklarda tedavi edilebilecek hastaların oluşturduğu yükten arındırarak, hastane hizmetlerinin kalitesini artırmak ve sağlıkla ilgili maliyetleri düşürmektir. Çalışmada uzman hekimlerin ülkemizdeki sevk sistemi ve ilerleyen dönemlerde uygulamaya geçilmesi beklenen kademeli sevk zinciri hakkındaki görüşlerini tespit etmek amaçlanmaktadır. GEREÇ VE YÖNTEM: Kesitsel ve tanımlayıcı nitelikte olan araştırmamız yüz yüze anket uygulamasıyla yapılmıştır. Çalışmamız 14.09.2023 ile 14.11.2023 tarihleri arasında İstanbul ilindeki şehir hastanelerinde aktif görev yapan uzman hekimlerden oluşan 202 katılımcı ile yapılmıştır. Çalışmada katılımcılara ilk bölümde yaş, cinsiyet, sağlık yöneticiliği ve mesleki deneyimleri gibi sosyodemografik özelliklerini tanımlamak amacıyla 18 soru yöneltilmiştir. Sonraki bölümde uzman hekimlerin mevcut ve tekrardan yapılanması planlanan sevk sistemi hakkındaki öngörülerini (15 soru), kaygılarını (12 soru) ve önerilerini (10 soru) tespit etmek amacıyla 37 soru yöneltilmiştir. Elde edilen verilerin cronbach's alpha ile güvenirlik analizi, skewness ve kurtosis değerlerine bakılıp dağılımın normalliği test edilerek istatistiksel analize tabi tutulmuştur. p
Özet (Çeviri)
AİM: Referral chain is a guidance system aimed at directing patients step by step to appropriate healthcare services starting from the primary care level according to their needs, with the aim of ensuring effective utilization of the healthcare system. The primary goal of the referral chain is to relieve hospitals providing services at the secondary and tertiary levels from the burden of patients who can be treated at lower levels, thus improving the quality of hospital services and reducing healthcare-related costs. The aim of this study is to determine the opinions of expert physicians regarding the referral system in our country and the gradual referral chain expected to be implemented in the future. MATERIALS AND METHODS: Our study, which has a cross-sectional and descriptive nature, was conducted through face-to-face survey applications. The study was conducted with 202 participants consisting of specialist physicians actively working in city hospitals in Istanbul between September 14, 2023, and November 14, 2023. In the study, participants were asked 18 questions in the first section to define their sociodemographic characteristics such as age, gender, health management, and professional experience. In the subsequent section, 37 questions were directed towards determining the participant's predictions (15 questions), concerns (12 questions) and suggestions (10 questions) regarding the current and planned restructuring of the referral system. The collected data were subjected to statistical analysis after conducting a reliability analysis using Cronbach's alpha, and the normality of the distribution was tested by examining skewness and kurtosis values. A p-value of less than 0.05 was considered statistically significant. RESULTS: 38.1% of the participants indicated that direct access to hospitals should be completely prevented, while 59.9% stated that direct access to hospitals should not be completely prevented, but sanctions should be applied if the referral chain is not followed. Among the participating specialist physicians excluding family medicine, 50.3% rated the appropriateness of treatments provided by family physicians for diseases related to their own specialties below 6 out of 10. Only 42.9% of other specialty physicians considered medical indication as a factor influencing family physicians' referral decisions. The percentage of specialists who consider medicolegal concerns as factors in patient referrals is 67.5%. Similarly, the percentage of specialists who consider patients' referral requests as factors is 66.2%. The percentage of other specialist physicians who perceive lack of knowledge/experience among family physicians as reasons for referral is 74.7%. Family medicine physicians were found to have a higher total Anxiety score compared to physicians in other specialties. Significant differences were found between specialist physicians who had worked in Primary Health Care Centers (ASM) and those who believed that malpractices would increase with the implementation of the referral chain. There was a significant difference between family medicine specialists and other specialists regarding the perception that specialization overshadowed holistic patient care. Likewise, significant differences were observed between specialty groups regarding the belief that the referral system would increase the workload at the primary care level and lead to an increase in malpractices. As age and professional experience increase, specialist physicians' prediction scores regarding the anticipated implementation of the referral chain were found to be high, while their anxiety scores were low. The percentage of participants who believe that the community will adopt the referral chain implementation was determined to be 43.3%. 54.4% of the participants believe that an effective and quality referral system can be implemented. CONCLUSION: Specialist physicians have common predictions and concerns regarding the referral system in many areas. However, there are different levels of anxiety between family medicine specialists and other specialists regarding issues such as increased workload at the primary care level, fear of malpractice, stress, and increased responsibilities. It is concluded that in order for the referral system to be effective and efficient, in-service training should be provided, referral criteria should be clearly defined, legal infrastructure should be strengthened, and public awareness should be raised
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