Üçüncü Basamak Sağlık Hizmeti Veren Bir Merkezde İzlenen Prematüre Bebeklerin Sağlık, Eğitim, Rehabilitasyon ve Sosyal Alanlardaki Karşılanmamış Gereksinimleri

Abstract

Amaç: Antenatal ve neonatal bakım koşullarındaki iyileşmelere bağlı olarak prematüre bebeklerin yaşam oranları artmıştır. Mortalitedeki azalmaya rağmen, kısa ve uzun dönemde bebeklerin morbiditelerinin arttığı; sağlık sorunları ve gelişimsel riskleri açısından sağlıklı yaşıtlarına göre farklı hizmet modelleri ile izlenmeleri gerekliliği ortaya çıkmıştır. Riskleri ya da özel gereksinimleri nedeniyle izlemde olan prematüre bebeklerin sağlık, eğitim-rehabilitasyon ve sosyal hizmetler alanlarında gereksinimlerinin olduğu bilinmektedir. Bu araştırmada, ülkemizde bütüncül izlem modelinin benimsendiği, en iyi koşulların sağlandığı üçüncü basamak sağlık hizmeti veren bir merkezde izlenen bebeklerin sağlık, eğitim, rehabilitasyon ve sosyal gereksinimlerinden karşılanmamış gereksinimlerinin ve “hizmet açığının” saptanması amaçlanmaktadır.Gereç ve Yöntemler: Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Gelişimsel Pediatri Bilim Dalı polikliniğine ilk kez ya da kontrolde başvuran prematüre bebekler, uzmanlar tarafından değerlendirildi. Bu değerlendirmede çocukların var olan sağlık, eğitim-rehabilitasyon ve sosyal hizmetler gereksinimleri ve bu gereksinimlerin karşılanıp karşılanmadığı “hizmet gereksinimi uzman formu” ile saptanmış, hizmet açığı belirlendi.Bulgular: Araştırmaya yaşları 4-39 ay % 25-75 aralığı: 9-22,5 olan 42 prematüre bebek dahil edildi. Birinci basamak sağlık hizmetlerinden %55’inin, eğitim-rehabilitasyon ve sosyal hizmetlerden % 36’sının ve üçüncü basamak sağlık hizmetlerinden %14’ünün karşılanmadığı ve hizmet açığı olduğu saptandı.Sonuç: Bu araştırmada, prematüre bebeklerin, üçüncü basamak bir sağlık merkezinde, “bütüncül izlem modeli” ilkelerine göre izlenmelerine ve ülkemiz koşullarına göre en iyi bakımı ve izlemi almalarına karşın gerek sağlık gerekse eğitim-rehabilitasyon, sosyal hizmetler yönünden “hizmet açığı” olduğu saptanmıştır. Bu açığın devam etmesine neden olan koşulların belirlenmesi ve önlenmesine yönelik stratejilerin geliştirilmesi gereklidir.

Keywords

• Prematüre
• bütüncül izlem
• karşılanmamış hizmet gereksinimi
• sağlık-eğitim ve rehabilitasyon hizmetleri

Unmet Needs Of Premature Babies In Health, Education, Rehabilitation And Social Services: A Tertiary Center Experience

Abstract

Aim: The mortality rate of the premature births were decreased with the improvements in antenatal and neonatal care. Despite the morbidity rate is increasing, within the short and long term follow-ups. The studies showed that premature babies need specialized follow up models, such as “medical home model”. Also premature babies and their families need primary care, tertiary care and education, rehabilitation and social services. The aim of the study is to determine the rate of unmet needs of premature babies in health, education, rehabilitation and social services.Material and Methods: Children and their families who participated in the study were evaluated by the specialists in Ankara University School of Medicine Pediatrics, Developmental Pediatrics Department policlinic. “Children with unmet needs evaluation form” was developed and used by the clinician to determine the needs and unmet needs of children within primary and tertiary health care and education-rehabilitation and social services needs.Results: Of the study group 42 premature babies were enrolled. There were 62% male children, between 4-39 months of age and approximately half 52% were born with very low birth weight. All of the children had primary health care and education-rehabilitation and social services needs. There were 55%; 36%; and 14% unmet needs in primary health care; education-rehabilitation and social services; and tertiary health care needs respectively.Conclusion: In this study, even the premature babies and their families are followed by the means of medical home model and an-optimally conditioned tertiary care unit, there were unmet needs in health care, education-rehabilitation and social services. More studies are needed to determine the causes of unmet needs in services, and preventive strategies to decrease the rate of the unmet needs.

Keywords

• Prematurity
• medical home model
• unmet needs
• health-education and rehabilitation services

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