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

Year 2018, Volume: 18 Issue: 3, 256 - 266, 28.09.2018

Güven Bektemur Seçil Arıca Mehmet Ziya Gençer

https://doi.org/10.17098/amj.461442

Cited By: 1

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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