Aile Hekimlerinin Anafilaksi Teşhisi ve Tedavisine İlişkin Hazırlık ve Bilgi Düzeyleri

Year 2023, , 66 - 73, 15.03.2023

Mahir Serbes , Sanem Nemmezi Karaca

https://doi.org/10.53424/balikesirsbd.1244214

Cited By: 1

Abstract

Amaç: Anafilaksi hekimler tarafından yeterince tanınmamakta ve tedavi edilmemektedir. Bu da hekimlerdeki kritik bilgi boşluklarını göstermektedir. Bu çalışma, sağlık sisteminde birinci basamakta hizmet eden aile hekimlerinin (AH) anafilaksi bilgi düzeylerini değerlendirmeyi ve bilgi düzeylerine etkileyen faktörleri belirlemeyi amaçlamıştır. Gereç ve Yöntem: Gönüllüler arasında internet tabanlı Google Formlar anketi kullanılarak Sivas, Türkiye’deki AH’ler üzerinde kesitsel bir çalışma yapıldı. Yaş, meslekte çalışma yılı ve kariyer durumu dahil olmak üzere demografik özellikler, ve çocuklarda anafilaksinin teşhisi ve yönetimi ile ilgili bilgileri değerlendirildi. Bulgular: Ankete toplam 140 AH’i katılmıştır (34 [%24.3] pratisyen hekim [PH], 20 [%14.3] sözleşmeli aile hekimi [SAH], 74 [%52.9] asistan ve 12 [%8.6] uzman). Tanı, akut tedavi ve epinefrin oto-enjektör kullanımına ilişkin tüm soruları doğru cevaplayanların sayısı sırasıyla 11 (%7.9), 52 (%37.4) ve 27 (%19.3) idi. Anafilaksi tanısında 100 (%72,5) katılımcı, anafilaksinin cilt belirtileri olmadan da oluşabileceğinin farkında değildi ve sadece 48 (%34.8) katılımcı, gastrointestinal semptomları olası bir anafilaksi sunumu olarak tanımladı. Asistanlar (11, %14.9) ve uzmanlar (2, %16.7) ankette daha iyi performans gösterdi ve tüm soruları doğru yanıtlayan katılımcıların oranı PH' lere (%2, %5.9) ve SAH' lere (%1, %5.0) kıyasla daha yüksekti. Geçen yıl bir eğitim faaliyetine katılım, tüm anket maddelerini doğru yanıtlamayla ilişkili tek bağımsız faktördü. Sonuç: Kariyer durumu ve iş deneyimlerine bakılmaksızın tüm aile hekimleri arasında anafilaksi tanıma ve yönetimini iyileştirmeye ihtiyaç vardır. Bu da her yıl düzenli ve güncellenmiş eğitimsel aktivitelere katılımın sağlanmasıyla olur.

Keywords

aile hekimleri, anafilaksi, bilgi düzeyi, tanı, tedavi

Preparedness and Knowledge Level of Family Physicians Regarding Anaphylaxis Diagnosis and Management

Abstract

Objective: Anaphylaxis is under-recognized and undertreated by physicians, indicating critical knowledge gaps. This study aimed to assess the knowledge levels of anaphylaxis among family physicians (FPs) as they are the primary first-line healthcare providers and identify the factors influencing their knowledge levels. Materials and Methods: A cross-sectional study using an internet-based Google Forms questionnaire was conducted among voluntary FPs in Sivas, Turkey. Demographic features, including age, years in practice, and career position, and knowledge related to the diagnosis and management of anaphylaxis in children were assessed. Results: A total of 140 FPs participated in the survey (34 [24.3%] general practitioners [GPs], 20 [14.3%] contracted family physicians [CFPs], 74 [52.9%] residents in training [RITs], and 12 [8.6%] specialists). The number of participants who correctly answered all questions regarding diagnosis, acute treatment, and epinephrine auto-injector use was 11 (7.9%), 52 (37.4%), and 27 (19.3%), respectively. In diagnosing anaphylaxis, 100 (72.5%) participants were unaware that anaphylaxis can occur without skin manifestations, and only 48 (34.8%) identified gastrointestinal symptoms as a possible anaphylaxis presentation. RITs (11, 14.9%) and specialists (2, 16.7%) had better performance on the questionnaire, with higher proportions of participants who answered all questions correctly, compared to GPs (2, 5.9%) and CFPs (1, 5.0%). Attendance at an educational activity in the last year was the only independent factor associated with answering all questionnaire items correctly. Conclusion: There is a need to improve anaphylaxis recognition and management among all FPs regardless of their career position and work experience, underlining the importance of regular and updated educational interventions

Keywords

family physicians, anaphylaxis, knowledge, diagnosis, management

References

• REFERENCES Alvarez-Perea, A., Ameiro, B., Morales, C., Zambrano, G., Rodríguez, A., Guzmán, M., Zubeldia, J. M., & Baeza, M. L. (2017). Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup. The journal of allergy and clinical immunology. In practice, 5(5), 1256–1263. https://doi.org/10.1016/j.jaip.2017.02.011.
• Arga, M., Topal, E., Yılmaz, S., Erdemli, P. C., Bıçakcı, K., & Bakırtaş, A. (2021). Healthcare workers` knowledge level regarding anaphylaxis and usage of epinephrine auto-injectors. The Turkish journal of pediatrics, 63(3), 372–383. https://doi.org/10.24953/turkjped.2021.03.004.
• Brown, S. G., Stone, S. F., Fatovich, D. M., Burrows, S. A., Holdgate, A., Celenza, A., Coulson, A., Hartnett, L., Nagree, Y., Cotterell, C., & Isbister, G. K. (2013). Anaphylaxis: clinical patterns, mediator release, and severity. The Journal of allergy and clinical immunology, 132(5), 1141–1149.e5. https://doi.org/10.1016/j.jaci.2013.06.015.
• Cardona, V., Ansotegui, I. J., Ebisawa, M., El-Gamal, Y., Fernandez Rivas, M., Fineman, S., Geller, M., Gonzalez-Estrada, A., Greenberger, P. A., Sanchez Borges, M., Senna, G., Sheikh, A., Tanno, L. K., Thong, B. Y., Turner, P. J., & Worm, M. (2020). World allergy organization anaphylaxis guidance 2020. The World Allergy Organization journal, 13(10), 100472. https://doi.org/10.1016/j.waojou.2020.100472
• El-Sayed, Z. A., El-Owaidy, R., Hussein, S. M., Hossam, D., El-Sawi, I. H., Adel, A., Almalky, M., Elshebiny, E., Ismaeel, A. Y., Osman, N. S., Shoman, W., Abdel Hafez, M. A., Ibrahim, M. A., Salama, A. A., & Sobh, A. (2021). Physicians' knowledge and practice concerning diagnosis and management of anaphylaxis: The situation in Egypt. African journal of emergency medicine: Revue africaine de la medecine d'urgence, 11(4), 464–470. https://doi.org/10.1016/j.afjem.2021.07.005.
• Ercan, H., Ozen, A., Karatepe, H., Berber, M., & Cengizlier, R. (2012). Primary school teachers' knowledge about and attitudes toward anaphylaxis. Pediatric allergy and immunology:official publication of the European Society of Pediatric Allergy and Immunology, 23(5), 428–432. https://doi.org/10.1111/j.1399-3038.2012.01307.x Fustiñana, A. L., Rino, P. B., & Kohn-Loncarica, G. A. (2019). Detection and management of Anaphylaxis in children. Reconocimiento y manejo de la Anafilaxia en pediatría. Revista chilena de pediatria, 90(1), 44–51. https://doi.org/10.32641/rchped.v90i1.839. González-Díaz, S. N., Villarreal-González, R. V., Fuentes-Lara, E. I., Salinas-Díaz, M. D. R., de Lira-Quezada, C. E., Macouzet-Sánchez, C., Macías-Weinmann, A., Guzmán-Avilán, R. I., & García-Campa, M. (2021). Knowledge of healthcare providers in the management of anaphylaxis. The World Allergy Organization journal, 14(11), 100599. https://doi.org/10.1016/j.waojou.2021.100599.
• Muraro, A., Worm, M., Alviani, C., Cardona, V., DunnGalvin, A., Garvey, L. H., Riggioni, C., de Silva, D., Angier, E., Arasi, S., Bellou, A., Beyer, K., Bijlhout, D., Bilò, M. B., Bindslev-Jensen, C., Brockow, K., Fernandez-Rivas, M., Halken, S., Jensen, B., Khaleva, E., … European Academy of Allergy and Clinical Immunology, Food Allergy, Anaphylaxis Guidelines Group (2022). EAACI guidelines: Anaphylaxis (2021 update). Allergy, 77(2), 357–377. https://doi.org/10.1111/all.15032.
• Prince, B. T., Mikhail, I., & Stukus, D. R. (2018). Underuse of epinephrine for the treatment of anaphylaxis: mise opportunities. Journal of asthma and allergy, 11, 143–151. https://doi.org/10.2147/JAA.S159400
• Shaker, M. S., Wallace, D. V., Golden, D. B. K., Oppenheimer, J., Bernstein, J. A., Campbell, R. L., Dinakar, C., Ellis, A., Greenhawt, M., Khan, D. A., Lang, D. M., Lang, E. S., Lieberman, J. A., Portnoy, J., Rank, M. A., Stukus, D. R., Wang, J., Collaborators, Riblet, N., Bobrownicki, A. M. P., … Wang, J. (2020). Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. The Journal of allergy and clinical immunology, 145(4), 1082–1123. https://doi.org/10.1016/j.jaci.2020.01.017.
• Topal, E., Çatal, F., Özdemir, R., Karadağ, A., Yıldırım, N., Ermiştekin, H., Sinanoğlu, M.S., Keçiören, G., & Karakoç, H.T. (2014). Measuring the primary care physician`s knowledge about diagnosis and treatment of cow`s milk allergy and adrenaline auto injector usage. ,12 (1), 9-14. Tuncel, T., Sancaklı, O., Bag, O., Cetin, H. S., & Özdoğru, E. E. (2021). Physicians' Approach to Anaphylaxis in Childhood. Pediatric emergency care, 37(12), e1425–e1428. https://doi.org/10.1097/PEC.0000000000002064
• Turner, P. J., Worm, M., Ansotegui, I. J., El-Gamal, Y., Rivas, M. F., Fineman, S., Geller, M., Gonzalez-Estrada, A., Greenberger, P. A., Tanno, L. K., Borges, M. S., Senna, G., Sheikh, A., Thong, B. Y., Ebisawa, M., Cardona, V., & WAO Anaphylaxis Committee (2019). Time to revisit the definition and clinical criteria for anaphylaxis? The World Allergy Organization journal, 12(10), 100066. https://doi.org/10.1016/j.waojou.2019.100066.
• Wijekoon, C. N., Wettasinghe, I., Fernando, D., Dissanayake, A. S., Gunawardana, M., Minuwanpitiya, G., & Thenuwara, P. (2021). Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis. BMC medical education, 21(1), 152. https://doi.org/10.1186/s12909-021-02588. Yardımcı Y, Akbıyık D, Aypak C, Yıkılkan H, & Görpelioğlu S (2016). Primary Care Practise in Turkey and Training of Contracted Family Physicians. TJFM&PC. https://doi.org/10.5455/tjfmpc.207946
• Yildiz R, Gokmirza Ozdemir P, Sut N, & Yazicioglu M. (2022). Physicians Working At Different Clinical Settings: Can They Recognize and Manage Anaphylaxis? Osmangazi Journal of Medicine.44(1)112-119. https://doi.org/10.20515/otd.960249