Covid-19 Pandemisinin Birinci Basamak Sağlık Hizmetleri ve Aile Hekimlerine Yansıması: Türkiye'de Hekim-Hasta İlişkisi

Abstract

Arka Plan ve Amaç: Bu araştırma, COVID-19 pandemisinin birinci basamak sağlık hizmetleri ve aile hekimleri üzerindeki yansıması, özellikle hekim-hasta ilişkisi bağlamında incelemektedir. Bu araştırma, aile hekimlerinin karşılaştıkları zorlukları ve uyum stratejilerini analiz ederek, hekim-hasta ilişkisine ilişkin literatüre katkıda bulunmayı ve gelecekteki pandemi hazırlıkları için içgörüler sağlamayı amaçlamaktadır. Gereç ve Yöntem: COVID-19 salgını sırasında hekimlerin hekim-hasta ilişkisine ilişkin bakış açılarını keşfetmek için nitel bir araştırma tasarımı kullanılmıştır. Çalışma, 10 Mart 2023 ile 11 Nisan 2023 tarihleri arasında Türkiye'nin Antalya kentindeki birinci basamak sağlık hizmetleri (PHC'ler) ve aile hekimleri (FP'ler) ile yapılan görüşmeler yoluyla yürütülmüştür. Örneklem, ölçüt ve kartopu örnekleme yöntemleri kullanılarak seçilen Antalya'daki birinci basamak sağlık hizmetlerinde çalışan 21 hekimden oluşmaktadır. Bulgular: Bu temalar “hekim- hasta etkileşimi”, “numune alımı ve ilaç” ve “hasta memnuniyeti” olarak belirlenmiştir. Sonuç: Bu çalışma COVID-19 pandemisinin birincil sağlık bakımı ve aile hekimleri üzerindeki yansımalarını ortaya koymaktadır. Bulgular, pandemi sırasında hekim-hasta iletişiminin zayıfladığını, hasta memnuniyetinin değiştiğini ve hekimlerin etik kaygılarla karşı karşıya kaldığını göstermektedir. Ayrıca, artan iş yükü ve psikolojik baskı nedeniyle hekimlerin mesleki memnuniyetinin azaldığı belirlenmiştir. Sonuçlar, birincil sağlık bakım hizmetlerinin güçlendirilmesi ve hekimlerin gelecekte benzer kriz durumlarında desteklenmesi gerektiğini göstermektedir.

Keywords

• Covid 19
• birinci basamak sağlık hizmetleri
• aile hekimi
• pandemi
• hasta-hekim ilişkisi

Supporting Institution

This research has not received any funding from any funding organization or sector.

Ethical Statement

The scientific study titled 'Reflection of the COVID-19 Pandemic on PHCs and FPs, Physician-Patient Relationship in Turkey' has been unanimously approved as compliant with ethical principles and human rights in both scope and application. This approval was granted by the Social and Human Sciences Ethics Committee of Süleyman Demirel University, Turkey, under decision number E-87432956-050.99-452238, dated February 21, 2023. After each participant received detailed information about the study's purpose, procedures, risks, and their rights, they voluntarily agreed to participate and provided official consent. Signed "Informed voluntary consent" documents were obtained from the physicians participating in the study.

A Qualitative Research on the Reflection of the Covid-19 Pandemic on Primary Healthcare Services and Family Physicians: The Physician-Patient Relationship in Turkey

Abstract

Background and Aim: This research investigates the reflection of the COVID-19 pandemic on primary healthcare services and family physicians. This study analyzes the challenges faced by family physicians. This research seeks to contribute to the literature on the physician-patient relationship and provide insights for future pandemic preparedness. Material and Method: A qualitative research design was employed to explore physicians’ perspectives on the physician-patient relationship during the COVID-19 outbreak. The study was conducted through interviews with primary healthcare centers (PHCs) and family physicians (FPs) in Antalya, Turkey, between March 10, 2023, and April 11, 2023. The sample consisted of 21 physicians working in primary healthcare centers in Antalya, selected using criterion and snowball sampling methods. Results: These themes were identified as ‘Physician-Patient Interaction,’ ‘Sample Collection and Medication’, and ‘Patient Satisfaction.’ Conclusion: This study reveals the reflections of the COVID-19 pandemic on primary health care and family physicians. The findings show that physician-patient communication has weakened during the pandemic, patient satisfaction has varied, and physicians have faced ethical concerns. In addition, it has been determined that physicians' professional satisfaction has decreased due to increased workload and psychological pressure. The results show that primary health care services should be strengthened and physicians should be supported in similar crisises in the future

Keywords

• Covid-19
• Family Physician
• Pandemic
• Primary healthcare services

References

1. 1. Naidoo, K., Schaefer, R., Jenkins, L. S., & Von Pressentin, K. B. The evolving role of family physicians during the coronavirus disease 2019 crisis: An appreciative reflection. African Journal of Primary Health Care and Family Medicine, (2020); 12(1), 1-4.
2. 2. Rawaf, S., Allen, LN, Stigler, FL, Kringos, D., Quezada Yamamoto, H., & van Weel, C. Lessons on the COVID-19 pandemic for and by primary care professionals worldwide. European Journal of General Practice, (2020); 26 (1), 129–133.
3. 3. Doğan E, Karavuş M, Hıdıroğlu S A. Qualitative Research to Evaluate the Problems Encountered by Primary Care Physicians Regarding Patients. The Journal of Turkish Family Physician. (2017); 8(1), 2-10.
4. 4. WONCA Europe. The European Definition of General Practice/Family Medicine, Barcelona. (2002); 1-11.
5. 5. Vaughan C, Lukewich J, Mathews M, Marshall E G., Hedden L, Spencer S, ... & Brown J B. Family physicians’ perspectives on the impact of COVID-19 on preventative care in primary care: findings from a qualitative study. Family practice. (2024): 41(4), 518-524.
6. 6. Awadallah, N S., Czaja, A. S, Fainstad, T, McNulty, M C., Jaiswal, K R., Jones, T S, Rumack, C M. The impact of the COVID-19 pandemic on family medicine residency training. Family Practice, (2021); 38(Supplement_1), i9-i15.
7. 7. Zhou Y, Ma Y, Yang WF, Wu X. Doctor-Patient Relationship During the COVID-19 Pandemic. BMC Family Practice. (2021); 22(1): 255.
8. 8. Tabche C, Raheem M, Alolaqi A, Rawaf S et al. Effect of Electronic Health Records on Doctor-Patient Relationship in Arabian Gulf Countries. A Systematic Review. Frontiers in Digital Health. (2023); 5: 1252227.

9. 9. Nwoga H O, Ajuba M O, Ezeoke U E. Effect of COVID-19 on doctor-patient relationship. International Journal of Community Medicine and Public Health. (2020); 7(12), 4690–4696.
10. 10. Vilovic, T., Bozic, J., Vilovic, M., Rusic, D., Zuzic Furlan, S., Rada, M., & Tomicic, M. Family physicians’ standpoint and mental health assessment in the light of COVID-19 pandemic—a nationwide survey study. International journal of environmental research and public health, (2021); 18(4), 2093.
11. 11. Önal S, Gülsüm K., Telemedicine in Remote Patient Monitoring Applications During the Pandemic and Its Place in Primary Care. Clinical Medicine Family Medicine (2020); 12(3): 98-106.
12. 12. Atak M, Şahin Ç E, Sezerol M A. Primary Health Care Services in Türkiye During the COVID-19 Pandemic. Önal AE. Public Health and COVID-19. (2020); 1, 129-134.
13. 13. Ozden M, Saban A. Qualitative Study Paradigm and Theoretical Foundations. Ankara: Anı Publishing; (2019); 245.
14. 14. Gürbüz S, Şahin F. Research methods in social sciences: Philosophy method analysis. Ankara: Seçkin Publishing; (2017); 426.
15. 15. Yıldırım A, Şimşek H. Qualitative Research Methods in Social Sciences. Ankara: Seçkin Publishing House; (2008); 10(1), 366.
16. 16. Yıldırım A, Şimşek H. Qualitative Research Methods in Social Sciences. Ankara: Seçkin Publishing House; (2013); 406.
17. 17. Braun V, Clarke V. Using Thematic Analysis in Psychology. Qualitative Research in Psychology. (2006); 3(2), 77–101.
18. 18. Merriam S B. Qualitative research. A guide to design and implementation: Revised and expanded from qualitative research and case study applications in education: The Jossey-Bass Higher and Adult Education Series; (2009); 322.
19. 19. Patton M Q. Qualitative Research and Evaluation Methods (B. Bütün & S. B. Demir, Trans.). Ankara: Pegem Academy; (2014); 806.
20. 20. Karataş G G, Eke E. The İmpact of the COVID-19 Pandemic on Primary Health Care and Family Physicians. SDU Journal of Health Management. (2024); 6(1), 28-55.
21. 21. Khalil-Khan, A., & Khan, M. A. The impact of COVID-19 on primary care: a scoping review. Cureus, (2023); 15(1).
22. 22. Mathews M, Idrees S, Ryan D, et al. System-Based Interventions to Address Physician Burnout: A Qualitative Study of Canadian Family Physicians' Experiences During the COVID-19 Pandemic. Int J Health Policy Manag. (2024); 13:8166.
23. 23. Andreadis K, Muellers K, Ancker JS, Horowitz C, Kaushal R, Lin JJ. Telemedicine Impact on the Patient-Provider Relationship in Primary Care during the COVID-19 Pandemic. Med Care. (2023);61(Suppl 1): S83-S88.
24. 24. Jeong Y, Crowell T, Devon-Sand A, Sakata T, Sattler A, Shah S, Tsai T, Lin S Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19 J Med Internet Res (2024);26: e47667
25. 25. Alkhamees AA, Aljohani MS, Kalani S, Ali AM, Almatham F, Alwabili A, Alsughier NA, Rutledge T. Physician’s Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2023; 20(5):4598.
26. 26. Hoff T, Trovato K, Kitsakos A. Burnout Among Family Physicians in the United States: A Review of the Literature. Qual Manag Health Care. (2024);33(1):1-11.
27. 27. Stummer FO, Voggenberger L, Gomez Pellin Md, et al. Insights into the use of telemedicine in primary care in times of the SARS-CoV-2 pandemic—a cross-sectional analysis based on the international PRICOV-19 study in Austria. BMC Prim Care. (2023);24(Suppl 1):218.
28. 28. Melnikow J, Xing G, Miller ME, et al. Workplace support for physicians during the COVID-19 pandemic: Did it affect burnout? BMC Health Serv Res. (2024); 24:888.
29. 29. Hartavi S, Çelikay Söyler H. Examination of psychological distress, burnout, and hygiene behaviors among primary healthcare workers during the COVID-19 pandemic. J Soc Humanit Adm Sci. (2022);5(11):1603–1617.
30. 30. Yazicioglu B, Oruc MA, Ozdemir S. Evaluation of family physicians' anxiety during the COVID-19 process: provincial example from Turkey. BMC Psychol. (2022) Dec 17;10(1):313.
31. 31. Ayaslıer AA, Albayrak B, Çelik E, Yıldız A, Ertuğrul B, Karaman M. Burnout in primary healthcare physicians and nurses in Turkey during COVID-19 pandemic. Prim Health Care Res Dev. (2023);24: e4.
32. 32. Polat Yuluğ D, Öztürk B, Baydar Toprak O, Kocaoğlu G, Satar M, Öztürk M, et al. Physicians’ irrational attitudes on the antibiotic prescribing for the treatment of COVID-19 in Turkey: A multicenter survey. BMC Health Serv Res. (2024); 24:650.
33. 33. Sarkar MK, Dey S, Kumar R, Varshney S, Gupta P, Das Munshi B, Lnu R, Kumar A, Kumar V. Patients' satisfaction on telemedicine service in relation to COVID-19 and non-COVID-19 problems: a cross-sectional comparative study. Cureus. (2022) Nov 21;14(11): e31720.
34. 34. Choong KA. Digital-first primary care: An ambivalent legacy of Covid-19? Med Leg J. (2024); Dec;92(4):201–205.