Solunum Yolu Enfeksiyonu Belirtileri Gösteren Çocukların Gereksiz Acil Servis Başvurularını Azaltmak İçin Annelere Yönelik Yarı Deneysel Kontrollü Bir Eğitim Müdahalesi

Abstract

Amaç: Solunum yolu enfeksiyonu (SYE) semptomları ile başvuran çocuklar birinci basamakta tedavi edilebilmesine rağmen, bu semptomlar çocukların acil servise başvurmasının en yaygın nedenidir. Bu çalışmanın amacı, annelere aile hekimleri tarafından verilen eğitimin, SYE semptomları olan çocukların acil servise gereksiz başvurularını azaltma ve SYE hakkındaki bilgi, tutum ve davranışların geliştirilmesine etkisini araştırmaktır. Metod: Yarı deneysel, tek kör, kontrollü bir eğitim müdahalesi 6 ay-6 yaş arası çocukların anneleri ile yürütülmüştür. Aile Hekimliği birimleri kontrol ve müdahale grubu olarak randomize edilmiştir. Sosyodemografik özellikler, SYE semptomları nedeniyle acil servise başvurular, ateşle ilgili uygulamalar sorgulanmış ve SYE semptomları hakkında Bilgi, Tutum ve Davranış (BTD) önermelerini içeren bir anket müdahale öncesi ve sonrasında her iki gruba da uygulanmıştır. Müdahale grubuna akut SYE semptomlarının ve alarm bulgularının evde yönetimine odaklanan bire bir, yüz yüze eğitim ile bir broşür verilmiştir. Kontrol grubuna herhangi bir müdahalede bulunulmamıştır. Bulgular: Çalışma 178 anne ile tamamlanmıştır (Kontrol: 118, Müdahale: 60). Annelerin BTD puanları her iki grupta da anlamlı olarak artmıştır (Kontrol: 76.9-82.2; p<0.001; Müdahale: 76.9-83.6; p<0.001), ancak grupların delta puanları arasında anlamlı fark yoktur (p=0.193). SYE semptomları nedeniyle acil servise yapılan başvuruların ortanca sayısı her iki grup için de azalmıştır (p=0.180). Ancak, hastalık şiddeti nedeniyle acil servise başvurular Kontrol grubunda artarken Müdahale grubunda azalmıştır. Sonuç: Bu çalışma, çocuklarda SYE semptomları ile gereksiz acil servis başvurularını azaltmak için Türkiye'de Birinci Basamakta yürütülen eğitim müdahalelerinin ilkidir. Bununla birlikte, popülasyon özellikleri, müdahale özellikler, bulaşma yanlılığı veya Hawthorne etkisi beklenen etkiyi azaltmış olabilir.

Keywords

• aile hekimliği
• belirti ve bulgular
• çocuk acil servisi
• gereksiz
• solunum yolu enfeksiyonları

A Quasi-Experimental Controlled Educational Intervention for Mothers To Reduce Unnecessary Emergency Department Admissions in Children with Respiratory Tract Infection Symptoms

Abstract

Objective:Although children presenting with respiratory tract infection (RTI) symptoms can be managed by in primary care, these symptoms are the most common reasons for children to present to the emergency department(ED). The aim of this study is to investigate the effect of the education given to mothers by their family physician in reducing the unnecessary admissions of children with RTI symptoms to the ED. Method:A quasi-experimental, single-blinded, controlled educational intervention study was conducted with the mothers of 6 months–6 years old children. Family Medicine Units were randomized as control and intervention group. Sociodemographic features, admissions to ED, fever-related practices were questioned and a questionnaire including propositions on Knowledge, Attitude and Behaviour (KAB) about RTI symptoms (KABaRTIS) were applied in both groups before-after the intervention. Intervention group received one-to-one, face-to-face education focusing on home management of acute RTI symptoms and alarm findings, also a booklet was given. No intervention was made to the control group. Result:Study was completed with 178 mothers(Control:118, Intervention:60). The KABaRTIS scores of the mothers increased significantly in both groups(Control:76.9-82.2;p<0.001; Intervention:76.9-83.6;p<0.001), but the delta scores between groups was not significant(p=0.193). The median number of admissions to ED due to RTI symptoms decreased for both groups(p=0.180). However, ED admissions due to severity increased in Control-group and decreased in Intervention-group. Conclusion:This is the first educational intervention conducted in Primary Care in Türkiye to reduce unnecessary emergency department admissions with RTI symptoms in children. Nevertheless, population characteristics, interventional properties, contamination bias or Hawthorne effect may have reduced the expected effect.

Keywords

• family practice
• signs and symptoms
• pediatric emergency medicine
• unnecessary
• respiratory tract infections

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