Management of Family Medicine Practice

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Saliha Serap ÇİFÇİLİ
Marmara Üniversitesi Tıp Fakültesi, Aile Hekimliği ABD, İstanbul, Türkiye
Article Language: TR
Avrupa Aile Hekimliği 2002 tanımına göre; Aile Hekimi/Genel Pratisyenin altı çekirdek yeterliliğinden biri, 'Birinci Basamağın Yönetimi'dir. Bu yeterlilik altında şu iki temel özelliğe atıfta bulunulur:

1- Birinci basamağın sağlık sistemi ile ilk tıbbi temas noktasını oluşturması; yaş, cinsiyet, sağlık sorunu benzeri herhangi bir özelliği temel alan bir ayrım yapmaksızın, hizmet talep eden her bireye hizmet sunması,
2- Sağlık hizmetinin, gerek birinci basamak düzeyinde, gerekse diğer sağlık hizmet sunum basamakları ile koordinasyonu, bu yolla hem kaynakların korunması hem de gerektiğinde bireyin savunmanlığının yürütülmesi.

Birinci Basamağın Yönetimi; olasılıkla hizmetin sunulduğu ülkenin sağlık sisteminin özellikleri, sağlık politikasında birinci basamak sağlık hizmetinin ne ölçüde öncelendiği ve buna bağlı olarak birinci basamak sağlık hizmetine ayrılan bütçe, insan gücü ve uygulayıcıların hizmetin yönetimine katılım düzeyinden en çok etkilenen yeterliktir. Ülkemizde Aile Hekimliği uzmanlığının Tababet Uzmanlık tüzüğünde yer alması 1983, uzmanlık eğitiminin başlaması 1985 yılına tarihlenmektedir. İlk yıllarda disiplinin gelişimi, çeşitli nedenler ile görece yavaş ilerlemiştir. Bu konuda bilgi edinmek isteyen okurlar, konu ile ilgili çeşitli yazılara; Türkiye Aile Hekimliği Dergisi arşivi, ulusal aile hekimliği kitapları, ve yine Türkiye Klinikleri Aile Hekimliği Özel sayısı olarak yayınlanmış 'Ülkemizde Aile Hekimliğinin Sağlığın Geliştirilmesine Katkısı' başlıklı kitaptan ulaşabilirler. Aile Hekimleri Uzmanları Derneği (AHUD)'nin 1990 yılında kurulması, bu bakımdan bir milat olarak kabul edilebilir. Bu dönemde tıp fakültelerinde aile hekimliği anabilim dallarının kurulması ile disiplinin gelişimi ivmelenmiştir. Disiplinin gelişimi bazı açılardan gerçekten çok parlaktır. Kısa sürede uluslararası meslek örgütleri ile işbirlikleri kurulmuş, çok sayıda akademisyen yetişmiş, başta Türkiye Aile Hekimliği Dergisi olmak üzere bilimsel dergiler yayınlanmış, ulusal ve uluslararası düzenli bilimsel etkinlikler gerçekleştirilmiştir.

Bir yandan akademik gelişim sürerken diğer yandan Sağlıkta Dönüşüm Programı kapsamında birinci basamak sağlık hizmetlerinin Aile Sağlığı Merkezlerinde (ASM) sunulması yönünde değişim de yapılanmıştır. Ne yazık ki bu iki sürecin gelişimi birbirini destekleyecek şekilde sürmemiştir. Aile Hekimliği disiplininin önderleri, güçlü bir birinci basamak sağlık hizmetinin topluma çok önemli bir katkı sağlayacağının bilincindedir. Bu nedenle ASM'lerde sunulmakta olan birinci basamak sağlık hizmetinin geliştirilmesi adına bilgi üretmeye, uygulama örneklerini geliştirmeye devam etmektedirler.

Hâlen ASM yapılanması, yasal düzenlemeleri ve uygulaması ile ilişkili çeşitli sorunlar vardır. Tüm Türkiye'de uygulamanın başladığı 2010 yılından itibaren Aile Hekimliği Birimi (AHB) başına düşen birey sayısında, hedeflenen azalma gerçekleştirilmemiştir. Bir AHB'de bir hekim bir hemşire/ebe çalışmaktadır. Oysa AHB'lerin görevlerinin tamamının bu işgücü ile sağlanamayacağı açıktır. Bu bağlamda bu kitabın hazırlanmasına ilham veren temel soru şudur: Aile Hekimliği disiplininin temel ilkeleri ile uyumlu bir sağlık hizmet sunumu açısından 'Aile Hekimliği Uygulama Alanının Yönetimi' anlamında hangi noktadayız?

Bu kitapta terim olarak 'Aile Sağlığı Merkezi Yönetimi' özellikle seçilmemiş 'Aile Hekimliği Uygulama Alanının Yönetimi' terimi kullanılmıştır. Bu kitap içeriğinde tartışılmak istenen kavram aslında Aile Hekimliği ilkeleri ve yeterlilikleri doğrultusunda uygulama alanının yönetimidir. Doğal olarak birçok bölümde konu, ASM örneği üzerinden tartışılmıştır.

Kitabın Aile Hekimliği bilgi birikimine ve bu alanda çalışan tüm profesyonellere yararlı olması ümidi ile kitaba katkı sunan tüm değerli yazarlara ve ülkemizde Aile Hekimliği disiplininin gelişimi için emeği geçmiş olan hocalarım ve meslektaşlarıma içtenlikle teşekkür ederim.

Prof. Dr. Saliha Serap ÇİFÇİLİ
Editör
In the European definition of Family Medicine/General Practice 2002, one of the six core competencies of a Family Physician/General Practitioner is the 'Management of Primary Care'. This competency refers to the following two key features:

Being the first point of contact within the healthcare system; providing access to every individual who requests service regardless of age, sex, gender, or any kind of characteristic.

1- Coordination of care, working with other professionals in a primary care setting, coordinating care in secondary or tertiary facilities, protecting resources, and advocating for the patient if needed.
2- Among the core competencies, management of primary care is probably the most affected by the characteristics of the health care system, how much primary care is prioritized in the general health policy, the budget and manpower allocated accordingly, and how much the practitioners are involved in policy making.

In Türkiye, the inclusion of family medicine in 'Medical Specialization Legislation' dates back to 1983, and vocational training started in 1985. In the early years, the discipline progressed relatively slowly for various reasons. Readers who want to read further about this subject can refer to various articles on the subject published in family medicine journals, especially in the Turkish Journal of Family Practice; national Family Medicine Textbooks, and another special topics book by Türkiye Klinikleri, titled 'The Contribution of Family Medicine to Improve Health in Türkiye', 2020. The foundation of the Family Physicians' Society in 1990 followed by the foundation of several Family Medicine departments in medical schools could be considered s a milestone in the development of Family Medicine. The progress of the discipline is quite brilliant in certain aspects such as collaboration with international professional organizations; the rapid growth of successful academic personnel, the publishing of many journals, the Turkish Journal of Family Medicine in particular, and the organization of many scientific meetings.

In parallel with this academic growth, a major change, the provision of primary health care in Family Health Centers has been started as a part of the Health Transformation Program of Türkiye. Unfortunately, these two developments have not always supported each other. The pioneers of Family Medicine in Türkiye are and have always been well aware of the important contribution of strong primary care to the community. Thus, they continue to produce evidence for the development of primary healthcare and excellent examples of family medicine practice.

There are still several problems concerning FHC's constitution, legislation, and practice. The number of patients in a Family Medicine Unit (FMU) did not decrease as previously planned. Each unit is still composed of a physician and a nurse/midwife. However, the responsibilities of an FMU are quite wide for such a team. In this context, the question which led to preparing this book is; where are we in terms of management of Family Medicine Practice compatible with family medicine principles?

In this book, the term 'Management of Family Medicine Practice' is specially chosen instead of 'Management of Family Health Center'. The concept in discussion is actually the management of primary care/ family medicine practice in line with the principles of Family Medicine. Naturally, in many chapters, the subject is discussed using FMH examples.

I hope that this book contributes to the family medicine literature and the professionals of the area. I sincerely thank the valuable writers of the chapters; teachers, and colleagues of family medicine who have contributed to the development of family medicine in Türkiye.

Prof. Dr. Saliha Serap ÇİFÇİLİ
Editor

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