REÇETE EDİLEN ANTİBİYOTİK VE İLAÇ KULLANIMININ SOSYOEKONOMİK BELİRLEYİCİLERİ VE AİLE HEKİMLİĞİ İLE İLİŞKİSİ

Year 2020, Issue: Özel Sayı-Special Issue - İşletme Kamu ve Ekonomi 2020 Özel Sayısı, 987 - 1003, 25.12.2020

Abdullah Tirgil

https://doi.org/10.30798/makuiibf.800396

Abstract

Yanlış ve aşırı antibiyotik tüketiminin bireylerin sağlığı üzerinde doğrudan etkileri olduğu gibi, ülkelerin sınırlı sağlık hizmeti bütçelerini etkileyen dolaylı sonuçları da vardır. Gelişmekte olan ülkeler için ilaç ve antibiyotik tüketiminin belirleyicileri hakkında çok az kanıt bulunmaktadır. Aile hekimliği ile hekimlerin reçete ettiği antibiyotik tüketimi arasındaki ilişkiyi yıllar içinde incelemekteyiz. Ulusal temsiliyeti olan Türkiye Sağlık Araştırmalarını 2008-2012 yıllarını kapsayacak şekilde çalışmamızda kullanmaktayız. Reçete edilen antibiyotik ve ilaç kullanımını belirleyen faktörleri anlamak için En Küçük Kareler yöntemini uygulayarak çok değişkenli bir regresyon analizi kullanmaktayız. Bulgular, antibiyotik kullanım eğiliminin 2010'da düştüğünü ve 2008'e kıyasla 2012'de de düşmeye devam ettiğini göstermektedir. Ayrıca aile hekimi ziyaretinin, Sağlıkta Dönüşüm Programının amacı ile tutarsız olacak şekilde, antibiyotik kullanım olasılığını artırdığını gözlemlemekteyiz. Ancak, aile hekimi ziyareti ile antibiyotik kullanımı arasındaki pozitif ilişki yıllar geçtikçe zayıflamaktadır. Türkiye çeşitli önlemler almış ve antibakteriyel direnci bir dereceye kadar azaltmayı başarmış olsa da, antibiyotikler halen daha tedavi edici yöntemler arasında en çok başvurulan ilaç türü olarak karşımıza çıkmaktadır.

Keywords

Reçete edilmiş antibiyotik kullanımı, reçete edilmiş ilaç kullanımı, aile hekimliği, sosyoekonomik belirleyenler

SOCIOECONOMIC DETERMINANTS OF PRESCRIPTION ANTIBIOTIC AND MEDICINE USE AND ITS RELATIONSHIP WITH FAMILY MEDICINE

Abstract

Improper use and over-consumption of antibiotics have direct implications on the health of individuals as well as indirect consequences impacting limited health care budgets of countries. There is scarce evidence on the determinants of medicine and antibiotic consumption for developing nations. We examine the relationship between family medicine and physician-prescribed antibiotic consumption over the years. We use nationally representative Turkey's Health Surveys for the years 2008 through 2012. We employ a multivariate regression analysis by implementing the Ordinary Least Squares method to understand the factors which determine prescribed antibiotic and medicine use. Findings indicate that antibiotic utilization trend declines in 2010 and continue falling in 2012 as well compared to 2008. We also find that visiting family medicine increases the probability of antibiotic utilization, which is inconsistent with the aim of the Health Transformation Program. However, the positive relationship between the family medicine visit and antibiotic use weakened over the years. Although Turkey took several measures and succeeded to reduce antibacterial resistance to some extent, antibiotics are still the most resorted drug type among therapeutic groups.

Keywords

Prescribed antibiotics utilization, prescribed medicine utilization, family medicine, socioeconomic determinants

References

• AKDAĞ, R. (2011), Turkey health transformation program assessment report (2003-2011). Retrieved October.10:2014.
• ALTUNSOY, A., AYPAK, C., AZAP, A., ERGÖNÜL, Ö., & BALIK, İ. (2011) The impact of a nationwide antibiotic restriction program on antibiotic usage and resistance against nosocomial pathogens in Turkey. International journal of medical sciences, 8(4), 339. doi.org/10.7150/ijms.8.339
• ATUN, R., AYDIN, S., CHAKRABORTY, S., SÜMER, S., ARAN, M., GÜROL, I., NAZLIOĞLU, S., OZGÜLCÜ, S., AYDOĞAN, U., AYAR, B., DİLMEN, U., & AKDAĞ, R. (2013). Universal health coverage in Turkey: enhancement of equity. Lancet (London, England), 382(9886), 65–99. doi.org/10.1016/S0140-6736(13)61051-X
• AYDIN, B., ve GELAL, A. (2012). Akılcı İlaç Kullanımı: Yaygınlaştırılması ve Tıp Eğitiminin Rolü. DEÜ Tıp Fakültesi Dergisi, 26 (1): 57-63. COVVEY, J. R., JOHNSON, B. F., ELLIOTT, V., MALCOLM, W., & MULLEN, A. B. (2014). An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. The Journal of antimicrobial chemotherapy, 69(3), 835–841. https://doi.org/10.1093/jac/dkt439
• DEVRİM, İ., GÜLFİDAN, G., ORUÇ, Y., YAŞAR, N., SORGUÇ, Y., AYHAN, F.Y., BAYRAM, N., & ÜNAL, N. (2009) Point-Prevalence Study Relating to Antibiotic Usage in Dr. Behçet Uz Children Hospital; Comparison of 2008 and 2012 Data. Journal of Pediatric Infection/Cocuk Enfeksiyon Dergisi. 3(1). doi:10.5152/ced.2012.11
• ERTUĞRUL, M.B., ÖZGÜN, H., SAYLAK, M.Ö., & SAYIM, N. (2009) Antibiotic Use and Its Cost in Surgical Clinics of a University Hospital: A One-Day Point Prevalence Survey. Klimik Dergisi. 22(2):44-7. doi.org/10.24938/kutfd.490693
• FILIPPINI, M., MASIERO, G., & MOSCHETTI, K. (2006). Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health policy (Amsterdam, Netherlands), 78(1), 77–92. doi.org/10.1016/j.healthpol.2005.09.009
• IEIS. Turkish Pharmaceutical Market, 2018. Accessed on 1st May, 2020 http://ieis.org.tr/ieis/assets/front/sektorraporu2018/Turkish_Pharmaceutical_Market_2018.pdf
• ILHAN, M. N., DURUKAN, E., ILHAN, S. O., AKSAKAL, F. N., OZKAN, S., & BUMIN, M. A. (2009). Self-medication with antibiotics: questionnaire survey among primary care center attendants. Pharmacoepidemiology and drug safety, 18(12), 1150–1157. doi.org/10.1002/pds.1829
• KARABAY, O., & HOSOGLU, S. (2008). Increased antimicrobial consumption following reimbursement reform in Turkey. The Journal of antimicrobial chemotherapy, 61(5), 1169–1171. doi.org/10.1093/jac/dkn055
• KARABAY, O., ÖZDEMİR, D., GÜÇLÜ, E., YILDIRIM, M., İNCE, N., KÜÇÜKBAYRAK, A., ÇAKIR, S., GÜLENÇ, M., İNCE, M., & DEMİRLİ, K. (2011). Attitudes and behaviors of Family Physicians regarding use of antibiotics. Journal of Microbiology and Infectious Diseases.1(02),53-57. DOI: 10.5799/ahinjs.02.2011.02.0013
• MARRA, F., MAK, S., CHONG, M., & PATRICK, D. M. (2010). The relationship among antibiotic consumption, socioeconomic factors and climatic conditions. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale, 21(3), e99–e106. doi.org/10.1155/2010/965268
• McGOWAN, J. E. (2001). Economic Impact of Antimicrobial Resistance. Emerging Infectious Diseases, 7(2), 286-292. doi.org/10.3201/eid0702.700286.
• MOLLAHALİLOĞLU, S., ALKAN, A., DÖNERTAŞ, B., OZGULCU, S., & AKICI, A. (2013). Assessment of antibiotic prescribing at different hospitals and primary health care facilities. Saudi pharmaceutical journal: SPJ: the official publication of the Saudi Pharmaceutical Society, 21(3), 281–291. doi.org/10.1016/j.jsps.2012.10.004
• ÖZKURT, Z., EROL, S., KANADALI, A., ERTEK, M., ÖZDEN, K., & TAŞYARAN, M.A. (2005). Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists. Japanese journal of infectious diseases.58(6):338.
• ÖZTÜRK, S., BAŞAR, D., ÖZEN, İ. C., & ÇİFTÇİ, A. Ö. (2019). Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey. Daru: journal of Faculty of Pharmacy, Tehran University of Medical Sciences, 27(2), 735–742. doi.org/10.1007/s40199-019-00311-1
• PARLAK, E., ÇAYIR, Y., & ERTÜRK, A. (2013). Rational Antibiotic Use Among Family Physicians: A Cross-Sectional Study from Erzurum. Euras J Fam Med.2(1):27-32.
• SABA, R., İNAN, D., TURHAN, Ö., YALÇIN, A.N., GÜLSEREN, F., & MAMİKOĞLU, L. (2011) Surveillance of antimicrobial use in a Turkish university hospital. Turkish Journal of Medical Sciences. 41(4):701-10. DOI: 10.3906/sag-1005-812
• SAĞIR, M. & PARLAKPINAR, H. (2014). Rational Use of Medicaments. İnönü Üniversitesi Sağlık Bilimleri Dergisi. 3(2):32-5.
• STOKES, J., GUROL-URGANCI, I., HONE, T., & ATUN, R. (2015). Effect of health system reforms in Turkey on user satisfaction. Journal of global health, 5(2), 020403. doi.org/10.7189/jogh.05.020403
• TEPAV. (2017) Türkiye'de Antibiyotik Direnç: Ekonomik Değerlendirme ve Öneriler. Accessed on 1st May, 2020, https://www.tepav.org.tr/upload/files/1504774735-1.Turkiye___de_Antimikrobiyal_Direnc___Ekonomik_Degerlendirme_ve_Oneriler.pdf
• TERNHAG, A., GRÜNEWALD, M., NAUCLER, P., & WISELL, K. T. (2014). Antibiotic consumption in relation to socio-demographic factors, co-morbidity, and accessibility of primary health care. Scandinavian journal of infectious diseases, 46(12), 888–896. doi.org/10.3109/00365548.2014.954264
• TİRGİL, A., GUROL-URGANCI, I. & ATUN, R. (2018). Early experience of universal health coverage in Turkey on access to health services for the poor: regression kink design analysis. Journal of global health, 8(2), 020412. doi.org/10.7189/jogh.08.020412
• WORLD HEALTH ORGANIZATION. (2015), Global action plan on antimicrobial resistance. accessed on 1st May, 2020, https://apps.who.int/iris/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1
• YILMAZ, G., BULUT, C., YILDIZ, F. (2009). Examining Antibiotic Use at an Education and Research Hospital in Turkey: Point Prevalence Results. Turkish Journal of Medical Sciences, 39(1), 125-131.