Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Change in Utilization of Health Services and its Affecting Factors in Kayseri City Center: A Comparative Population-Based Cross-Sectional Study in 2004 and 2017
Kayseri İl Merkezinde Sağlık Hizmetleri Kullanımındaki Değişim ve Etkileyen Faktörler: 2004 ve 2017 Yılları Karşılaştırmalı Topluma Dayalı Kesitsel Çalışma
Vesile ŞENOLa, Ferhan ELMALIb, Fevziye ÇETİNKAYAc, Melis NAÇARd, Rukiye YALAPa
aDepartment of Nutrition and Dietetics, Kapadokya University Faculty of Health Science, Nevşehir, Türkiye
bDepartment of Biostatistics, İzmir Kâtip Çelebi University Faculty of Medicine, İzmir, Türkiye
cDepartment of Public Health, Erciyes University Faculty of Medicine, Kayseri, Türkiye
dDepartment of Medical Education, Erciyes University Faculty of Medicine, Kayseri, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(1):49-63
doi: 10.5336/medsci.2022-91590
Article Language: EN
Full Text
ABSTRACT
 Objective: This study aimed to examine the change in health service use and its affecting factors by comparing the findings of 2 studies conducted at different times, with the same data collection tools, in the same health service region. Material and Methods: The first cross-sectional study was conducted in 2004, in urban areas in Kayseri, with 501 households and 1,880 people in Primary Health Centers. The second was carried out in 2017, in 30 Family Health Centers, with 801 households and 2,253 people. The data were collected by the face-to-face interview method using a questionnaire. In statistical analysis, mean±standard deviation, median (Q1-Q3), Mann-Whitney U, Kruskal-Wallis, Pearson χ2 , logistic regression analysis were used. The value p <0.05 was accepted as statistically significant. Results: The rate of health service utilization (HSU) increased from 79.6% to 84.8%, the average number of visits to physicians per person increased from 4.9 to 6.9. While the proportion of primary HSU increased to 45.8%, requests for visits to public hospital decreased to 26.4%. Healthcare use was significantly higher in male gender (2.2-2.3 times), 65 years and older (2.8-3.2 times), in people with good income (1.8-1.5 times), and in those with negative health perception (1.8-1.9 times). Conclusion: There has been a significant improvement in HSU parameters, particularly in Primary Health Care Centers services. Male gender, good level income, advanced age (≥65), and negative health perception are the main determinants of healthcare use. These results require a better understanding of the factors that make access to the health facilities difficult and the development of strategies that ensure fair use of health services.

Keywords: Health services; utilization; health services accessibility; change
ÖZET
 Amaç: Bu çalışma, farklı 2 zaman diliminde aynı bölgelerde aynı veri toplama araçları kullanılarak yapılan 2 çalışma sonucu karşılaştırılarak, sağlık hizmeti kullanımındaki değişimi ve etkileyen faktörleri incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Kesitsel nitelikli çalışmaların ilki 2004 yılında Kayseri'de 7 kentsel alan Sağlık Ocağı bölgesinde 501 hane ve 1.880 kişi; ikincisi 2017 yılında Kayseri kentsel alan 30 Aile Sağlığı Merkezi bölgesinde 801 hane ve 2.253 kişi üzerinde yürütülmüştür. Veriler araştırma bilgi formu kullanılarak yüz yüze görüşme yöntemi ile toplanmıştır. İstatistiksel değerlendirmede ortalama±standart sapma, medyan (Q1-Q3), Mann-Whitney U, Kruskal-Wallis, Pearson ki-kare ve lojistik regresyon analizi uygulanmıştır. p <0,05 değeri istatistiksel olarak anlamlı kabul edilmiştir. Bulgular: Örneklem gruplarının yaş ortlaması 28,01 ve 29,31'dir. Sağlık hizmeti kullanım oranı %79,6'dan %84,8'e, kişi başı hekime başvuru ortalaması 4,9'dan 6,9'a yükselmiştir. Birinci basamak hizmet kullanımı %45,8'e yükselirken, kamu hastanelerine başvurular %26,4'e düşmüştür. Sağlık hizmeti kullanımı erkek cinsiyette (2,2-2,3 kat), 65 ve üzeri yaş grubunda (2,8-3,2 kat), gelir düzeyi iyi olanlarda (1,8-1,5 kat), olumsuz sağlık algısına sahip kişilerde (1,8-1,9 kat) anlamlı düzeyde daha yüksektir. Sonuç: Birinci basamak sağlık hizmetleri başta olmak üzere, sağlık hizmeti kullanım parametrelerinde belirgin düzeyde iyileşme görülmüştür. Erkek cinsiyet, iyi düzey gelir, ileri yaş (≥65) ve olumsuz sağlık algısı hizmet kullanımının temel belirleyicileridir. Bu sonuçlar hizmete erişimi güçleştiren faktörlerin daha iyi anlaşılmasını ve sağlık hizmetlerinin adil kullanımını sağlayan stratejilerin geliştirilmesini gerekli kılmaktadır.

Anahtar Kelimeler: Sağlık hizmeti; kullanım; sağlık hizmetlerine erişebilirlik; değişim
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