Defansif tıp uygulamalarının belirlenmesi: Karma yöntem araştırması
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Tarih
2020
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info:eu-repo/semantics/openAccess
Özet
Dünyada değişen ekonomi politikaları çerçevesinde sağlık politikaları ve sistemleri de zaman içerisinde değişmektedir. Geçtiğimiz 15-20 yıla baktığımızda ülkemizde sağlık alanında kapsamlı değişimler yaşandığı görülmektedir. Sağlık hizmetlerinin hasta merkezli ve kanıta dayalı tıp modelleriyle verilmeye başlanması, hasta-hekim ilişkisini alışılmışın dışına taşımıştır. Siyasi söylemler, hasta haklarındaki gelişmeler, Türk Ceza Kanunundaki değişiklikler, zorunlu mesleki hekimlik sigortasının hayata geçirilmesi ve basının olumsuz tutumu malpraktis davalarının sayılarını artırarak, tazminat tutarlarında hekim gelirleriyle orantısız artışlar oluşturmuştur. Bu ortamda hekimlerin kendilerini koruma güdüsü ile defansif tıp uygulamalarına yöneldiği görülmektedir. Araştırmada defansif tıp uygulamalarının derinlemesine araştırılması amaçlanmıştır. Çalışma, kesitsel, tanımlayıcı, nicel ve nitel yaklaşımların bir arada kullanıldığı karma yöntemle yürütülmüştür. Veriler araştırmacı tarafından literatür doğrultusunda oluşturulan anket ve derinlemesine görüşme formları ile toplanmıştır. Haziran 2018- Ocak 2019 tarihlerinde aşamalı olarak yürütülen çalışmada 253 hekimle anket, 30 hekimle derinlemesine görüşme yapılmış ve derinlemesine görüşmelerde 596 hasta dosyası defansif uygulamalar kapsamında doküman incelemesine tabi tutulmuştur. Verilerin analizinde SPSS 13.00, Rqda ve Excel programları kullanılmıştır. Araştırmanın nicel bölümünde hekimlerin defansif tıp uygulamalarına yönelik tutumlarının yüksek olduğu görülmektedir. Seçilen iki parametrede laboratuvar istemlerinde tutum puanının %40,3 uygulama oranının %10,6; görüntülemede ise tutum puanının %37,9 uygulama oranının %14,20 olduğu tespit edilmiştir. Hekimlerin defansif tıp uygulamaların yönelik tutumlarının çok yüksek olduğu ancak yüksek tutumun uygulamalara henüz düşük oranda yansıdığı sonucuna varılmıştır. Derinlemesine görüşmelerde poliklinik önündeki yığılma, kargaşa ve hasta yoğunluğunun hekimleri defansif tıp uygulamalarına yönelttiği belirlenmiştir. Ayrıca defansif tıp uygulamaların hekimlik mesleğinin rutininde yeni tedavi protokolü olarak yer aldığı sıklıkla ifade edilmiştir
When economic policies change in the world, health policies and health systems systems also change. When we look at the past 15-20 years, it is seen that there are extensive changes in the field of health in our country. The introduction of health services with patient-centered and evidence-based medicine models has taken the patient-physician relationship beyond the ordinary. Political discourses, developments in patient rights, changes in the Turkish Criminal Law, the implementation of compulsory occupational health insurance and the negative attitude of the press have increased the number of cases of malpractice, making disproportionate increases in compensation amounts with physician income. In this environment, it is seen that physicians tend to defensive medicine practices with the motivation to protect themselves. In the research, it was aimed to investigate defensive medicine applications in depth. The study was designed as a mix that used cross-sectional, descriptive, quantitative and qualitative approaches together. The data were collected through questionnaires and in-depth interview forms created by the researcher in line with the literature. In the study carried out gradually between June 2018 and January 2019, a survey was conducted with 253 physicians, and in-depth interviews with 30 physicians, and 596 patient files were subjected to document analysis within the scope of defensive applications. SPSS 13,00, Rqda and Excel programs were used to analyze the data. In the quantitative part of the study, it is seen that physicians have high attitudes towards defensive medicine practices. In the two parameters selected, it was determined that the attitude score in laboratory requests was 40.3%, the application rate was 10.6%, and in imaging, the attitude score was 37.9%, and the application rate was 14.20%. It was concluded that physicians' attitudes towards defensive medicine practices were very high, but high attitudes were reflected in practice at a low rate, yet. In in-depth interviews, the accumulation in front of the outpatient clinic, turmoil and patient density has led physicians to defensive medicine practices. It has also been frequently stated that defensive medicine practices are included in the routine of the medical profession as a new treatment protocol.
When economic policies change in the world, health policies and health systems systems also change. When we look at the past 15-20 years, it is seen that there are extensive changes in the field of health in our country. The introduction of health services with patient-centered and evidence-based medicine models has taken the patient-physician relationship beyond the ordinary. Political discourses, developments in patient rights, changes in the Turkish Criminal Law, the implementation of compulsory occupational health insurance and the negative attitude of the press have increased the number of cases of malpractice, making disproportionate increases in compensation amounts with physician income. In this environment, it is seen that physicians tend to defensive medicine practices with the motivation to protect themselves. In the research, it was aimed to investigate defensive medicine applications in depth. The study was designed as a mix that used cross-sectional, descriptive, quantitative and qualitative approaches together. The data were collected through questionnaires and in-depth interview forms created by the researcher in line with the literature. In the study carried out gradually between June 2018 and January 2019, a survey was conducted with 253 physicians, and in-depth interviews with 30 physicians, and 596 patient files were subjected to document analysis within the scope of defensive applications. SPSS 13,00, Rqda and Excel programs were used to analyze the data. In the quantitative part of the study, it is seen that physicians have high attitudes towards defensive medicine practices. In the two parameters selected, it was determined that the attitude score in laboratory requests was 40.3%, the application rate was 10.6%, and in imaging, the attitude score was 37.9%, and the application rate was 14.20%. It was concluded that physicians' attitudes towards defensive medicine practices were very high, but high attitudes were reflected in practice at a low rate, yet. In in-depth interviews, the accumulation in front of the outpatient clinic, turmoil and patient density has led physicians to defensive medicine practices. It has also been frequently stated that defensive medicine practices are included in the routine of the medical profession as a new treatment protocol.
Açıklama
Anahtar Kelimeler
Defansif Tıp, Malpraktis, Laboratuvar, Görüntüleme, Tetkik, Defensive Medicine, Malpractice, Laboratory, Imaging, Examination
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
23
Sayı
4
Künye
Özer, K. & Aslan, A. (2020). Defansif tıp uygulamalarının belirlenmesi: karma yöntem araştırması. Hacettepe Sağlık İdaresi
Dergisi, 23(4), 639-664.
