Factors Affecting Working Hours and Out-of-Hours Preferences in Hospital and Primary Health Care Utilization

Öz

Objective: This study aimed to investigate why individuals in Turkey continue to choose hospitals as their first point of contact despite the strengthening of primary healthcare services, and to identify the factors influencing hospital utilization during and outside working hours. Methods: Designed as a descriptive, cross-sectional, and analytical study, the research was conducted between June 1 and October 15, 2023, at District State Hospital. The study included individuals aged 18 years and older who presented to the emergency department or internal medicine outpatient clinic during or outside working hours. Using convenience sampling, 373 participants completed a structured questionnaire. Data were analyzed with chi-square tests and logistic regression using Jamovi software. Results: Overall, 66.8% of participants sought care during working hours, the majority visiting the internal medicine clinic. Emergency department use was observed at similar rates both during and outside working hours. Women represented a higher proportion of overall hospital visits, while employed individuals, those who were single, and those from larger households were more likely to prefer the emergency department. Participants with chronic diseases predominantly visited internal medicine clinics, whereas those without chronic conditions were more frequent emergency department users. Regular primary care attendance was associated with reduced emergency department utilization. Participants stated that they would prefer family health centers if these offered extended working hours, rapid diagnostic testing, and access to specialists. Conclusion: The findings highlight that hospital utilization is shaped by multifaceted sociodemographic, structural, and health literacy factors. Enhancing primary care capacity, strengthening after-hours access, and improving health literacy are critical for reducing the burden on Emergency Departments.

Anahtar Kelimeler

• primary healthcare
• emergency department use
• health literacy
• hospital utilization

Destekleyen Kurum

none

Etik Beyan

No criminal elements or unlawful statements were included in the article, and research and publication ethics were adhered to throughout the study. The research was conducted upon approval from the Clinical Research Ethics Committee of Health Sciences University Antalya Training and Research Hospital (Ethics Committee Approval Date: 25.05.2023, Approval Decision No: 7/23). The purpose of the study was explained to all participants, voluntary participation was ensured, and verbal informed consent was obtained. The data collected were evaluated anonymously, and confidentiality principles were strictly observed.

Teşekkür

We would like to thank the Antalya Provincial Health Directorate and Korkuteli State Hospital for facilitating this study.

HASTANE VE BİRİNCİ BASAMAK SAĞLIK HİZMETİ BAŞVURULARINDA MESAİ İÇİ/DIŞI TERCİHLERİ ETKİLEYEN FAKTÖRLER

Öz

Amaç: Bu çalışma, birinci basamak yerine hastane tercihini ve mesai içi/dışı başvuru davranışlarını etkileyen faktörleri incelemeyi amaçlamıştır. Yöntem: Kesitsel çalışma İlçe Devlet Hastanesi'nde 373 erişkin katılımcıyla yürütülmüştür. Veriler yapılandırılmış anketle toplanmış, ki-kare ve lojistik regresyon analiziyle değerlendirilmiştir. Bulgular: Katılımcıların %66,8'i mesai saatlerinde hastaneyi tercih etmiş; çoğu (%74,3) Dahiliye Polikliniğine başvurmuştur. Kayıtlı Aile Hekimi olmayanların Dahiliye Polikliniğine başvurma olasılığı 120 kat daha yüksek bulunmuştur (p=0.003). Kırsalda yaşayanların Dahiliye tercih olasılığı 12.56 kat artmıştır (p=0.011). Kronik hastalığı olanlar Dahiliye Polikliniğini, olmayanlar Acil Servisi daha sık kullanmıştır. Düzenli Aile Hekimi takibi olan bireylerde Acil Servis kullanımı belirgin düşüktür. Mesai dışı Acil Servis başvurularında sağlık okuryazarlığı belirleyicidir; hastanede bölüm bulabilenlerin mesai dışı başvuru olasılığı 50 kat artmaktadır (p=0.001). ASM'nin gece/hafta sonu açık olmasını ve uzman doktor bulunmasını isteyenlerin mesai dışı başvuru olasılıkları sırasıyla 14.6 ve 23.8 kat daha yüksektir (p<0.001). Katılımcılar, ASM'de tüm tetkiklerin yapılması, uzman doktor bulunması ve mesai dışı hizmet sunulması halinde birinci basamağı tercih edebileceklerini belirtmiştir. Sonuç: Bulgular, bireylerin hastane başvurularının çok boyutlu sosyodemografik, yapısal ve sağlık okuryazarlığı faktörleriyle ilişkili olduğunu göstermektedir. Birinci basamak kapasitesinin artırılması, mesai dışı erişimin genişletilmesi ve sağlık okuryazarlığının geliştirilmesi, Acil Servis yükünü azaltmada kritiktir.

Anahtar Kelimeler

• birinci basamak sağlık hizmetleri
• Acil Servis kullanımı
• sağlık okuryazarlığı
• hastane başvuruları

Destekleyen Kurum

yoktur

Etik Beyan

Makalede hiçbir suç unsuruna veya kanuna aykırı ifadeye yer verilmemiş, araştırma yapılırken araştırma ve yayın etiğine uygun hareket edilmiştir. Araştırma, Sağlık Bilimleri Üniversitesi Antalya Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınarak yürütülmüştür (Etik Kurul Onay Tarihi: 25.05.2023, Onay Karar No: 7/23). Tüm katılımcılara çalışmanın amacı açıklanmış, gönüllülük esas alınmış ve sözlü onamları alınmıştır. Elde edilen veriler anonim olarak değerlendirilmiş ve gizlilik ilkelerine titizlikle uyulmuştur.

Teşekkür

Antalya İl Sağlık Müdürlüğü'ne ve Korkuteli Devlet Hastanesi'ne çalışmaya olanak tanıdıkları için teşekkür ederiz.

Kaynakça

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