Senaryoya Dayalı Bir Sanal Hasta Programının Hekimlerin Diyabetik Ayak Enfeksiyonu ve Komplike İntraabdominal Enfeksiyon için Mevcut Kılavuzlara Uyumlarını Artırmaya Yönelik Kullanımı

Abstract

Diyabetik ayak enfeksiyonu (DAE) ve komplike intraabdominal enfeksiyon (KIE) hedefli sanal bir hasta programına katılım sağlayan hekimlerin tanı ve tedavi pratiklerinin değerlendirilmesi amaçlanmıştır. Bu çalışma DAE (n=210) ve KIE (n=42) hedefli sanal bir hasta programına katılım sağlayan 252 hekim ile gönüllülük esasına göre yürütüldü. Hekimlerin bilgisayar grafik teknolojileri temelinde geliştirilen program dahilinde yaptıkları aşamalı hasta değerlendirilmesi verileri (hasta özellikleri, hastalık özellikleri, fizik muayene, laboratuvar ve radyolojik bulgular) kaydedildi. KIE Olgu Senaryosunda, tanı; hekimlerin %75,0’i tarafından doğrulanırken, cerrahi  girişim ve seftriakson + metronidazol (37,6%) veya ertapenem (34,1%) en sık yapılan tedavi seçimi idi. DAE Olgu Senaryosunda tanı, hekimlerin %98,0’i tarafından doğrulanırken, hekimlerin %71,0’i en sık ertapenem (%55,0) olmak üzere antibiyotik tedavisi başlanmasını  uygun buldu. Sonuç olarak, bulgularımız “senaryoya dayalı” sanal hasta programlarının sağladığı hızlı ve güncel geri bildirim ve öğrenim çıktılarının bireysel takibi yoluyla hekimlerin KIE ve DAE klinik karar alma becerilerinin gelişimine katkıda bulunabileceğini göstermektedir. Dolayısıyla, bulgularımız hekimlerin KIE için tedavi uygulamalarının özellikle ampirik antibiyotik seçimi konusunda, DAE tanı ve tedavi uygulamalarının ise enfeksiyon riskinin daha dikkatli değerlendirilerek daha uygun ampirik antibiyotik tedavi seçimi yapılması açısından iyileştirilmesi gerektiğine işaret etmektedir. 

Keywords

• Komplike intraabdominal enfeksiyon,diyabetik ayak enfeksiyonu,tanı,tedavi uygulamaları,senaryoya dayalı sanal hasta programı

A Scenario-Based Virtual Patient Program To İmprove Adherence To Guidelines for Diabetic Foot İnfection and Complicated İntra-Abdominal İnfection among Physicians

Abstract

In the study it was aimed to evaluate diagnostic and practice patterns of physicians who participated for scenario-based virtual patient programs on complicated intra-abdominal infection (IAI) and diabetic foot infection (DFI). This study was conducted with 252 physicians who participated on a voluntary basis in two scenario-based virtual patient programs relating to complicated IAI (n=210) and DFI (n=42) which provide data on stepwise evaluation of patient (patient characteristics, disease characteristics, physical examination, laboratory and radiological findings) as requested by the physician and were developed using computer graphics technology. For IAI Case Scenario, the diagnosis was confirmed by 75.0% of physicians, while   surgical intervention with ceftriaxone + metronidazole (37.6%) or with ertapenem (34.1%) was the most commonly selected treatment modalities. For DFI Case Scenario, the diagnosis was confirmed by 98.0% of physicians, and 71.0% of physicians considered initiation of antibiotic treatment and mostly with ertapenem (55.0%). In conclusion, our findings revealed that use of “scenario-based” virtual patient programs provided rapid and up-to-date feedback and self-monitoring of learning outcomes to improve clinical reasoning skills of physicians on IAI and DFI. Accordingly, our findings indicate practice pattern of physicians for complicated IAI should be improved in terms of more appropriate selection of empirical antibiotherapy, while diagnostic and practice patterns for DFI should also be improved in terms of more careful assessment of risk factors for infection and appropriate selection of empirical antibiotherapy.

Keywords

• Intraabdominal enfeksiyon,diyabetik ayak enfeksiyonu,tanı,tedavi uygulamaları,senaryoya dayalı sanal hasta programı

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