Kırsal hastanede sınırlı fizibilite ile genel cerrahi uygulamaları; Retrospektif kohort çalışma

Öz

Amaç: Kırsal alanda yaşayan birçok sakin, sağlık hizmetlerine erişimleri, kent dışı bölgelerde yaşayanlara göre daha zordur. ABD nüfusunun %20'sinin kırsal bölgelerde yaşıyor olmasına rağmen, hekimlerin sadece %9'u bu alanlarda çalışıyor ve özellikle genel cerrahlar küçük kırsal kasabalarda yetersiz kalmış gibi görünüyor. Bu çalışma ilçe devlet hastanesinde genel cerrahi açıdan yapılan uygulamaların tespiti amacıyla planlandı. 

Yöntemler: Çalışma Konya il merkezinden yaklaşık 150 km uzakta bulunan 25 yataklı Bozkır Devlet Hastanesinde gerçekleştirildi. 2009 yılında genel cerrahi polikliniğine başvuran hasta dosyaları incelendi. Elektif ve acil uygulanan major ve minor ameliyatlar kayıt edildi ve sonuçları irdelendi.

Bulgular: Çalışma süresince 4312 hasta poliklinikte görüldü. 2009 yılı toplam çalışılan gün sayısı 224 olup ortalama gün başına 22 hasta düşmektedir. Çalışma süresi içerisinde 35 adet major ameliyat yapıldı. On iki apendektomi, 15 adet kasık fıtığı, altı adet pilonidal sinus, bir guatr ve bir adet boğulmuş herni vakasında barsak rezeksiyonu ve herni onarımı ameliyatı yapıldı.

Sonuç: Hastanemizde edindiğimiz deneyim, bölgemizin sosyal yapısı ve ihtiyaçları ile ilgili olabilir. Kırsal kesimde çalışan cerrah, üçüncü basamak hastane hizmetleri gibi, hastalarla yüzleşmek ve gereksinimleri karşılamak için deneyimli ekiplere ve yeterli altyapıya ihtiyaç duyabilmektedir.

Anahtar Kelimeler

• Kırsal hastane,Cerrahi uygulamalar,Kohort

General surgery service with limited feasibility in a rural hospital; Retrospective cohort study

Abstract

Aim: Many residents living in rural areas have access to health services more difficult than those living in urban areas. Although 20% of the US population lives in rural areas, only 9% of physicians work in these areas, and in particular general surgeons appear to be inadequate in small rural towns. This study was planned in order to determine the applications made from the general surgery in the district state hospital.

Methods: The study was carried out at the Bozkır State Hospital with 25 beds located approximately 150 km away from the center of Konya. In 2009, patient files were reviewed for general surgery polyclinic. Elective and urgent (major and minor) operations were recorded. The results are examined.

Results: During the study period, 4312 patients were seen in the outpatient clinic. The total number of working days in 2009 is 224 and the average number of patients per day is 22. During the study period, 35 major operations were performed. Twelve appendectomies, 15 inguinal hernias, six pilonidal sinus, one goiter and one intestinal resection in a case with strangulated inguinal hernia were performed.

Conclusion: The experience we have in our hospital may be related to the social structure and needs of our region. A rural surgeon, like third-line hospital services, may need experienced teams and adequate infrastructure to confront patients and meet their needs.

Keywords

• Rural hospital,Surgery service,Cohort

References

1. 1. Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res. 2008;8:19.
2. 2. Dolea C, Stormont L, Braichet J. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010;88(5):379-85.
3. 3. Chankova S, Muchiri S, Kombe G. Health workforce attrition in the public sector in Kenya: a look at the reasons. Hum Resour Health. 2009;7:58.
4. 4. Appiagyei A, Kiriinya RN, Gross JM, Wambua DN, Oywer EO, Kamenju AK, et al. Informing the scale-up of Kenya’s nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production. Hum Resour Health. 2014;12(47):1-10.
5. 5. World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: Global Policy Recommendations. 2010 Accessed April 22 2015
6. 6. Serneels P, Montalvo JG, Pettersson G, Lievens T, Butera JD, Kidanu A. Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bull World Health Organ. 2010 May;88(5):342-9.
7. 7. Binagwaho A, Kyamanywa P, Farmer PE, Nuthulaganti T, Umubyeyi B, Nyemazi JP et al. The Human Resources for Health Program in Rwanda – A New Partnership. The New England Journal of Medicine. 2013;369(21):2054-9.
8. 8. Buchan J. Reviewing the benefits of health workforce stability. Human Resources for Health. 2010;8:29.

9. 9. Basak F. Addition of a general surgeon without addition of appropriate support is inadequate to improve outcomes of trauma patients in a rural setting: a cohort study of 1962 consecutive patients. Eur J Trauma Emerg Surg. 2017 Dec;43(6):835-9.
10. 10. Thompson MJ, Lynge DC, Larson EH, Tachawachira P, Hart LG. Characterizing the general surgery workforce in rural America. Arch Surg. 2005;140:74-9.
11. 11. Zuckerman R, Doty B, Gold M, Bordley J, Dietz P, Jenkins P, Heneghan S. General surgery programs in small rural New York State hospitals: A pilot survey of hospital administrators. J Rural Health 2006;22:339-42.
12. 12. Kwakwa F, Jonasson O. The general surgery workforce. Am J Surg. 1997;173:59-62.
13. 13. Jonasson O, Kwakwa F, Sheldon GF. Calculating the workforce in general surgery. JAMA. 1995;274:731-4.
14. 14. Ritchie WP, Rhodes RS, Biester TW. Workloads and practice patterns of general surgeons in the United States, 1995-1997: A report from the American Board of Surgery. Ann Surg. 1999;230:533-43.
15. 15. Landercasper J, Bintz M, Cogbil TH, Bierman SL, Buan RR, Callaghan JP, et al. Spectrum of general surgery in rural America. Arch Surg. 1997;132:494-7.
16. 16. Accreditation Council for Graduate Medical Education. Residency Review Committee for Surgery Case Log Statistical Reports. Available at: http://www.acgme.org/residentdatacollection/documentation/statistical_reports.asp. Accessed on August 20, 2007.
17. 17. Wurie HR, Samai M and Witter S. Retention of health workers in rural Sierra Leone: findings from life histories. Hum Resour Health. 2016;14(3):1-15.
18. 18. Brooks RG, Walsh M, Mardon RE, Lewis M, Clawson A. The roles of nature and nurture in the recruitment and retention of primary care physicians in rural areas: A review of the literature. Acad Med. 2002;77:790-8.
19. 19. Öksüz A, Atadağ Y, Aydın A, Kaya D. The frequency of analgesic drug use in 65 years and above diseases and their causes; an experience of family medicine unit. J Surg Med. 2017;1(1):12-4.
20. 20. Aydın A, Atadağ Y, Kaya D, Köşker HD, Başak F, Uçak S. Aile Hekimliği Uygulamasının Bir Eğitim ve Araştırma Hastanesine Ayaktan Hasta Başvurularındaki Etkisi.. Arch Clin Exp Med. 2017;2(3):74-8. 21. American Hospital Association and The Lewin Group. Challenges facing rural hospitals. Trend Watch. 2002;4:1.