Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Şehir Hastanelerinde Görev Yapmakta Olan Uzman Hekimlerin Sevk Sistemi Hakkındaki Düşünceleri Üzerine Tanımlayıcı Çalışma
Descriptive Study on the Opinions of Specialist Physicians Working in City Hospitals About the Referral System
Süleyman AKGÜNa , Hilal ÖZKAYAa
aBaşakşehir Çam ve Sakura Şehir Hastanesi Aile Hekimliği Kliniği, İstanbul, Türkiye
Turkiye Klinikleri J Health Sci. 2025;10(2):496-507
doi: 10.5336/healthsci.2024-104870
Article Language: TR
Full Text
ÖZET
 Amaç: Etkin ve kaliteli bir sağlık hizmeti sunumu için kullanılan yöntemlerden biri de sevk zinciri uygulamasıdır. Bu çalışma ile uzman hekimlerin Türkiye'deki sevk sistemi ve uygulamaya geçilmesi beklenen kademeli sevk zinciri uygulaması hakkındaki görüşlerini tespit etmek amaçlanmaktadır. Gereç ve Yöntemler: Kesitsel ve tanımlayıcı nitelikte olan bu araştırma yüz yüze anket uygulamasıyla yapılmıştır. Bu çalışma, Eylül-Kasım 2023 tarihleri arasında İstanbul ilindeki şehir hastanelerinde görev yapan uzman hekimler arasından gönüllü olan 202 katılımcı ile yapılmıştır. Çalışmada, katılımcıların mevcut ve tekrardan yapılanması planlanan sevk sistemi hakkındaki görüşlerini tespit etmek amacıyla 37 soru yöneltilmiştir. Çalışmadaki istatistiksel analizler; IBM SPSS sürüm 25.0 kullanılarak Pearson korelasyon testi, bağımsız örneklem t-testi ve ki-kare testleri uygulanarak hazırlanmıştır. Bulgular: Katılımcıların neredeyse tamamı hastanelere doğrudan başvuruların tamamen veya kısmen engellenmesi gerektiğini ortaya koymuştur. Katılımcıların 2/3'ü medikolegal çekincelerin ve hastaların sevk edilme talebinin alınan sevk kararını etkilediğini düşünmektedir. Aile hekimlerinin bilgi/deneyim eksikliğini sevk edilme nedenleri arasında gören diğer uzman hekimlerin oranı %74,7 olarak tespit edilmiştir. Aile hekimlerinde diğer branş hekimlerine kıyasla kaygılar toplam puanının yüksek olduğu izlenmiştir. Aile hekimliği uzmanları ile diğer uzmanlar arasında branşlaşmanın hastalara bütüncül yaklaşımı gölgelediği düşüncesi, sevk sisteminin birinci basamakta iş yükünün artacağı kanaati ve malpraktislerde artış izleneceği kanaati hakkında anlamlı farklılıklar saptanmıştır. Yine katılımcıların neredeyse yarısı toplumun sevk zinciri uygulamasını benimsemeyeceğini ve etkin kaliteli bir sevk sisteminin uygulanamayacağını düşünmektedir. Sonuç: Uzman hekimlerin sevk sistemi hakkında birçok konuda ortak öngörü ve kaygılara sahip olduğu görülmektedir. Ancak sevk zinciri uygulaması ile birinci basamakta yaşanabilecek iş yükü, malpraktis, stres ve sorumluluklar gibi konularda aile hekimliği uzmanları ile diğer uzmanlar arasında kaygı yönünde anlamlı farklılıklar saptanmıştır.

Anahtar Kelimeler: Aile hekimliği; sağlık hizmetleri sistemi; sevk zinciri; şehir hastanesi; tıbbi uzmanlık
ABSTRACT
 Objective: One of the methods used to provide effective and quality healthcare service is the referral chain application. This study aims to determine the opinions of specialist physicians about the referral system in Türkiye and the gradual referral chain application that is expected to be implemented. Material and Methods: This cross-sectional and descriptive research was conducted using a face-to-face survey. This study was conducted between September-November 2023 with 202 volunteer participants among specialist physicians working in city hospitals in İstanbul. In the study, 37 questions were asked to determine the participants' opinions about the current and restructuring referral system. Statistical analyzes in the study; Prepared by applying Pearson correlation test, independent samples t-test and chi-square tests using IBM SPSS version 25.0. Results: Almost all participants revealed that direct admissions to hospitals should be completely or partially prevented. 2/3 of the participants think that medicolegal reservations and patients' requests for referral affect the referral decision. The rate of other specialist physicians who considered family physicians' lack of knowledge/experience among the reasons for referral was determined to be 74.7%. It was observed that the total score of concerns was higher in family physicians compared to physicians in other branches. Significant differences were detected between family medicine specialists and other specialists regarding the opinion that branching overshadows the holistic approach to patients, the opinion that the workload of the referral system will increase in primary care, and the opinion that malpractices will increase. Again, almost half of the participants think that society will not adopt the referral chain practice and that an effective, quality referral system cannot be implemented. Conclusion: It seems that specialist physicians have common predictions and concerns about many issues about the referral system. However, with the referral chain application, significant differences were detected between family medicine specialists and other specialists in terms of anxiety regarding issues such as workload, malpractice, stress and responsibilities that may be experienced in primary care.

Keywords: Family medicine; health care system; referral chain; city hospital; medical specialty
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