How Should Referral Chain be Implemented in Family Medicine in Turkey?

Abstract

Objectives: The objective of this study is to examine the views of the family physicians on the applicability of the referral chain which is likely to be introduced in Turkey in the period ahead and how to apply it.

Materials and Methods: This descriptive cross‐sectional study was conducted via one‐on‐one interviews and e‐mailings with 201 family physicians of various ranks on 10.01.2018 ‐ 18.03.2018, in form of a survey that inquired their views on the referral chain likely to be introduced to the family practice system.

Results: While 85.07% of the all 201 family physicians favored the introduction of the referral chain system, 55.72% of them stated that the referral system is applicable in Turkey. 50.87% of the participants, who were against any restrictions regarding the institutions that they would refer to, demand referring their patients to the hospitals and relevant branch specialists that they prefer as medical doctors. 96.01% of the participants favored informing the public through public spots another 98% stressed that the patient population per each family physician should be reduced. 91.04% of the participants supported the increased emphasis on preventive medicine in family practice whereas 75.62% of them were in favor of the promotion of the referral chain by charging the patients submitting in the secondary health institutions before they resort to family practice, 81.59% thought that the time spent for home care health services should be increased in parallel to the size of the disabled and elderly (65+) population which is primarily subject to family practice, 69.65% of them supported the idea that the family physicians should be entitled to refer their patients directly to the relevant sub branch specialists, 27.86% said that the family physician should be able to see the relevant specialist together with his patient and attend his/her patients' appointment with that specialist, and 24.37% endorsed improving the quality of telephonic health services in family practice and that the patients subject to family practice should be able to access their physicians and get information and the physicians should be able to directly refer their patients whose symptoms they spotted, when needed.

Conclusion: The family physicians attending our survey overwhelmingly supported the introduction of referral chain to the family practice system, as they also shared their views that in order to improve the family practice system and to get the referral chain function appropriately, additional steps should be taken based on the current examples in family practice and referral chain systems in various regions of the world.

Keywords

• Family practice,gatekeeping system,mandatory referral system

Türkiye’de Aile Hekimliğinde Sevk Zinciri Nasıl Uygulanmalıdır?

Abstract

Amaç: Bu çalışmanın amacı aile hekimlerinin, Türkiye’de gelecekte uygulanması muhtemel sevk zinciri ile alakalı olarak uygulanabilirliği ve nasıl uygulanabileceği noktasında görüşlerini araştırmaktır.

Materyal ve Metot: Bu kesitsel tanımlayıcı çalışma 10.01.2018 – 18.03.2018 tarihleri arasında aile hekimi, aile hekimi uzmanı ve aile hekimi asistanı toplam 201 hekime yüz yüze görüşme yöntemi ve e‐posta yoluyla aile hekimliği sisteminde uygulanması muhtemel sevk sistemine dair görüşlerini sorgulayan anket uygulanmıştır.

Bulgular: Ankete katılan toplam 201 hekimin %85,07’si aile hekimliği sistemine sevk zincirinin gelmesi gerektiğini savunurken %55,72’si sevk sisteminin Türkiye’de uygulanabileceği yönünde görüş beyan etmiştir. Sevk edecekleri kurumlar konusunda kısıtlanmak istemeyen katılımcıların, %50,87’si il içerisinde istedikleri hastaneye ve uzmanlık branşına hastaları sevk edebilmeyi istemektedir.

Katılımcıların %96,01’i kamu spotları ile halkın bilinçlenmesi gerektiğini savunurken %98’i aile hekimi başına sorumlu olunan nüfusun azaltılması gerektiğini düşünmektedir. Çalışmaya katılan hekimlerin

%91,04’ü aile hekimliğinde, koruyucu hekimliğin daha çok ön plana çıkartılmasını, %75,62’si aile hekimliğine başvurulmadan 2.basamak sağlık kuruluşlarına giden hastalardan ek ücret alınarak sevk zincirinin teşvik edilmesi gerektiğini, %81,59’u evde sağlık hizmetlerine ayrılan zamanın aile hekimliğine bağlı 65 yaş üstü ve engelli nüfus ile paralel olarak arttırılması gerektiğini, %96,01’i sevk zincirinde 65 yaş üstü ve engelli hastaların sevk edildikten sonra ilgili sağlık kuruluşuna ulaşımı ile ilgili bir birimin yerel yönetimler ve Sağlık Bakanlığı işbirliğiyle kurulması gerektiğini, %69,65’i Aile hekimlerinin, hastalarını doğrudan yan dal uzmanlarına sevk edebilmesi gerektiğini düşünürken %27,86’sı Aile hekimi sevk ettiği hastası ile birlikte ilgili uzmana gidebilmeli ve ilgili uzmanının muayenesine katılabilmesi gerektiğini, %24,37’si Aile hekimliğinde telefonla sağlık hizmetlerinin geliştirilmesi ve aile hekimliğine bağlı hastaların telefonla hekime ulaşarak bilgi alması gerektiğinde hekimin telefonla semptomlarını öğrendiği hastalarının lüzum halinde sevkini gerçekleştirebilmesi gerektiği yönünde fikir beyan etmiştir.

Sonuç: Çalışmamıza katılan aile hekimleri büyük oranda aile hekimliği uygulamasına sevk zincirinin gelmesi gerektiğini düşünmekte olup aile hekimliği uygulamasının geliştirilmesi ve sevk zincirinin sağlıklı bir şekilde işletilebilmesi için Dünya’da mevcut aile hekimliği ve sevk zincirleri sistemleri örnekleri değerlendirilerek ek adımlar atılması gerektiği yönünde fikir beyan etmektedirler.

Keywords

• Aile Hekimliği,sevk zinciri sistemi,zorunlu sevk sistemi

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