Publication: Birinci, ikinci ve üçüncü basamak sağlık kuruluşlarında peptik ülser yakınmalarında Helicobacter pylori'ye yönelik tedavi yaklaşımları
Abstract
Amaç: Bu çalışmada birinci, ikinci ve üçüncü basamak sağlık kuruluşlarında çalışan hekimlerin, peptik ülser yakınmaları olan hastalara yaklaşımları ve Helicobacter pyloriye yönelik tedavi yaklaşımlarının tanımlanması amaçlanmıştır. Çalışma Planı: Tanımlayıcı tipteki bu araştırmada, veriler Anadolu yakasındaki bir Sağlık Grup Başkanlığı'na bağlı sağlık ocaklarında çalışan 20 (birinci basamak), tam teşekküllü bir devlet hastanesinde çalışan 14 (ikinci basamak) ve bir tıp fakültesi hastanesinde çalışan 26 (üçüncü basamak) hekime yüz yüze anket uygulanarak toplandı. İstatistiksel analizlerde ki-kare ve Kolmogorov-Smirnov testleri kullanıldı.Bulgular ve Sonuç: Peptik ülser tanısı koyma yöntemleri açısından sağlık kuruluşları arasında istatistiksel olarak anlamlı fark bulundu (Dmax=0.95, p=0.0000). Birinci basamaktaki hekimlerin %100'ü tanıyı öykü, fizik muayene ve tedaviye yanıta göre koyarken, ikinci basamakta çalışan hekimlerde bu oran %7.7 idi. Üçüncü basamaktaki hekimlerin tamamı ise tanıyı endoskopi yardımı ile koyduklarını bildirdiler. Birinci, ikinci, üçüncü basamak hekimleri arasında (i) tedavide antibiyotik olarak klaritromisin kullanma (sırasıyla %60, %85.7, %92.3); (H) peptik ülser yakınması olan hastalara beslenme rejimi önerme (sırasıyla %85.0, %85.7, %26.9; p=0.0003); (iii) peptik ülser tanılı hastalara antidepresan tedavisi başlama oranları (sırasıyla %30.0, %50.0, %11.5; p=0.029) ve (iv) tedavi süreleri açısından (p=0.003) anlamlı farklılıklar gözlendi.
Objectives: This study was designed to define the attitudes of doctors working at primary, secondary and tertiary health care institutions to patients with peptic ulcer complaints and their choice of treatment for Helicobacter pylori. Study Design: In this descriptive study, data were collected by a questionnaire administered to 20 health center doctors of a Health District Directorate, 14 doctors of a general hospital and 26 doctors of a university hospital, all of which were in the Anatolian Region. Statistical analyses were made using chi-square and Kolmogorov-Smirnov tests. Results and Conclusion: With respect to the diagnostic methods for peptic ulcer, significant differences existed between the institutions (Dmax=0.95, p=0.0000). All primary care physicians based their diagnosis of peptic ulcer on history, physical examination and response to treatment, this being 7.7% for the secondary care physicians. On the other hand, all the physicians at the tertiary level reached diagnosis by the help of endoscopy. Significant differences were found between primary, secondary, and tertiary health care physicians with regard to (i) use of clarithromycin in the antibiotic treatment (60%, 85.7%, 92.3%); (ii) recommendation of a dietary regime to patients with peptic ulcer complaints (85.0%, 85.7%, 26.9%; p=0.0003); (iii) institution of antidepressant drugs in patients with a diagnosis of peptic ulcer (30.0%, 50.0%, 11.5%; p=0.029), and (iv) duration of treatment (p=0.003), respectively.
Objectives: This study was designed to define the attitudes of doctors working at primary, secondary and tertiary health care institutions to patients with peptic ulcer complaints and their choice of treatment for Helicobacter pylori. Study Design: In this descriptive study, data were collected by a questionnaire administered to 20 health center doctors of a Health District Directorate, 14 doctors of a general hospital and 26 doctors of a university hospital, all of which were in the Anatolian Region. Statistical analyses were made using chi-square and Kolmogorov-Smirnov tests. Results and Conclusion: With respect to the diagnostic methods for peptic ulcer, significant differences existed between the institutions (Dmax=0.95, p=0.0000). All primary care physicians based their diagnosis of peptic ulcer on history, physical examination and response to treatment, this being 7.7% for the secondary care physicians. On the other hand, all the physicians at the tertiary level reached diagnosis by the help of endoscopy. Significant differences were found between primary, secondary, and tertiary health care physicians with regard to (i) use of clarithromycin in the antibiotic treatment (60%, 85.7%, 92.3%); (ii) recommendation of a dietary regime to patients with peptic ulcer complaints (85.0%, 85.7%, 26.9%; p=0.0003); (iii) institution of antidepressant drugs in patients with a diagnosis of peptic ulcer (30.0%, 50.0%, 11.5%; p=0.029), and (iv) duration of treatment (p=0.003), respectively.