Defansif tıp uygulamalarına ilişkin maliyetin belirlenmesi: Retrospektif araştırma
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Türkiye Klinikleri Yayınevi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Hekimler, tıbbi uygulamalarında gelecekte yasaların karşısına çıkma riskini azaltmak ya da önlemek için rutin tıbbi işlemlerden saparak savunmaya dayalı tıp uygulamalarına yönelmektedir. Uygulamalar literatürde defansif tıp olarak adlandırılmaktadır. Çalışmada bu kapsamdaki uygulamaların ekonomik boyutu ele alınmıştır. Defansif tıp uygulamalarından kaynaklanan maliyetin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Retrospektif, kesitsel ve keşfedici tasarımla gerçekleştirilen çalışmada nitel yöntemlerden derinlemesine görüşme ve doküman incelemesi yöntemleri kullanılmıştır. Veriler Aralık 2018-Ocak 2019 tarihleri arasında üniversite hastanesi polikliniklerinde toplanmıştır. Acil servis ve konsültasyon poliklinikleri kapsam dışında bırakılmıştır. Başlangıçta malpraktis davaları, meslektaşların defansif tıp uygulamaları yönündeki görüşler, defansif tıp nedeniyle oluşan maliyet, maliyetin belirlenmesi yönünde görüşmeler yapılarak doküman incelemesi aşamasına ortam hazırlanmaya çalışılmıştır. İkinci aşamada hekimlerin hasta bazında bir önceki gün laboratuvar ve görüntüleme istemlerindeki defansif tıp eylemlerini “1-Tamamen (%100), 2-Çoğunlukla (%75), 3-Biraz (%50), 4-Hafifçe (%25), 5-Hiç (%0)” olarak doküman incelemesi kapsamında değerlendirmeleri istenmiştir. Ocak ayının sonunda görüşmelerde kavramlar ve süreçler tekrar edilmeye başlamıştır. Cerrahi ve dahili branşlardan toplam 30 hekime ulaşılarak toplam 596 hasta dosyası incelenmiştir. Verilerin değerlendirilmesinde sayı, yüzde ve aritmetik ortalama kullanılmıştır. Bulgular: Defansif tıp uygulamalarının, hekim-hastanın içinde bulunduğu tüm değişkenlerden etkilenebileceği ve hekimlerin maliyet konusunda farkındalık düzeylerinin düşük olduğu sıklıkla ifade edilmiştir. Defansif tıp uygulamaları vaka bazında %12,58 tespit edilmiştir. Polikliniklerde defansif nedenlerle laboratuvar ve görüntüleme istemlerinin direkt maliyete etkisi en az %1,63 olarak hesaplanmıştır. Sonuç: Bulgular, gözlemlenemeyen ve kapsam dışı tutulan diğer finansal enstrümanlar ile sosyal maliyetlerin hekim görüşleriyle birlikte değerlendirildiğinde defansif tıp uygulamalarının sağlık hizmetlerinin maliyetlerinde küçük ama ihmal edilmeyecek düzeyde artışa neden olduğu anlaşılmaktadır.
Physicians are turning to defensive medical practices by deviating from routine medical procedures in order to reduce or prevent the risk of future law enforcement in their daily medical practice. Applications are called defensive medicine in the literature. In this study, the economic dimensions of the applications are discussed. It was aimed to determine the cost arising from the defensive medicine applications. Material and Methods: In the study, which was carried out with a retrospective, cross-sectional and exploratory design, in-depth interview and document review methods from qualitative methods were used. The data were collected in the university hospital in polyclinics between December 2018-January 2019 at which time where Emergency service and consultation polyclinics were excluded. Initially, discussions were held to determine the Malpractice cases, the opinions of colleagues about defensive medicine practices, the cost caused by defensive medicine, and the cost of the document review phase was tried to be prepared. In the second stage, the defensive medical actions of the physicians in the laboratory and imaging requests on the basis of the patient the previous day “1-Totally (100%), 2- Mostly (75%), 3-Some (50%), 4-Slightly (25%), 5-None (0%)” they were asked to choose as part of the document review. At the end of January, concepts and processes began to be repeated in the negotiations. A total of 596 patient files were examined by reaching 30 physicians from surgical and internal medicine of branches. Number, percentage and arithmetic mean were used in the evaluation of the data. Results: It has often been stated that defensive medicine practices can be affected by all variables in which the physician-patient is present, and physicians have low levels of awareness about cost. Defensive medicine practices were identified by 12.58% on a case-by-case basis. In polyclinics, the effect of laboratory and imaging requests on direct cost for defensive reasons was calculated as at least 1.63%. Conclusion: The findings, when other financial instruments that cannot be observed and excluded, and social costs are evaluated together with physician opinions, it is understood that defensive medicine practices cause a small but not negligible increase in the costs of health services.
Physicians are turning to defensive medical practices by deviating from routine medical procedures in order to reduce or prevent the risk of future law enforcement in their daily medical practice. Applications are called defensive medicine in the literature. In this study, the economic dimensions of the applications are discussed. It was aimed to determine the cost arising from the defensive medicine applications. Material and Methods: In the study, which was carried out with a retrospective, cross-sectional and exploratory design, in-depth interview and document review methods from qualitative methods were used. The data were collected in the university hospital in polyclinics between December 2018-January 2019 at which time where Emergency service and consultation polyclinics were excluded. Initially, discussions were held to determine the Malpractice cases, the opinions of colleagues about defensive medicine practices, the cost caused by defensive medicine, and the cost of the document review phase was tried to be prepared. In the second stage, the defensive medical actions of the physicians in the laboratory and imaging requests on the basis of the patient the previous day “1-Totally (100%), 2- Mostly (75%), 3-Some (50%), 4-Slightly (25%), 5-None (0%)” they were asked to choose as part of the document review. At the end of January, concepts and processes began to be repeated in the negotiations. A total of 596 patient files were examined by reaching 30 physicians from surgical and internal medicine of branches. Number, percentage and arithmetic mean were used in the evaluation of the data. Results: It has often been stated that defensive medicine practices can be affected by all variables in which the physician-patient is present, and physicians have low levels of awareness about cost. Defensive medicine practices were identified by 12.58% on a case-by-case basis. In polyclinics, the effect of laboratory and imaging requests on direct cost for defensive reasons was calculated as at least 1.63%. Conclusion: The findings, when other financial instruments that cannot be observed and excluded, and social costs are evaluated together with physician opinions, it is understood that defensive medicine practices cause a small but not negligible increase in the costs of health services.
Açıklama
Anahtar Kelimeler
Üniversite Hastanesi, Defansif Tıp, Maliyet, University Hospital, Defensive Medicine, Cost
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
7
Sayı
1
Künye
Özer, K., Aslan, Ş. (2022). Defansif Tıp Uygulamalarına İlişkin Maliyetin Belirlenmesi: Retrospektif Araştırma. Türkiye Klinikleri Sağlık Bilimleri Dergisi, 7(1), 194 - 202. 10.5336/healthsci.2021-81016
