Tablo 4.<\/strong> A\u015f\u0131 uygulamas\u0131 i\u00e7in di\u011fer birimlerden y\u00f6nlendirme endikasyonlar\u0131<\/p><\/div>\nDi\u011fer birimlerden y\u00f6nlendirilen 384 ki\u015finin 221\u2019inin kronik hastal\u0131\u011f\u0131 oldu\u011fu, en s\u0131k a\u015f\u0131 talep endikasyonunun \u201csa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131\/stajyer \u00f6\u011frenci\u201d oldu\u011fu, en s\u0131k yap\u0131lmas\u0131 istenen a\u015f\u0131n\u0131n hepatit B oldu\u011fu g\u00f6r\u00fcld\u00fc (Tablo 4).<\/p>\n
Sa\u011fl\u0131kl\u0131 42 ki\u015fiye yap\u0131lan a\u015f\u0131 uygulamalar\u0131 de\u011ferlendirildi\u011finde, bu gruptaki bireylere 25 tetanos a\u015f\u0131s\u0131, 14 hepatit B a\u015f\u0131s\u0131, 2 KKK ve 1 konjuge pn\u00f6mokok a\u015f\u0131s\u0131 13 (KPA-13) uyguland\u0131\u011f\u0131 belirlendi.<\/p>\n
\u0130RDELEME<\/b><\/h2>\n
Bula\u015f\u0131c\u0131 hastal\u0131klar gibi halk sa\u011fl\u0131\u011f\u0131 sorunlar\u0131n\u0131n ele al\u0131nmas\u0131nda toplum kat\u0131l\u0131m\u0131n\u0131n art\u0131r\u0131lmas\u0131 ve sa\u011fl\u0131kl\u0131 davran\u0131\u015flar\u0131n te\u015fvik edilmesi giderek daha fazla \u00f6nem kazanmaktad\u0131r. \u00d6te yandan a\u015f\u0131lama kapsam\u0131 bir\u00e7ok geli\u015fmekte olan \u00fclkede \u00f6nemli bir endi\u015fe kayna\u011f\u0131 olmaya da devam etmektedir (10).<\/p>\n
Eri\u015fkin A\u015f\u0131 Poliklini\u011fi\u2019nin aktif oldu\u011fu ilk bir y\u0131ll\u0131k s\u00fcre\u00e7te uygulanan a\u015f\u0131lar ve a\u015f\u0131 uygulanan bireylerin de\u011ferlendirildi\u011fi bu \u00e7al\u0131\u015fmada, 1353 farkl\u0131 ki\u015fiye, 2045 i\u015flemde, toplam 2149 doz\u00a0 <\/span>a\u015f\u0131n\u0131n uyguland\u0131\u011f\u0131 belirlendi. Bir y\u0131ll\u0131k s\u00fcre\u00e7te az\u0131msanmayacak d\u00fczeyde olan bu uygulamalar\u0131n toplum ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131na olumlu katk\u0131 sa\u011flayaca\u011f\u0131 a\u00e7\u0131kt\u0131r.<\/p>\nBula\u015f\u0131c\u0131 hastal\u0131k y\u00fck\u00fc n\u00fcfusun en gen\u00e7 ve en ya\u015fl\u0131 kesimlerinde en y\u00fcksek d\u00fczeydedir. Bunun nedeni sa\u011fl\u0131kl\u0131 bebeklerde ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin yeterince olgunla\u015fmam\u0131\u015f olmas\u0131 ve anneden al\u0131nan k\u0131sa s\u00fcreli ba\u011f\u0131\u015f\u0131kl\u0131k fakt\u00f6rleri d\u0131\u015f\u0131nda \u00f6nceden var olan koruyucu bellek yan\u0131tlar\u0131n\u0131n bulunmamas\u0131d\u0131r. Ya\u015fl\u0131 n\u00fcfusta ise \u00f6nceden var olan ba\u011f\u0131\u015f\u0131kl\u0131k haf\u0131zas\u0131n\u0131n varl\u0131\u011f\u0131na ra\u011fmen ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131tlar\u0131 \u00e7ocuklara g\u00f6re daha zay\u0131f olma e\u011filimindedir (11). Her ne kadar bu iki grupta bula\u015f\u0131c\u0131 hastal\u0131k y\u00fck\u00fcn\u00fcn fazla oldu\u011fu ifade edilse de eri\u015fkin bireylerde imm\u00fcn yetmezlik durumu, ast\u0131m, kronik kalp veya akci\u011fer hastal\u0131klar\u0131 gibi kronik hastal\u0131klar ile gebelik ve sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 olmak da risk olu\u015fturan durumlard\u0131r (12).<\/p>\n
Eri\u015fkin a\u015f\u0131lar\u0131 yeti\u015fkinler aras\u0131nda morbidite ve mortalitenin \u00f6nlenmesinde \u00f6nemli bir koruyucu sa\u011fl\u0131k uygulamas\u0131d\u0131r ve olumlu maliyet etkinlik profiline sahiptir (13). Buna ra\u011fmen geli\u015fmekte olan \u00fclkelerde ulusal eri\u015fkin a\u015f\u0131lama y\u00f6nergelerinin bulunmamas\u0131 veya sa\u011fl\u0131k kurumlar\u0131 aras\u0131nda farkl\u0131l\u0131k g\u00f6steren a\u015f\u0131lama y\u00f6nergelerinin varl\u0131\u011f\u0131, eri\u015fkin a\u015f\u0131lama uygulamalar\u0131nda belirsizliklere neden olmaktad\u0131r (14).<\/p>\n
\u00dclkemizde, EKMUD 2024 y\u0131l\u0131 Eri\u015fkin Ba\u011f\u0131\u015f\u0131klama Rehberi\u2019nde eri\u015fkinlerde risk gruplar\u0131 da g\u00f6z \u00f6n\u00fcnde bulundurularak difteri, tetanos, bo\u011fmaca, influenza, pn\u00f6mokok, hepatit A ve B, su\u00e7i\u00e7e\u011fi, zona, k\u0131zam\u0131k, k\u0131zam\u0131k\u00e7\u0131k, kabakulak, meningokok, HPV, Hib, kuduz, polio ve COVID-19 a\u015f\u0131lar\u0131 \u00f6nerilmektedir (7). Di\u011fer yanda T\u00fcrkiye Aile Hekimli\u011fi Uzmanl\u0131k Derne\u011fi (TAHUD), Eri\u015fkin Ba\u011f\u0131\u015f\u0131klama Dan\u0131\u015fma Kurulu taraf\u0131ndan eri\u015fkin a\u015f\u0131 uygulamalar\u0131na rehberlik etmesi amac\u0131yla Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n 2100170 numaral\u0131 Risk Grubu A\u015f\u0131lama Genelgesi esas al\u0131narak Eri\u015fkin Risk Grubu Ba\u011f\u0131\u015f\u0131klama Algoritmas\u0131 geli\u015ftirilmi\u015ftir (15).\u00a0<\/span><\/p>\n\u00dc\u00e7\u00fcnc\u00fc basamak bir hastane olan kurumumuzda, nefroloji, romatoloji, infeksiyon hastal\u0131klar\u0131, onkoloji, g\u00f6\u011f\u00fcs hastal\u0131klar\u0131, endokrinoloji gibi klinikler riskli hasta takibi a\u00e7\u0131s\u0131ndan yo\u011fun b\u00f6l\u00fcmlerdir. Ara\u015ft\u0131rmam\u0131zda di\u011fer polikliniklerden y\u00f6nlendirilen 384 bireyden 221\u2019inin (%57.5) kronik hastal\u0131\u011f\u0131 oldu\u011fu belirlendi. Eri\u015fkin A\u015f\u0131 Poliklini\u011fi\u2019ne en \u00e7ok y\u00f6nlendirmenin \u0130nfeksiyon Hastal\u0131klar\u0131 Poliklini\u011fi\u2019nden yap\u0131ld\u0131\u011f\u0131 (%35.94), bunu Aile Hekimli\u011fi Poliklini\u011fi\u2019nin (%33.59), Romatoloji Poliklini\u011fi\u2019nin (%16.67) ve Nefroloji Poliklini\u011fi\u2019nin (%7.03) izledi\u011fi g\u00f6r\u00fcld\u00fc. \u0130kinci basamak bir devlet hastanesinde eri\u015fkin ba\u011f\u0131\u015f\u0131klama \u00fcnitesinde y\u00fcr\u00fct\u00fclen bir \u00e7al\u0131\u015fmada a\u015f\u0131 uygulanan hastalar\u0131n %37.6\u2019s\u0131n\u0131n (n=32) nefroloji, %42.4\u2019\u00fcn\u00fcn (n=36) g\u00f6\u011f\u00fcs hastal\u0131klar\u0131, %16.5\u2019inin (n=14) ise infeksiyon hastal\u0131klar\u0131 polikliniklerinden y\u00f6nlendirildi\u011fi bildirilmi\u015ftir (16). Ara\u015ft\u0131rmam\u0131zda a\u015f\u0131 uygulamas\u0131 i\u00e7in y\u00f6nlendirme yapan poliklinikler aras\u0131nda g\u00f6\u011f\u00fcs hastal\u0131klar\u0131n\u0131n yer almamas\u0131 dikkat \u00e7ekicidir. Bu nedenle ilgili klinik hekimlerine y\u00f6nelik ek bilgilendirme yap\u0131ld\u0131.<\/p>\n
Ara\u015ft\u0131rmam\u0131zda di\u011fer polikliniklerden y\u00f6nlendirilen ki\u015filere yap\u0131lan a\u015f\u0131lar de\u011ferlendirildi\u011finde, y\u00f6nlendirilenlerin %62.91\u2019ine hepatit B a\u015f\u0131s\u0131, %8.89\u2019una konjuge pn\u00f6mokok a\u015f\u0131s\u0131 yap\u0131ld\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. Y\u00f6nlendirilen ki\u015filerin y\u00f6nlendirilme endikasyonlar\u0131 incelendi\u011finde ise ki\u015filerin biyolojik ajan kullan\u0131m\u0131\/planlanmas\u0131, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 bask\u0131layan ila\u00e7 kullan\u0131m\u0131\/planlanmas\u0131, edinsel imm\u00fcn yetmezlik, kronik b\u00f6brek hastal\u0131\u011f\u0131, diyabetik olma gibi risklere sahip olduklar\u0131 g\u00f6r\u00fcld\u00fc.<\/p>\n
\u00dc\u00e7\u00fcnc\u00fc basamak bir \u00fcniversite hastanesi aile hekimli\u011fi poliklini\u011fine ba\u015fvuran 500 eri\u015fkin hastan\u0131n a\u015f\u0131lanma durumlar\u0131n\u0131n de\u011ferlendirildi\u011fi bir \u00e7al\u0131\u015fmada, kat\u0131l\u0131mc\u0131lar\u0131n 18 ya\u015f\u0131ndan sonra yapt\u0131rd\u0131\u011f\u0131 a\u015f\u0131lar incelendi\u011finde; 97 ki\u015finin tetanos (%19.4), 41 ki\u015finin influenza (%8.2), 38 ki\u015finin (%7.6) hepatit B, 14 ki\u015finin (%2.8) meningokok a\u015f\u0131s\u0131 yapt\u0131rd\u0131\u011f\u0131 belirlendi (17). \u00c7al\u0131\u015fmam\u0131zda ise en s\u0131k hepatit B a\u015f\u0131s\u0131n\u0131n (%55.42) uyguland\u0131\u011f\u0131, bunu influenza (%12.89) ve tetanos ve tetanos-difteri (%11.45) a\u015f\u0131lar\u0131n\u0131n izledi\u011fi g\u00f6r\u00fcld\u00fc.\u00a0<\/span><\/p>\nAra\u015ft\u0131rmam\u0131zda hepatit B ve influenza a\u015f\u0131lar\u0131n\u0131n, Sar\u0131g\u00fcl ve arkada\u015flar\u0131n\u0131n (17) \u00e7al\u0131\u015fmas\u0131na g\u00f6re belirgin olarak daha y\u00fcksek oranda uygulanmas\u0131n\u0131n nedeni; kurum \u00e7al\u0131\u015fanlar\u0131 ve stajyer \u00f6\u011frencilerin ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n Eri\u015fkin A\u015f\u0131 Poliklini\u011fi\u2019mizde yap\u0131lmas\u0131 ve bu iki a\u015f\u0131n\u0131n Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan \u00fccretsiz temin edilmesi olabilir. Di\u011fer birimlerden poliklini\u011fimize y\u00f6nlendirilen 384 ki\u015fiden 77\u2019sinin (%20.05) sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131\/stajyer \u00f6\u011frenci olmas\u0131 da bu yorumu desteklemektedir. Ancak \u00c7al\u0131\u015fan Sa\u011fl\u0131\u011f\u0131 Birimi\u2019nden a\u015f\u0131 i\u00e7in yap\u0131lan y\u00f6nlendirmeler, a\u015f\u0131 talep formu doldurulmaks\u0131z\u0131n genellikle hastane bilgi y\u00f6netim sistemi \u00fczerinden Aile Hekimli\u011fi Poliklini\u011fi\u2019nden kons\u00fcltasyon istemi \u015feklinde ger\u00e7ekle\u015ftirildi\u011finden, a\u015f\u0131 talep formu ile y\u00f6nlendirme yapan birimler aras\u0131nda Kurum Hekimli\u011fi Birimi s\u0131n\u0131rl\u0131 say\u0131da (n=8) kalm\u0131\u015ft\u0131r (Tablo 3). Bu nedenle Aile Hekimli\u011fi Poliklini\u011fi\u2019nden yap\u0131lan y\u00f6nlendirme say\u0131s\u0131 g\u00f6rece daha y\u00fcksek g\u00f6r\u00fcnmektedir.<\/p>\n
Ara\u015ft\u0131rmam\u0131zda bir y\u0131ll\u0131k s\u00fcre\u00e7te a\u015f\u0131lanan bireylerin g\u00f6rece gen\u00e7 ya\u015f grubunda olmas\u0131 (ya\u015f ortalamas\u0131: 37.4 \u00b1 16.2 y\u0131l), a\u015f\u0131lanan sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131\/stajyer s\u0131kl\u0131\u011f\u0131 ile ili\u015fkili olabilir. A\u015f\u0131 talep formu doldurulan 77 sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 ve stajyerin ya\u015f ortalamas\u0131 24.49 \u00b1 9.48 y\u0131l iken di\u011fer kliniklerden y\u00f6nlendirilen ve hastal\u0131k tan\u0131s\u0131 bulunan bireylerin (n=307) ya\u015f ortalamas\u0131n\u0131n 45.97 \u00b1 15.78 y\u0131l olmas\u0131 bu d\u00fc\u015f\u00fcnceyi desteklemektedir.<\/p>\n
Co\u015fkun ve arkada\u015flar\u0131n\u0131n (18) bir \u015fehir hastanesi a\u015f\u0131 \u00fcnitesinde y\u00fcr\u00fctt\u00fckleri yak\u0131n tarihli bir \u00e7al\u0131\u015fmada, bir y\u0131ll\u0131k s\u00fcre i\u00e7erisinde 1005 ki\u015fiye a\u015f\u0131 uyguland\u0131\u011f\u0131, a\u015f\u0131 yap\u0131lan ki\u015filerin ortalama ya\u015flar\u0131n\u0131n 37.6 y\u0131l ve %55.2\u2019sinin erkek oldu\u011fu bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ise a\u015f\u0131lanan bireylerin \u00e7o\u011funlu\u011funu kad\u0131nlar (%60.31, n=816) olu\u015fturmakla birlikte \u00e7al\u0131\u015fmadaki bireylerin ya\u015f ortalamas\u0131 37.4 y\u0131l ile \u015fehir hastanesinde y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmaya benzer idi.\u00a0<\/span><\/p>\n\u015eehir hastanesinde y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmada, a\u015f\u0131 \u00fcnitesinde 2021 y\u0131l\u0131 boyunca uygulanan a\u015f\u0131lar de\u011ferlendirildi\u011finde en \u00e7ok a\u015f\u0131 uygulamas\u0131n\u0131n %44.2 ile hepatit B a\u015f\u0131s\u0131 oldu\u011fu, bunu s\u0131ras\u0131 ile tetanos (%14.4), pn\u00f6mokok (%11.9) ve meningokok (%11.4) a\u015f\u0131lar\u0131n\u0131n izledi\u011fi bildirilmi\u015ftir (18). Benzer \u015fekilde \u00e7al\u0131\u015fmam\u0131zda en s\u0131k hepatit B a\u015f\u0131s\u0131n\u0131n (%55.42, n=1191) uyguland\u0131\u011f\u0131, bunu influenza (%12.89, n=277) ve tetanos (%11.45, n=246) a\u015f\u0131lar\u0131n\u0131n izledi\u011fi g\u00f6r\u00fcld\u00fc. Co\u015fkun ve arkada\u015flar\u0131n\u0131n (18) \u00e7al\u0131\u015fmas\u0131ndan farkl\u0131 olarak bu \u00e7al\u0131\u015fmada konjuge pn\u00f6mokok (%2.23), polisakkarit pn\u00f6mokok (%0.56), meningokok (%1.21) a\u015f\u0131 uygulanma oranlar\u0131n\u0131n olduk\u00e7a d\u00fc\u015f\u00fck oldu\u011fu belirlendi.\u00a0<\/span><\/p>\nMevsimsel grip, k\u00fcresel n\u00fcfusun %5\u201310\u2019unu etkileyerek y\u0131lda 290 000\u2013650 000 \u00f6l\u00fcme neden olmakta ve \u015fiddetli grip i\u00e7in risk gruplar\u0131 aras\u0131nda imm\u00fcn yetmezlik durumu olanlar, ast\u0131m, kronik kalp veya akci\u011fer hastal\u0131klar\u0131 gibi kronik hastal\u0131\u011f\u0131 olanlar, ya\u015fl\u0131 yeti\u015fkinler, gebeler, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve 6\u201324 ayl\u0131k k\u00fc\u00e7\u00fck \u00e7ocuklar yer almaktad\u0131r (12).<\/p>\n
\u00c7al\u0131\u015fmam\u0131zda uygulanan a\u015f\u0131lar\u0131n aylara g\u00f6re da\u011f\u0131l\u0131m\u0131 incelendi\u011finde, en fazla a\u015f\u0131 uygulamas\u0131n\u0131n Ekim 2023 d\u00f6neminde (n=402) ger\u00e7ekle\u015fti\u011fi ve uygulanan a\u015f\u0131lar\u0131n %61.9\u2019unun (n=249) influenza a\u015f\u0131s\u0131 oldu\u011fu belirlendi. Grip a\u015f\u0131s\u0131n\u0131n koruyuculu\u011fu ilk 1\u20132 hafta sonra ba\u015flamakta ve sa\u011fl\u0131kl\u0131 eri\u015fkinlerde 6\u20138 aya kadar devam etmektedir. Buna ra\u011fmen ileri ya\u015f ve imm\u00fcn yetmezli\u011fi bulunan bireylerde koruyuculuk s\u00fcresi 100 g\u00fcne kadar d\u00fc\u015febilmektedir. T\u00fcrkiye\u2019de grip mevsimi sonbahar sonunda ba\u015flay\u0131p ilkbahar sonuna kadar devam etti\u011fi i\u00e7in grip a\u015f\u0131lamas\u0131n\u0131n ekim ay\u0131nda ger\u00e7ekle\u015ftirilmesi uygundur (19). Buna g\u00f6re hastanemizde \u00e7al\u0131\u015fanlara uygulanan mevsimsel grip a\u015f\u0131s\u0131n\u0131n zamanlamas\u0131n\u0131n uygun oldu\u011fu ve koruyucu etkisinin de y\u00fcksek olaca\u011f\u0131 s\u00f6ylenebilir.\u00a0<\/span><\/p>\nSa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n mevsimsel grip y\u00f6n\u00fcnden risk alt\u0131nda oldu\u011fu bilinmekle birlikte, literat\u00fcrde mevsimsel grip a\u015f\u0131s\u0131 uygulamalar\u0131 ile ili\u015fkili \u00e7al\u0131\u015fmalara bak\u0131ld\u0131\u011f\u0131nda sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda bu risk durumu i\u00e7in yeterli fark\u0131ndal\u0131k olmad\u0131\u011f\u0131 g\u00f6r\u00fclmektedir (19,20). Bir g\u00f6\u011f\u00fcs hastal\u0131klar\u0131 hastanesinde sa\u011fl\u0131k personelinin sadece %4.3\u2019\u00fcn\u00fcn mevsimsel grip a\u015f\u0131s\u0131 yapt\u0131rd\u0131\u011f\u0131 bildirilmi\u015ftir (20).\u00a0<\/span><\/p>\n\u00c7al\u0131\u015fman\u0131n \u00f6nemli k\u0131s\u0131tl\u0131l\u0131klar\u0131ndan biri sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na uygulanan influenza a\u015f\u0131lar\u0131n\u0131n oran\u0131n\u0131n ayr\u0131 olarak de\u011ferlendirilmemi\u015f olmas\u0131d\u0131r. Yap\u0131lan bir \u00e7al\u0131\u015fmada, aile hekimlerinin sadece %12.4\u2019\u00fcn\u00fcn her y\u0131l d\u00fczenli olarak grip a\u015f\u0131s\u0131 oldu\u011fu bildirilmi\u015ftir (19). Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n, a\u015f\u0131 uygulamalar\u0131 konusunda toplumun te\u015fvik edilmesinde rol model oldu\u011fu a\u00e7\u0131kt\u0131r. Bu nedenle sa\u011fl\u0131k kurulu\u015flar\u0131nda planlanacak a\u015f\u0131 uygulamalar\u0131 ve a\u015f\u0131lanmaya te\u015fvik etmeye y\u00f6nelik e\u011fitimlerin, toplumdaki a\u015f\u0131lanma oranlar\u0131na olumlu katk\u0131 sa\u011flayaca\u011f\u0131n\u0131 d\u00fc\u015f\u00fcn\u00fcyoruz.<\/p>\n
G\u00fcn\u00fcm\u00fczde eri\u015fkin ya\u015f grubunda kullan\u0131lan a\u015f\u0131lar; kronik hastal\u0131klar gibi komorbiditeler, imm\u00fcn yetmezlik durumlar\u0131, seyahat, meslek, ya\u015f gibi fakt\u00f6rlerle ili\u015fkili olarak risk grubuna \u00f6zel de\u011ferlendirilebilece\u011fi gibi t\u00fcm eri\u015fkinlere uygulanabilen a\u015f\u0131lar olarak da ele al\u0131nabilir. Ya\u015fa \u00f6zel a\u015f\u0131lama \u00f6nerileri, bula\u015f\u0131c\u0131 hastal\u0131klara yakalanma riskinin artt\u0131\u011f\u0131 ya\u015fam d\u00f6nemleri dikkate al\u0131narak geli\u015ftirilmi\u015ftir. \u00d6zellikle invazif pn\u00f6mokokal hastal\u0131klar\u0131n \u00f6nlenmesi amac\u0131yla konjuge pn\u00f6mokok a\u015f\u0131lar\u0131 hem \u00e7ocukluk \u00e7a\u011f\u0131 rutin a\u015f\u0131lama program\u0131nda yer almakta hem de 65 ya\u015f \u00fczeri eri\u015fkinlerde uygulanmas\u0131 \u00f6nerilmektedir (21).<\/p>\n
Diyabet hastalar\u0131n\u0131n a\u015f\u0131lanma durumlar\u0131n\u0131n ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 \u00e7ok merkezli bir \u00e7al\u0131\u015fmada; a\u015f\u0131 poliklini\u011fi olan kurumlarda bireylerin kendileri i\u00e7in \u00f6nerilen a\u015f\u0131lar\u0131 yapt\u0131rma oran\u0131n\u0131n olmayan kurumlara g\u00f6re 15 kat fazla oldu\u011fu, a\u015f\u0131 poliklini\u011fi varl\u0131\u011f\u0131nda b\u00fct\u00fcn a\u015f\u0131lar\u0131n yap\u0131lma oran\u0131n\u0131n artt\u0131\u011f\u0131, KPA13 ile a\u015f\u0131lanm\u0131\u015f birey say\u0131s\u0131n\u0131n yakla\u015f\u0131k iki kat\u0131na \u00e7\u0131kt\u0131\u011f\u0131 bildirilmi\u015f ve bireylerin a\u015f\u0131ya eri\u015fimini kolayla\u015ft\u0131rman\u0131n a\u015f\u0131lanma oranlar\u0131n\u0131n artmas\u0131na katk\u0131 sa\u011flayaca\u011f\u0131 ifade edilmi\u015ftir (22).<\/p>\n
Bireysel ve toplumsal d\u00fczeyde bula\u015f\u0131c\u0131 hastal\u0131k y\u00fck\u00fcn\u00fcn azalt\u0131lmas\u0131nda en etkili y\u00f6ntemlerden biri, hastal\u0131klar\u0131n ortaya \u00e7\u0131kmas\u0131n\u0131n \u00f6nlenmesidir. Bu ise etkin bir a\u015f\u0131lama ile m\u00fcmk\u00fcn olabilir. A\u015f\u0131 teredd\u00fct\u00fc ve maliyet kayg\u0131lar\u0131n\u0131n yan\u0131 s\u0131ra, sa\u011fl\u0131k kurulu\u015flar\u0131na ba\u015fvuran risk grubundaki bireylerin a\u015f\u0131 a\u00e7\u0131s\u0131ndan de\u011ferlendirilmemesi veya uygun merkezlere y\u00f6nlendirilmemesi gibi ka\u00e7\u0131r\u0131lm\u0131\u015f f\u0131rsatlar da eri\u015fkin a\u015f\u0131lamas\u0131n\u0131n \u00f6n\u00fcndeki \u00f6nemli engeller aras\u0131ndad\u0131r (14). Bu nedenle di\u011fer poliklinikler ile eri\u015fkin a\u015f\u0131 poliklinikleri aras\u0131nda sistematik y\u00f6nlendirme ve i\u015f birli\u011fi s\u00fcre\u00e7lerinin geli\u015ftirilmesi \u00f6nemlidir.\u00a0<\/span><\/p>\nEri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131nda toplumsal hedef de\u011ferlerinin belirlenmesi ve bu hedef de\u011ferlere ula\u015f\u0131lmas\u0131, bula\u015f\u0131c\u0131 hastal\u0131k y\u00fck\u00fcn\u00fc azaltarak toplum sa\u011fl\u0131\u011f\u0131 \u00fczerine olumlu katk\u0131lar sa\u011flayabilir. Bu nedenle \u00fclkemizde say\u0131lar\u0131 giderek artan eri\u015fkin a\u015f\u0131 polikliniklerinin toplumun tamam\u0131n\u0131 kapsayacak \u015fekilde yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 \u00f6nem ta\u015f\u0131maktad\u0131r. \u00d6te yandan, eri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131nda \u00f6nemli sorumluluklara sahip olan aile hekimlerinin ba\u011f\u0131\u015f\u0131klama konusunda yeterli bilgi d\u00fczeyine sahip olmas\u0131, sa\u011fl\u0131k otoriteleri taraf\u0131ndan bilgi eksikliklerinin tespit edilmesi ve giderilmesi, a\u015f\u0131lar\u0131n zaman\u0131nda ve planl\u0131 bir \u015fekilde temin edilmesi toplumsal ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n art\u0131r\u0131lmas\u0131na katk\u0131 sa\u011flayabilir.\u00a0<\/span><\/p>\nA\u015f\u0131ya eri\u015fim konusunda \u00f6nemli bir s\u0131n\u0131rlay\u0131c\u0131 etmen olan maliyet unsurunun azalt\u0131labilmesi i\u00e7in \u00fclkemizde \u00e7ocuklara y\u00f6nelik y\u00fcr\u00fct\u00fclen Geni\u015fletilmi\u015f Ba\u011f\u0131\u015f\u0131klama Program\u0131 kapsam\u0131nda hen\u00fcz yer almayan ve bireyler taraf\u0131ndan \u00fccreti kar\u015f\u0131l\u0131\u011f\u0131 temin edilen a\u015f\u0131lar\u0131n da eri\u015fkin ba\u011f\u0131\u015f\u0131klama programlar\u0131na dahil edilmesi yararl\u0131 olabilir. Ayr\u0131ca eri\u015fkinlere y\u00f6nelik ulusal a\u015f\u0131lama \u015femalar\u0131n\u0131n geli\u015ftirilmesi ve gereksinimi olan bireylerin uygun a\u015f\u0131ya uygun zamanda ula\u015fabilmesinin sa\u011flanmas\u0131, eri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131n\u0131n g\u00fc\u00e7lendirilmesine katk\u0131 sa\u011flayabilir. COVID-19 pandemisinde uygulanan yayg\u0131n a\u015f\u0131lama faaliyetlerinde elde edilen ba\u015far\u0131, \u00fclkemizin bu konuda gerekli kurumsal kapasite ve insan g\u00fcc\u00fcne sahip oldu\u011funu g\u00f6stermektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"
G\u0130R\u0130\u015e A\u015f\u0131lama, bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n yay\u0131lmas\u0131n\u0131 \u00f6nleyen, hastal\u0131k y\u00fck\u00fcn\u00fc azaltan, etkili ve maliyet etkin bir halk sa\u011fl\u0131\u011f\u0131 uygulamas\u0131d\u0131r. Bu y\u00f6n\u00fcyle toplum sa\u011fl\u0131\u011f\u0131n\u0131n en \u00f6nemli ba\u015far\u0131lar\u0131 aras\u0131nda yer almakta ve k\u00fcresel ba\u011f\u0131\u015f\u0131klama sayesinde her y\u0131l milyonlarca \u00f6l\u00fcm engellenmektedir (1). G\u00fcn\u00fcm\u00fczde a\u015f\u0131 ile ba\u011f\u0131\u015f\u0131klama konusunda akla \u00f6ncelikle \u00e7ocukluk d\u00f6nemi a\u015f\u0131lar\u0131 gelmekle birlikte ba\u011f\u0131\u015f\u0131klama s\u00fcreci ya\u015fam boyu devam etmekte […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[6288,4391,6287,6290,6289],"class_list":["post-32011","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-asi-endikasyonlari","tag-bulasici-hastaliklar","tag-eriskin-bagisiklama","tag-koruyucu-saglik-hizmetleri","tag-kronik-hastaliklar"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=32011"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32011\/revisions"}],"predecessor-version":[{"id":32296,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32011\/revisions\/32296"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=32011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=32011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=32011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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