Hastalar Neden Antibiyotik İster ve Hekimler Neden Antibiyotik Reçete Eder?: Birinci Basamakta Kesitsel Bir Çalışma

Öz

Amaç: Antibiyotiklerin uygunsuz kullanımı dünya çapında bir halk sağlığı sorunudur. Ne yazık ki, Türkiye özellikle yüksek oranda antibiyotik reçetesi ile olumsuz bir üne sahiptir. Bu çalışmanın amacı, Türkiye’deki birinci basamak hekimlerinin antibiyotik reçete etmelerinde etkili olan faktörleri belirlemek ve hekimlerin akılcı antibiyotik kullanımı konusundaki bilgi düzeylerini değerlendirmektir.
Materyal ve Metot: Bu kesitsel çalışma, Ankara ilinde 8 farklı ilçedeki Aile Sağlığı Merkezleri ve Toplum Sağlığı Merkezleri'nde gerçekleştirildi. Hekimlere bilgi düzeylerini ve akılcı antibiyotik kullanımı ile ilgili tutumlarını değerlendirmek için, kendilerinin cevaplayacağı bir anket uygulandı. Elde edilen veriler SPSS 21.0 yazılımı kullanılarak analiz edildi.
Bulgular: Çalışmaya 84 (%42) erkek ve 116 (%58) kadın olmak üzere 200 doktor katıldı. Hekimlerin %38,5'i hastaların antibiyotik isteğini reddetmiş olduklarını belirttiler. 11 yıl ve daha uzun süredir hekimlik yapanların “hastanın beklenti ve ısrarı”ndan etkilendiği görülürken, 10 yıl ve daha az süredir çalışanların “eşlik eden hastalık varlığı” ndan etkilendiği görüldü. (p1=0,044, p2=0,012). Hekimlerin antibiyotiklerle ilgili en çok antimikrobiyal direnç ve maliyet konularında bilgi eksiklikleri olduğu saptandı. 
Sonuç: Antibiyotiklerin rasyonel kullanımı açısından, hekimlerinin antibiyotikler ve antibiyotiklerin akılcı kullanımı ile ilgili bilgi düzeyi ve bunların antibiyotik reçeteleme davranışları ile ilişkisi son derece önemlidir. Bu nedenle, toplumda uygun olmayan antibiyotik kullanımını önlemek açısından gereksiz antibiyotik reçetelenmesine neden olan faktörlerin ortaya çıkarılması önemlidir. 

Anahtar Kelimeler

• Akılcı antibiyotik kullanımı,birinci basamak,aile hekimi

Why Do Patients Want Antibiotics and Why Do Physcians Prescribe Antibiotics?: A Cross-Sectional Study In Primary Health Care

Abstract

Objectives: The inappropriate use of antibiotics is a worldwide public healthcare problem. Unfortunately, Turkey has a negative reputation with a particularly high rate of antibiotic prescription. The aim of this study is to determine the factors affecting Turkish primary care physicians in prescribing antibiotics and to evaluate the knowledge levels of the physicians on the rational use of antibiotics.
Materials and Methods: This cross - sectional study was carried out in Family Health Centers and Community Health Centers in 8 different districts in Ankara. A self-reporting questionnaire was administered to the physicians to evaluate their level of knowledge and attitudes towards the rational use of antibiotics. The data obtained were analysed using SPSS 21.0 software. 
Results: The study included 200 physicians, comprising 84 (42%) males and 116 (58%) females. Of the total physicians, 38.5% stated that they had refused patient’s request for antibiotics. Those who had been working for ≥11 years were seen to be affected by ‘the patient’s expectations and insistence’ when prescribing antibiotics and those working for ≤10 years by ‘the presence of comorbid disease’ (p1=0.044, p2=0.012). The subjects on which the physicians were most lacking in knowledge related to antibiotics were determined to be antimicrobial resistance and cost. 
Conclusion: In terms of the rational use of antibiotics, physicians’ knowledge level about antibiotics and rational use of antibiotics and their associated behaviour in prescribing antibiotics are extremely important. Therefore, it is important to identify the factors that cause unnecessary antibiotic prescription in order to prevent inappropriate antibiotic use in the population.

Keywords

• Rational use of antibiotics,primary care,family physician

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