Sağlık Hizmetlerine Erişim ve Kendi Kendine İlaç Kullanımı İlişkisi: Türkiye Sağlık Araştırmasından Kanıtlar

Öz

Kendi kendine ilaç kullanımı bireyler ve sağlık sistemleri açısından potansiyel faydaların yanı sıra ilaç yan etkileri, ilaç etkileşimleri, düşük veya fazla doz ilaç kullanma, sağlık hizmetinin ertelenmesi gibi birçok probleme neden olabilmektedir. Bireyler uygun maliyetle ve uygun zamanda sağlık hizmeti alamadıkları zaman kendi kendine ilaç kullanmayı tercih edebilmektedirler. Bu kapsamda bu araştırmanın amacı Türkiye’de sağlık hizmetlerine erişim ve genel özellikler ile kendi kendine ilaç kullanımı durumu ilişkisinin incelenmesidir. Araştırmada TUİK tarafından sağlanmış olan 2022 yılına ait Türkiye Sağlık Araştırması Mikro Veri Seti kullanılmıştır. Sağlık hizmeti modülünde yer alan ve sağlık hizmetlerine erişimle ilgili olan değişkenlerle beraber cinsiyet, yaş grubu, medeni durum, gelir ve eğitim düzeyi ile son iki haftada kendi kendine ilaç kullanımı değişkenleri kullanılmıştır. Veri analizinde ki-kare testinden faydalanılmıştır. Türkiye’de kendi kendine ilaç kullanım oranının %33,1 olduğu; kadınlarda, 35-44 yaş grubunda, boşanmış bireylerde, düşük ve yüksek gelir düzeyinde ve doktora eğitim düzeyinde kendi kendine ilaç kullanım oranının daha yüksek olduğu tespit edilmiştir. Bireylerin sağlık hizmetlerine erişimleri ve sigortalılık durumuna ilişkin tüm değişkenler ile kendi kendine ilaç kullanımı arasında anlamlı ilişkiler tespit edilmiştir. Kendi kendine ilaç kullanımının kontrol altına alınmasında bireysel özelliklerin gözetildiği ve sağlık çalışanlarının katıldığı halk sağlığı programlarının ve erişilebilir sağlık hizmetlerinin artırılması önerilmektedir.

Anahtar Kelimeler

• Kendi kendine ilaç kullanımı
• sağlık hizmetlerine erişim
• mikro veri seti

The Relationship Between Access to Health Services and Self-Medication: Evidence from The Türkiye Health Survey

Öz

Self-medication can cause many problems such as side effects, drug interactions, under- or overdosing, and delayed healthcare, along with potential benefits for individuals and health systems. Individuals may prefer to self-medicate when they cannot receive healthcare at an appropriate time and cost. Therefore, this study aims to examine the relationships between access to healthcare, general characteristics and self-medication status in Türkiye. The Türkiye Health Survey Micro Data Set for the year 2022 was used in the study. Gender, age, marital status, income, education level, and self-medication in the last two weeks were used along with the variables related to access to health services. The chi-square test was used in data analysis. It was found that the rate of self-medication in Turkey was 33.1%; the rate of self-medication was higher in women, 35-44 age group, divorced individuals, low and high income levels, and PhD education level. Significant relationships were found between all variables related to individuals' access to health services, insurance status and self-medication. It is recommended that public health programs in which individual characteristics are taken into consideration and health professionals participate should be conducted and accessible health services should be increased in order to control self-medication.

Anahtar Kelimeler

• Self-medication
• access to healthcare
• micro data set

Kaynakça

1. Ahmad, A., Patel, I., Mohanta, G. P., & Balkrishnan, R. (2014). Evaluation of self medication practices in rural area of town Sahaswan at Northern India. Annals of Medical and Health Sciences Research, 4(8), 73-78.
2. Alrasheed, A. A. (2017). The impact of waiting time in primary care clinics on self-medication with antibiotics: a hospital based study in Saudi Arabia. Biomed Res, 28, 3119-24.
3. Al-Worafi, Y. M. (2024). Self-Medications in Developing Countries. In: Al-Worafi, Y. M. (eds) Handbook of Medical and Health Sciences in Developing Countries. Springer, Cham. https://doi.org/10.1007/978-3-030-74786-2_265-1
4. Arrais, P. S. D., Fernandes, M. E. P., Pizzol, T. D. S. D., Ramos, L. R., Mengue, S. S., Luiza, V. L., ... & Bertoldi, A. D. (2016). Prevalence of self-medication in Brazil and associated factors. Revista de Saude Publica, 50, 13s.
5. Babayeva, A. (2022). Yetişkin bireylerin kendi kendine ilaç kullanım özellikleri, Yüksek Lisans Tezi, Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Enstitüsü, Kırşehir.
6. Balamurugan, E., & Ganesh, K. (2011). Prevalence and pattern of self medication use in coastal regions of South India. Br J Med Pract, 4(3), a428.
7. Biswas, M., Roy, M. N., Manik, M. I. N., Hossain, M. S., Tapu, S. T. A., Moniruzzaman, M., & Sultana, S. (2014). Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City. BMC Public Health, 14, 1-7.
8. Dawood, O. T., Hassali, M. A., Saleem, F., Ibrahim, I. R., Abdulameer, A. H., & Jasim, H. H. (2017). Assessment of health seeking behaviour and self-medication among general public in the state of Penang, Malaysia. Pharmacy Practice (Granada), 15(3), 991.

9. Dror, D. M., Chakraborty, A., Majumdar, A., Panda, P., & Koren, R. (2016). Impact of community-based health insurance in rural India on self-medication & financial protection of the insured. Indian Journal of Medical Research, 143(6), 809-820.
10. Ekim, A., Akın, İ., & Ocakçı, A. F. (2018). Ergenlerde kendi kendine ilaç kullanımı. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, (3), 272-276. Garofalo, L., Di Giuseppe, G., & Angelillo, I. F. (2015). Self‐Medication Practices among Parents in Italy. BioMed Research International, 2015(1), 580650.
11. Grigoryan, L., Haaijer-Ruskamp, F. M., Burgerhof, J. G., Mechtler, R., Deschepper, R., Tambic-Andrasevic, A., ... & Birkin, J. (2006). Self-medication with antimicrobial drugs in Europe. Emerging Infectious Diseases, 12(3), 452.
12. Gualano, M. R., Bert, F., Passi, S., Stillo, M., Galis, V., Manzoli, L., & Siliquini, R. (2015). Use of self-medication among adolescents: a systematic review and meta-analysis. The European Journal of Public Health, 25(3), 444-50.
13. Gupta, P., Bobhate, P. S., & Shrivastava, S. R. (2011). Determinants of self-medication practices in an urban slum community. Asian J Pharm Clin Res, 4(3), 54-7.
14. Gursul, G., Fidan, C., Oksuz, E., & Kut, A. (2021). Self‐medication patterns among Turkish university students. Konuralp Medical Journal, 13(2), 257-264.
15. Ha, T. V., Nguyen, A. M. T., & Nguyen, H. S. T. (2019). Self-medication practices among Vietnamese residents in highland provinces. Journal of Multidisciplinary Healthcare, 12, 493-502.
16. Helal, R. M., & Abou-ElWafa, H. S. (2017). Self‐Medication in University Students from the City of Mansoura, Egypt. Journal of Environmental and Public Health, 2017(1), 9145193.
17. Ilhan, M. N., Durukan, E., Ilhan, S. Ö., Aksakal, F. N., Özkan, S., & Bumin, M. A. (2009). Self‐medication with antibiotics: questionnaire survey among primary care center attendants. Pharmacoepidemiology and Drug Safety, 18(12), 1150-1157.
18. Isabel Tavares, A. (2013). Self-medication model and evidence from Portugal. International Journal of Social Economics, 40(11), 990-1009.
19. Juneja, K., Chauhan, A., Shree, T., Roy, P., Bardhan, M., Ahmad, A., ... & Anand, A. (2024). Self-medication prevalence and associated factors among adult population in Northern India: A community-based cross-sectional study. SAGE Open Medicine, 12, 20503121241240507.
20. Keshari, S. S., Kesarwani, P., & Mishra, M. (2014). Prevalence and pattern of self-medication practices in rural area of Barabanki. Indian J Clin Pract, 25(7), 636-9.
21. Khoshbakht, R., Bonab, M. S., Hajizadegan, H., Nooghabi, E. T., Ghorbani, A., Asgari, M., ... & Sadeghian, H. (2023). Comparing self-medication and medical supervised treatment before hospitalization among patients with Covid-19: A retrospective case-control study. Journal of Infection and Public Health, 16, 119-124.
22. Kırılmaz, H., & Doğanyiğit, P. B. (2021). Kendi kendine ilaç kullanımı ve Sağlık İnanç Modeli ilişkisi. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi, 12(2), 200-209.
23. Kokabisaghi, F., Emadi, M. S. M., Tajik, A., Sharifi, F., Houshmand, E., & Varmaghani, M. (2024). The prevalence and causes of self‐medication among medical university students in Iran during COVID‐19 outbreak and its implications for public health and health systems: A cross‐sectional study. Health Science Reports, 7(3), e1983.
24. Machado-Alba, J. E., Echeverri-Cataño, L. F., Londoño-Builes, M. J., Moreno-Gutiérrez, P. A., Ochoa-Orozco, S. A., & Ruiz-Villa, J. O. (2014). Social, cultural and economic factors associated with self-medication. Biomédica, 34(4), 580-588.
25. May, U., Bauer, C., Schneider-Ziebe, A., & Giulini-Limbach, C. (2023). Self-care with non-prescription medicines to improve health care access and quality of life in low-and middle-income countries: systematic review and methodological approach. Frontiers in Public Health, 11, 1220984.
26. Moonajilin, M. S., Mamun, M. A., Rahman, M. E., Mahmud, M. F., Al Mamun, A. S., Rana, M. S., & Gozal, D. (2020). Prevalence and drivers of self-medication practices among savar residents in Bangladesh: A cross-sectional study. Risk Management and Healthcare Policy, 13, 743-752.
27. Moseray, A., Fatoma, P., & Kamara, A. B. S. (2024). Assessing the Reasons and Adverse Effects of Self-Medication in the Context of the COVID-19 Pandemic in Sierra Leone. A Case Study of Moriba Town Section. Risk Management and Healthcare Policy, 17, 1-13.
28. Motavali, Z. S., Abedi, H., & Davaridolatabadi, E. (2016). Self-medication and its effective modifiable factors among elderly referred health care centers in Shahr-e-Kord in 2015. Electronic Physician, 8(11), 3205-13.
29. Nayir, T., Okyay, R. A., Yesilyurt, H., Akbaba, M., Nazhcan, E., Acik, Y., & Akkus, H. I. (2016). Assessment of rational use of drugs and self-medication in Turkey: A pilot study from Elazig and its suburbs. Pakistan Journal of Pharmaceutical Sciences, 29 (supp. 4), 1429-35.
30. Nguyen, C. T., Nguyen, H. T., Boyer, L., Auquier, P., Fond, G., Do, K. N., ... & Ho, C. S. (2023). Prevalence and impacts of self-medication in a disadvantaged setting: the importance of multi-dimensional health interventions. Frontiers in Public Health, 11, 1176730.
31. Ocan, M., Obuku, E. A., Bwanga, F., Akena, D., Richard, S., Ogwal-Okeng, J., & Obua, C. (2015). Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health, 15, 1-11.
32. Okyay, R. A., & Erdoğan, A. (2017). Self-medication practices and rational drug use habits among university students: a cross-sectional study from Kahramanmaraş, Turkey. PeerJ, 5, e3990.
33. Öztora, S., Nepesova, G., Çaylan, A., & Dağdeviren, H. N. (2017). The practice of self-medication in an urban population. Biomedical Research-India, 28(14), 6160-6164.
34. Öztürk, S., Başar, D., Özen, İ. C., & Çiftçi, A. Ö. (2019). Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey. DARU Journal of Pharmaceutical Sciences, 27(2), 735-742.
35. Pagan, J. A., Ross, S., Yau, J., & Polsky, D. (2006). Self-medication and health insurance coverage in Mexico. Health Policy, 75(2), 170-177.
36. Rathod, P., Sharma, S., Ukey, U., Sonpimpale, B., Ughade, S., Narlawar, U., ... & Pandey, S. (2023). Prevalence, pattern, and reasons for self-medication: a community-based cross-sectional study from central India. Cureus, 15(1), e33917.
37. Roy, N., Islam, M. N., Shahjalal, M., Siddiky, A., Imran, S. M., Aktarujjaman, M., ... & Hossain, E. (2024). Self-medication practices among adult population in Bangladesh: A cross-sectional study. Epidemiologia, 5(2), 146-159.
38. Shaamekhi, H. R., Jafarabadi, M. A., & Alizadeh, M. (2019). Demographic determinants of self-medication in the population covered by health centers in Tabriz. Health Promotion Perspectives, 9(3), 181.
39. Shafie, M., Eyasu, M., Muzeyin, K., Worku, Y., & Martín-Aragón, S. (2018). Prevalence and determinants of self-medication practice among selected households in Addis Ababa community. PloS One, 13(3), e0194122.
40. Shah, S. J., Ahmad, H., Rehan, R. B., Najeeb, S., Mumtaz, M., Jilani, M. H., ... & Kadir, M. M. (2014). Self-medication with antibiotics among non-medical university students of Karachi: a cross-sectional study. BMC Pharmacology and Toxicology, 15, 1-7.
41. Shalini, A., & Logaraj, M. (2021). Prevalence and determinants of self-medication use among the adult population residing in a sub urban areas near Chennai, Tamil Nadu. Journal of Family Medicine and Primary Care, 10(5), 1835-1838.
42. Shrivastava, B., Bajracharya, O., & Shakya, R. (2022). Prioritizing intervention measures to prevent inappropriate self-medication practices using the Analytical Hierarchy Process. Exploratory Research in Clinical and Social Pharmacy, 5, 100117.
43. Tohan, M. M., Ahmed, F., Juie, I. J., Kabir, A., Howlader, M. H., & Rahman, M. A. (2024). Knowledge attitude and convenience on self-medication practices among university students in Bangladesh exploration using structural equation modeling approach. Scientific Reports, 14(1), 10837.
44. TUİK (2023). Türkiye sağlık araştırması mikro veri seti, Yayın no: 4702.
45. World Health Organization. (2000). Guidelines for the Regulatory Assessment of Medicinal Products for Use in Self-Medication. World Health Organization. https://iris.who.int/handle/10665/66154
46. Yousef, A. M. M., Al-Bakri, A. G., Bustanji, Y., & Wazaify, M. (2008). Self-medication patterns in Amman, Jordan. Pharmacy World & Science, 30, 24-30.
47. Yuefeng, L., Keqin, R., & Xiaowei, R. (2012). Use of and factors associated with self-treatment in China. BMC Public Health, 12, 1-9.
48. Zaidi, S. F., Hakami, A. Y., Khan, M. A., Khalid, A. A., Haneef, A. K., Natto, S. S., ... & Alghamdi, R. F. (2023). The awareness and practice of self-medication among the general public in Jeddah and Makkah. Cureus, 15(5), e39706.