{"id":32391,"date":"2026-09-29T11:18:16","date_gmt":"2026-09-29T08:18:16","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=32391"},"modified":"2026-09-29T16:34:07","modified_gmt":"2026-09-29T13:34:07","slug":"eriskin-asilamasinda-smslerin-etkisi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2026\/09\/29\/eriskin-asilamasinda-smslerin-etkisi\/","title":{"rendered":"Eri\u015fkin A\u015f\u0131lamas\u0131nda Bilgilendirme Mesajlar\u0131n\u0131n Etkisi: 6 Ayl\u0131k Retrospektif \u00c7al\u0131\u015fma"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/b><\/h2>\n

Yeti\u015fkinlerde pn\u00f6mokok, influenza, bo\u011fmaca ve zona gibi a\u015f\u0131yla \u00f6nlenebilir hastal\u0131klar ciddi hastal\u0131k ve \u00f6l\u00fcm y\u00fck\u00fcne neden olmaya devam etmektedir; bu nedenle bir\u00e7ok \u00fclkede ya\u015fam boyu ba\u011f\u0131\u015f\u0131klamay\u0131 g\u00fc\u00e7lendirerek sa\u011fl\u0131kl\u0131 ya\u015flanmay\u0131 desteklemeyi ama\u00e7layan eri\u015fkin a\u015f\u0131 programlar\u0131 geni\u015fletilmektedir (1). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), ya\u015flanan n\u00fcfus, artan kronik hastal\u0131k y\u00fck\u00fc, g\u00f6\u00e7 hareketleri ve iklim de\u011fi\u015fikliklerinin bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n epidemiyolojisini de\u011fi\u015ftirdi\u011fini ve bu nedenle eri\u015fkin ba\u011f\u0131\u015f\u0131klaman\u0131n \u00e7ocukluk \u00e7a\u011f\u0131 ba\u011f\u0131\u015f\u0131klamas\u0131 kadar kritik oldu\u011funu vurgulamaktad\u0131r (2,3).<\/p>\n

Eri\u015fkinlerde pn\u00f6mokok, influenza, difteri, tetanos, asell\u00fcler bo\u011fmaca, hepatit A ve B, k\u0131zam\u0131k, kabakulak, k\u0131zam\u0131k\u00e7\u0131k, su\u00e7i\u00e7e\u011fi, herpes zoster, meningokok, Haemophilus influenzae<\/i> tip B ve HPV a\u015f\u0131lar\u0131n\u0131n endikasyona g\u00f6re uygulanmas\u0131 \u00f6nerilmektedir (4). Ancak hem d\u00fcnyada hem de T\u00fcrkiye\u2019de eri\u015fkin a\u015f\u0131lanma oranlar\u0131 h\u00e2len hedeflenen seviyelerin olduk\u00e7a alt\u0131ndad\u0131r (1,5).<\/p>\n

Birle\u015fik Krall\u0131k\u2019ta 65 ya\u015f ve \u00fczeri n\u00fcfusta pn\u00f6mokok a\u015f\u0131lanma oranlar\u0131, 2003 y\u0131l\u0131nda ba\u015flat\u0131lan yo\u011fun a\u015f\u0131lama kampanyas\u0131n\u0131n ard\u0131ndan 2007 y\u0131l\u0131 itibar\u0131yla %70\u2019in \u00fczerine \u00e7\u0131km\u0131\u015f ve bu y\u00fcksek kapsay\u0131c\u0131l\u0131k d\u00fczeyi korunmu\u015ftur. Amerika Birle\u015fik Devletleri\u2019nde ise benzer \u015fekilde, son on be\u015f y\u0131ll\u0131k d\u00f6nemde 65 ya\u015f ve \u00fczeri bireylerde pn\u00f6mokok a\u015f\u0131lanma oranlar\u0131n\u0131n tutarl\u0131 bir \u015fekilde %60\u201370 band\u0131nda seyretti\u011fi bildirilmi\u015ftir (6). T\u00fcrkiye\u2019de yap\u0131lan \u00e7al\u0131\u015fmalar, influenza ve pn\u00f6mokok a\u015f\u0131lar\u0131n\u0131n \u00f6zellikle ya\u015fl\u0131 ve kronik hastal\u0131\u011f\u0131 olan bireylerde d\u00fc\u015f\u00fck oranda uyguland\u0131\u011f\u0131n\u0131 g\u00f6stermektedir (7\u20139). \u00c7e\u015fitli merkezlerden bildirilen bulgular, a\u015f\u0131lanma oranlar\u0131n\u0131n influenza i\u00e7in genellikle %10\u201340 aras\u0131nda, pn\u00f6mokok i\u00e7in %5\u201315 aras\u0131nda seyretti\u011fini, tetanos ve hepatit B a\u015f\u0131lamas\u0131n\u0131n ise daha d\u00fc\u015f\u00fck d\u00fczeylerde kald\u0131\u011f\u0131n\u0131 ortaya koymaktad\u0131r (7\u201311).\u00a0<\/span><\/p>\n

Eri\u015fkinlerde a\u015f\u0131 yapt\u0131rmama nedenleri aras\u0131nda fark\u0131ndal\u0131k eksikli\u011fi, hekimin a\u015f\u0131 \u00f6nermemesi, bireysel isteksizlik ve maliyet engeli \u00f6ne \u00e7\u0131kmaktad\u0131r (7,9,12). Hekimlerin rol model olmas\u0131, dan\u0131\u015fmanl\u0131k sa\u011flamas\u0131 ve bireyleri a\u015f\u0131ya y\u00f6nlendirmesi, a\u015f\u0131lanma davran\u0131\u015f\u0131nda en g\u00fc\u00e7l\u00fc belirleyicilerdir (3).<\/p>\n

Son y\u0131llarda eri\u015fkin ba\u011f\u0131\u015f\u0131klama oranlar\u0131n\u0131 art\u0131rmaya y\u00f6nelik dijital hat\u0131rlatma sistemleri, \u00f6zellikle k\u0131sa mesaj hizmeti (short message service, SMS) ile yap\u0131lan bilgilendirme uygulamalar\u0131 g\u00fcndeme gelmi\u015ftir. Yap\u0131lan meta-analizler, SMS hat\u0131rlatmalar\u0131n\u0131n a\u015f\u0131lanma oranlar\u0131n\u0131 anlaml\u0131 d\u00fczeyde art\u0131rd\u0131\u011f\u0131n\u0131, \u00f6zellikle d\u00fc\u015f\u00fck maliyetli ve \u00f6l\u00e7eklenebilir bir y\u00f6ntem olarak kullan\u0131labilece\u011fini ortaya koymu\u015ftur (13). Randomize kontroll\u00fc \u00e7al\u0131\u015fmalar, SMS hat\u0131rlatmas\u0131 alan bireylerin influenza gibi a\u015f\u0131lar\u0131 olma olas\u0131l\u0131\u011f\u0131n\u0131n anlaml\u0131 \u015fekilde artt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir (14,15).<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n yap\u0131ld\u0131\u011f\u0131 \u00fc\u00e7\u00fcnc\u00fc basamak e\u011fitim ve ara\u015ft\u0131rma hastanesinde, eri\u015fkin a\u015f\u0131 poliklini\u011fi hizmetleri, aile hekimli\u011fi klini\u011fine devredildikten sonra yeni bir uygulamaya ge\u00e7ilmi\u015ftir. Bu uygulama kapsam\u0131nda, 65 ya\u015f ve \u00fczeri bireyler ile diyabet, kronik kalp, akci\u011fer ve b\u00f6brek hastal\u0131klar\u0131 gibi infeksiyon riski ta\u015f\u0131yan bireylerin herhangi bir poliklinik ba\u015fvurusu sonras\u0131nda, SMS yoluyla telefonlar\u0131na \u201cRisk durumunda olman\u0131zdan dolay\u0131 hastanemizde bulunan eri\u015fkin a\u015f\u0131 poliklini\u011fine ba\u015fvurabilirsiniz\u201d \u015feklinde otomatik bir bilgilendirme mesaj\u0131 g\u00f6nderilmektedir. Bu \u015fekilde eri\u015fkin a\u015f\u0131 poliklini\u011fine y\u00f6nlendirilen hastalar\u0131n A\u015f\u0131 Takip Sistemi (ATS) \u00fczerinden ge\u00e7mi\u015f a\u015f\u0131 kay\u0131tlar\u0131 kontrol edilmekte; eksik a\u015f\u0131lar\u0131 hakk\u0131nda bilgilendirme yap\u0131lmakta ve gerekli a\u015f\u0131lar\u0131 yapt\u0131rmalar\u0131 konusunda te\u015fvik edilmektedirler.<\/p>\n

Bu do\u011frultuda \u00e7al\u0131\u015fmam\u0131zda, s\u00f6z konusu hastanede ba\u015flat\u0131lan SMS bilgilendirme uygulamas\u0131n\u0131n eri\u015fkin a\u015f\u0131 poliklini\u011fine ba\u015fvuru ve a\u015f\u0131lanma \u00fczerindeki etkisinin yan\u0131 s\u0131ra, dan\u0131\u015fmanl\u0131k sonras\u0131 a\u015f\u0131lanma durumunu, a\u015f\u0131lanmama gerek\u00e7elerini ve demografik belirleyicileri de\u011ferlendirmeyi ama\u00e7lad\u0131k.<\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

Retrospektif kesitsel olarak tasarlanan bu \u00e7al\u0131\u015fmada, Temmuz\u2013Aral\u0131k 2024 d\u00f6neminde Eri\u015fkin A\u015f\u0131 Poliklini\u011fi\u2019ne ba\u015fvuran 18 ya\u015f ve \u00fczeri 921 hastan\u0131n verileri de\u011ferlendirildi. Hastalar\u0131n ya\u015f, cinsiyet, e\u011fitim durumu, kronik hastal\u0131k varl\u0131\u011f\u0131 ve a\u015f\u0131lanma durumlar\u0131 hastane bilgi y\u00f6netim sistemi (HBYS) ve ATS \u00fczerinden elde edildi. Temmuz 2024\u2019te ba\u015flat\u0131lan SMS bilgilendirme sisteminin etkisini de\u011ferlendirmek amac\u0131yla, SMS \u00f6ncesi Temmuz\u2013Aral\u0131k 2023 d\u00f6nemine ait eri\u015fkin a\u015f\u0131lama verileri ATS \u00fczerinden al\u0131nd\u0131 ve uygulanan a\u015f\u0131lar\u0131n oranlar\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Hastalar\u0131n demografik \u00f6zellikleri, a\u015f\u0131 t\u00fcrleri, dan\u0131\u015fmanl\u0131k hizmeti sonras\u0131 a\u015f\u0131lanma durumlar\u0131 ve a\u015f\u0131lanmama gerek\u00e7eleri dosyalar\u0131na kaydedilmi\u015fti. A\u015f\u0131 olmay\u0131 reddeden hastalara, ba\u015fvuru s\u0131ras\u0131nda ret gerek\u00e7eleri sorulmu\u015f ve yan\u0131tlar\u0131 poliklinik muayene notuna eklenmi\u015fti.\u00a0<\/span><\/p>\n

Temmuz\u2013Aral\u0131k 2024 d\u00f6neminde poliklini\u011fe ba\u015fvuran t\u00fcm hastalar (N=921) i\u00e7in indeks tarih, ba\u015fvuru g\u00fcn\u00fc olarak kabul edildi. Bu tarihten \u00f6nceki a\u015f\u0131lanma durumu ATS kay\u0131tlar\u0131 \u00fczerinden \u201cpoliklinik \u00f6ncesi ba\u011f\u0131\u015f\u0131kl\u0131k\u201d olarak kaydedildi. Ba\u015fvuru s\u0131ras\u0131nda veya sonras\u0131nda poliklini\u011fimizde re\u00e7etelenen influenza a\u015f\u0131lar\u0131 ve merkezimizde uygulanan t\u00fcm a\u015f\u0131lar HBYS\/ATS kay\u0131tlar\u0131 arac\u0131l\u0131\u011f\u0131yla \u201cpoliklinik sonras\u0131 uygulanan dozlar\u201d \u015feklinde kaydedildi. \u201cPoliklinik \u00f6ncesi ba\u011f\u0131\u015f\u0131kl\u0131k\u201d ve \u201cpoliklinik sonras\u0131 uygulanan dozlar\u201d ayr\u0131 de\u011fi\u015fkenler olarak kaydedildi. Toplam ba\u011f\u0131\u015f\u0131kl\u0131k durumu, rapel dozlar ve pn\u00f6mokok a\u015f\u0131lar\u0131nda farkl\u0131 \u00fcr\u00fcnlerin uygulanmas\u0131 dikkate al\u0131narak, 1 Ocak 2025 tarihinde yap\u0131lan son ATS taramas\u0131ndaki kay\u0131tlar \u00fczerinden belirlendi.<\/p>\n

\u0130statistiksel Analizler<\/b><\/h3>\n

Verilerin analizinde IBM SPSS Statistics 27.0 (IBM Corp., Armonk, NY, ABD) program\u0131 kullan\u0131ld\u0131. S\u00fcrekli de\u011fi\u015fkenler ortalama \u00b1 standart sapma (SD) ve minimum-maksimum olarak ifade edildi. Kategorik de\u011fi\u015fkenler ise say\u0131 (n) ve y\u00fczde (%) \u015feklinde sunuldu. Kategorik de\u011fi\u015fkenler aras\u0131ndaki ili\u015fkileri de\u011ferlendirmek i\u00e7in \u03c7\u00b2 testi kullan\u0131ld\u0131; beklenen h\u00fccre frekanslar\u0131n\u0131n 5\u2019ten k\u00fc\u00e7\u00fck oldu\u011fu durumlarda Fisher kesin testi uyguland\u0131. Birden fazla kategori i\u00e7eren \u00e7apraz tablolar\u0131n analizinde Fisher-Freeman-Halton kesin testi kullan\u0131ld\u0131. \u0130statistiksel anlaml\u0131l\u0131k d\u00fczeyi p<\/i><0.05 olarak kabul edildi.<\/p>\n

Helsinki Bildirgesi\u2019ne uygun olarak y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fma i\u00e7in SB\u00dc \u0130zmir Bozyaka E\u011fitim ve Ara\u015ft\u0131rma Hastanesi Klinik Ara\u015ft\u0131rmalar Etik Kurulu\u2019ndan 8 Ocak 2025 tarihinde ve 2025\/03 karar numaras\u0131yla onay al\u0131nd\u0131.\u00a0<\/span><\/p>\n

BULGULAR<\/b><\/h2>\n
\"\"<\/a>

Tablo 1.<\/strong> Hastalar\u0131n Tan\u0131mlay\u0131c\u0131 \u00d6zellikleri<\/p><\/div>\n

Bu \u00e7al\u0131\u015fmada 921 birey incelendi ve ya\u015f ortalamas\u0131 63.99 \u00b1 16.39 y\u0131l olarak belirlendi. Kat\u0131l\u0131mc\u0131lar\u0131n 683\u2019\u00fc (%74.2) 65 ya\u015f ve \u00fczeri, 520\u2019si (%56.5) erkekti. E\u011fitimlerine bak\u0131ld\u0131\u011f\u0131nda kat\u0131l\u0131mc\u0131lar\u0131n 519\u2019unun (%56.4) ilkokul ve alt\u0131 e\u011fitim d\u00fczeyine sahip oldu\u011fu g\u00f6r\u00fcld\u00fc. A\u015f\u0131 olmaya istekli olanlar\u0131n say\u0131s\u0131 799 (%86.7), karars\u0131zlar\u0131n say\u0131s\u0131 ise 122 (%13.3) idi. Poliklini\u011fe ba\u015fvurunun en s\u0131k bildirilen nedeni, 756 ki\u015fi (%82.1) taraf\u0131ndan belirtilen hastane bilgilendirme mesajlar\u0131yd\u0131. Kat\u0131l\u0131mc\u0131lar\u0131n 543\u2019\u00fcnde (%59.0) en az bir kronik hastal\u0131k bulunurken, en yayg\u0131n hastal\u0131klar diyabet 297 (%32.2), kronik kalp hastal\u0131\u011f\u0131 226 (%24.5) ve kronik akci\u011fer hastal\u0131klar\u0131 99 (%10.7) olarak belirlendi (Tablo 1).<\/p>\n

2023 Temmuz\u2013Aral\u0131k d\u00f6neminde konjuge pn\u00f6mokok a\u015f\u0131s\u0131 (KPA13) 70 ve influenza a\u015f\u0131s\u0131 115 doz uygulanm\u0131\u015fken, 2024 Temmuz\u2013Aral\u0131k d\u00f6neminde KPA13 a\u015f\u0131s\u0131n\u0131n 414 ve influenza a\u015f\u0131s\u0131n\u0131n 642 doza y\u00fckseldi\u011fi g\u00f6r\u00fcld\u00fc. Mutlak art\u0131\u015f KPA13 a\u015f\u0131s\u0131 i\u00e7in 5.91 kat iken influenza a\u015f\u0131s\u0131 i\u00e7in yakla\u015f\u0131k 5.58 kat idi.<\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> Poliklinikte Uygulanan A\u015f\u0131lar\u0131n Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong> Poliklinik Ba\u015fvurusu \u00d6ncesi ve Sonras\u0131nda A\u015f\u0131lanma Oranlar\u0131 (N=921)<\/p><\/div>\n

Eri\u015fkin a\u015f\u0131 poliklini\u011fine ba\u015fvuran bireylerin a\u015f\u0131lanma oran\u0131 %91.6 (n=844) olarak belirlendi. Poliklinikte en s\u0131k uygulanan a\u015f\u0131 t\u00fcrleri influenza (%51.9, n=642) ve KPA13 (%33.4, n=414) olup bunu tetanos, hepatit A, hepatit B, 23-valanl\u0131 polisakkarit pn\u00f6mokok a\u015f\u0131s\u0131 (PPA23) ve di\u011fer a\u015f\u0131lar takip ediyordu (\u015eekil 1). A\u015f\u0131 Takip Sistemi sorgulamas\u0131na g\u00f6re hastalar\u0131n dan\u0131\u015fmanl\u0131k \u00f6ncesi ve sonras\u0131 a\u015f\u0131lanma durumlar\u0131 de\u011ferlendirildi\u011finde, tetanos a\u015f\u0131lanma oran\u0131 dan\u0131\u015fmanl\u0131k \u00f6ncesinde %24.3 (n=224) iken, %4.8 (n=44) ek a\u015f\u0131lama ile toplamda %29.1\u2019e (n=268) y\u00fckseldi\u011fi g\u00f6r\u00fcld\u00fc. Benzer \u015fekilde, pn\u00f6mokok [20-valanl\u0131 konjuge pn\u00f6mokok a\u015f\u0131s\u0131 (KPA20), KPA13, PPA23] a\u015f\u0131lanma oran\u0131 dan\u0131\u015fmanl\u0131k \u00f6ncesinde %35.4 (n=326) iken, poliklinikte uygulanan ilave dozlar sonucunda 44.4 y\u00fczde puanl\u0131k art\u0131\u015fla toplamda %79.8 (n=735) d\u00fczeyine ula\u015fm\u0131\u015ft\u0131r. Poliklinikte toplam 449 doz pn\u00f6mokok a\u015f\u0131s\u0131 uygulanm\u0131\u015f olmas\u0131na ra\u011fmen, net ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131ndaki art\u0131\u015f\u0131n doz say\u0131s\u0131ndan d\u00fc\u015f\u00fck kalmas\u0131, baz\u0131 hastalara uygulanan tekrar dozlar\u0131ndan veya rapel uygulamalar\u0131ndan kaynaklanmaktad\u0131r. \u0130nfluenza a\u015f\u0131s\u0131na ili\u015fkin dan\u0131\u015fmanl\u0131k \u00f6ncesi a\u015f\u0131lanma oran\u0131 ise %8.1 (n=75) olup dan\u0131\u015fmanl\u0131k sonras\u0131 69.7 y\u00fczde puana y\u00fckselerek toplamda %77.9 (n=717) d\u00fczeyine ula\u015ft\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc (Tablo 2).<\/p>\n

\"\"<\/a>

Tablo 3.<\/strong> Ya\u015f Gruplar\u0131na G\u00f6re Poliklinikte Uygulanan A\u015f\u0131lar\u0131n Da\u011f\u0131l\u0131m\u0131 ve \u0130statistiksel Kar\u015f\u0131la\u015ft\u0131rmas\u0131<\/p><\/div>\n

Ya\u015f gruplar\u0131 aras\u0131nda t\u00fcm a\u015f\u0131 t\u00fcrlerinde istatistiksel olarak anlaml\u0131 farkl\u0131l\u0131klar tespit edildi (p<\/i><0.001). Altm\u0131\u015f be\u015f ya\u015f ve \u00fczeri grupta influenza a\u015f\u0131lanma oran\u0131 %74.7 (n=510), pn\u00f6mokok a\u015f\u0131lanma oran\u0131 ise %56.4 (n=385) olarak bulundu. \u00d6te yandan 65 ya\u015f alt\u0131 bireylerde hepatit A a\u015f\u0131lanma oran\u0131 %13.0 (n=31), hepatit B a\u015f\u0131lanma oran\u0131 %15.1 (n=36) idi. Tetanos a\u015f\u0131lanma oran\u0131 65 ya\u015f alt\u0131 bireylerde %13.4 (n=32) iken 65 ya\u015f ve \u00fczeri bireylerde %1.8 (n=12) olarak bulundu (Tablo 3).<\/p>\n

E\u011fitim d\u00fczeyi ile hem eri\u015fkin d\u00f6nemde herhangi bir a\u015f\u0131 yapt\u0131rma durumu hem de poliklinikte a\u015f\u0131lanma oran\u0131 aras\u0131nda istatistiksel olarak anlaml\u0131 d\u00fczeyde bir ili\u015fki oldu\u011fu tespit edildi (s\u0131ras\u0131yla, p<\/i>=0.027 ve p<\/i><0.001). Eri\u015fkin d\u00f6nemde herhangi bir a\u015f\u0131 yapt\u0131rma oran\u0131, e\u011fitim d\u00fczeyi artt\u0131k\u00e7a artma e\u011filimi g\u00f6steriyordu. Bu oran en d\u00fc\u015f\u00fck okuryazar olmayan bireylerde (n=25, %89.3) g\u00f6r\u00fcl\u00fcrken, ortaokul mezunlar\u0131nda (n=55, %100.0), lise mezunlar\u0131nda (n=163, %99.4) ve y\u00fcksek\u00f6\u011fretim mezunlar\u0131nda (n=182, %99.5) en y\u00fcksek d\u00fczeylere ula\u015ft\u0131\u011f\u0131 tespit edildi.\u00a0<\/span><\/p>\n

Poliklinikte a\u015f\u0131lanma oranlar\u0131ndaki e\u011fitim temelli farkl\u0131l\u0131k ise \u00e7ok daha belirgindi; e\u011fitim d\u00fczeyi y\u00fckseldik\u00e7e bu oran\u0131n azald\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc. A\u015f\u0131lanmama oran\u0131 en y\u00fcksek okur yazar olmayan bireylerde (n=4, %14.3) ve ilkokul mezunlar\u0131nda (n=53, %12.1) g\u00f6r\u00fcl\u00fcrken, bu oran\u0131n lise mezunlar\u0131nda (n=6, %3.7) ve y\u00fcksek\u00f6\u011fretim mezunlar\u0131nda (n=5, %2.7) belirgin \u015fekilde d\u00fc\u015ft\u00fc\u011f\u00fc tespit edildi.<\/p>\n

\"\"<\/a>

\u015eekil 2.<\/strong> Dan\u0131\u015fmanl\u0131k Sonras\u0131 A\u015f\u0131 Yapt\u0131rmayan Bireylerin Pn\u00f6mokok A\u015f\u0131s\u0131 T\u00fcr\u00fcne G\u00f6re Da\u011f\u0131l\u0131m\u0131 ve A\u015f\u0131lanmama Nedenleri<\/p><\/div>\n

Poliklini\u011fe ba\u015fvuran toplam 921 ki\u015finin 844\u2019\u00fc (%91.6) poliklinikte en az bir doz a\u015f\u0131 yapt\u0131rm\u0131\u015f olup yaln\u0131zca 77\u2019sinin (%8.4) poliklinik sonras\u0131 ek bir a\u015f\u0131 yapt\u0131rmad\u0131\u011f\u0131 tespit edildi. A\u015f\u0131 yapt\u0131rmam\u0131\u015f 77 birey, a\u015f\u0131lanmama gerek\u00e7elerini daha net ortaya koyabilmek ad\u0131na reddettikleri pn\u00f6mokok a\u015f\u0131s\u0131n\u0131n t\u00fcr\u00fcne (\u00fccretli\/\u00fccretsiz) g\u00f6re iki temel grupta incelendi (\u015eekil 2).<\/p>\n

Birinci grubu, ge\u00e7mi\u015fte (\u22651 y\u0131l \u00f6nce) KPA13 a\u015f\u0131s\u0131 yap\u0131lm\u0131\u015f olan ancak poliklinikte ilave doz olarak \u00f6nerilen \u00fccretli pn\u00f6mokok a\u015f\u0131lar\u0131n\u0131 (PPA23\/KPA20) reddeden 54 ki\u015fi (%70.1) olu\u015fturdu. Bu gruptaki hastalar\u0131n a\u015f\u0131lanmama gerek\u00e7eleri incelendi\u011finde, en yayg\u0131n gerek\u00e7enin %79.6 (n=43) oran\u0131yla a\u015f\u0131 \u00fccretinin devlet taraf\u0131ndan kar\u015f\u0131lanmamas\u0131 oldu\u011fu tespit edildi. Geriye kalan 11 ki\u015finin (%20.4) ise a\u015f\u0131y\u0131 yapt\u0131rmadan \u00f6nce d\u00fc\u015f\u00fcnmek istedi\u011fini ifade etti\u011fi g\u00f6r\u00fcld\u00fc.<\/p>\n

\u0130kinci grubu ise poliklinik ba\u015fvurusu s\u0131ras\u0131nda herhangi a\u015f\u0131 uygulanmam\u0131\u015f ve \u00f6nerilen \u00fccretsiz KPA13 a\u015f\u0131s\u0131n\u0131 reddeden 23 ki\u015fi (%29.9) olu\u015fturdu. \u00dccretsiz a\u015f\u0131y\u0131 reddeden bireylerde en s\u0131k bildirilen neden, karar vermeden \u00f6nce d\u00fc\u015f\u00fcnmek istemeleriydi (n=9; %39.1). Bunu, a\u015f\u0131ya ihtiyac\u0131 olmad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnmek (n=4; %17.4), hastanede a\u015f\u0131 sto\u011funun ge\u00e7ici olarak bitmi\u015f olmas\u0131 (n=2; %8.7) ve a\u015f\u0131 hakk\u0131nda yeterli bilgisinin olmamas\u0131 (n=2; %8.7) izliyordu. Di\u011fer a\u015f\u0131lanmama gerek\u00e7eleri aras\u0131nda; kendi takipli hekimine dan\u0131\u015fma iste\u011fi, a\u015f\u0131 yapt\u0131rmay\u0131 istememek, a\u015f\u0131n\u0131n zorunlu olmamas\u0131, mevcut klinik durum, a\u015f\u0131lara kar\u015f\u0131 g\u00fcvensizlik ve nedenini belirtmemek yer al\u0131yordu; bu nedenlerin her biri 1 hasta (%4.3) taraf\u0131ndan dile getirilmi\u015fti.<\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Bu \u00e7al\u0131\u015fma, eri\u015fkin a\u015f\u0131lamay\u0131 te\u015fvik etmek amac\u0131yla kullan\u0131lan hedefli SMS bilgilendirme m\u00fcdahalesinin eri\u015fkin a\u015f\u0131 poliklini\u011fine ba\u015fvuru ve a\u015f\u0131lanma a\u00e7\u0131s\u0131ndan sonu\u00e7lar\u0131n\u0131 de\u011ferlendirdi. Bulgular, eri\u015fkin a\u015f\u0131 poliklini\u011fine ba\u015fvuranlar\u0131n yakla\u015f\u0131k d\u00f6rtte \u00fc\u00e7\u00fcn\u00fcn 65 ya\u015f ve \u00fczerinde oldu\u011funu; a\u015f\u0131 kapsam\u0131n\u0131n \u00f6zellikle influenza ve KPA13 a\u015f\u0131lar\u0131nda belirgin bi\u00e7imde artt\u0131\u011f\u0131n\u0131; ba\u015fvuru an\u0131nda herhangi bir eri\u015fkin a\u015f\u0131s\u0131 olma oran\u0131n\u0131n %57.5\u2019ten dan\u0131\u015fmanl\u0131k sonras\u0131 %98.5\u2019e y\u00fckseldi\u011fini ortaya koydu. Bu sonu\u00e7, ya\u015fl\u0131 ve komorbid bireylerde influenza ve pn\u00f6mokok a\u015f\u0131lar\u0131n\u0131n \u00f6nceliklendirildi\u011fine ili\u015fkin uluslararas\u0131 ve ulusal rehber \u00f6nerileriyle uyumludur (16\u201318). \u00dclkemizde eri\u015fkin a\u015f\u0131 polikliniklerine ba\u015fvuranlar\u0131n s\u0131kl\u0131kla 35\u201345 ya\u015f band\u0131nda k\u00fcmelendi\u011fi bildirilmi\u015ftir (19\u201322). Bu \u00e7al\u0131\u015fmada ise bilgilendirme mesajlar\u0131 ile \u00f6zellikle risk grubunda olan 65 ya\u015f ve \u00fczeri bireylerin ba\u015fvurular\u0131nda art\u0131\u015f tespit edildi.<\/p>\n

\u00dclkemizde yap\u0131lan yak\u0131n d\u00f6nem \u00e7al\u0131\u015fmalar, eri\u015fkin a\u015f\u0131lanma oranlar\u0131n\u0131n merkez, \u00f6rneklem ve eri\u015fim dinamiklerine ba\u011fl\u0131 olarak geni\u015f aral\u0131kta seyretti\u011fini g\u00f6stermi\u015ftir. Birinci basamakta a\u015f\u0131lanma oranlar\u0131; tetanos %19\u201342, influenza %8\u201334, hepatit B %8\u201318 aras\u0131nda rapor edilirken; pn\u00f6mokok \u00e7o\u011fu seride %0.2\u20134.7, zona ise %0\u20133 d\u00fczeylerinde bildirilmi\u015ftir (19\u201322). Bu \u00e7al\u0131\u015fmada ise poliklinik \u00f6ncesi influenza ve pn\u00f6mokok a\u015f\u0131lanma oranlar\u0131n\u0131n d\u00fc\u015f\u00fck oldu\u011fu, dan\u0131\u015fmanl\u0131k sonras\u0131nda ise y\u00fcksek d\u00fczeylere ula\u015ft\u0131\u011f\u0131 g\u00f6r\u00fcld\u00fc; bu durum, hem hedef pop\u00fclasyonun (ileri ya\u015f ve komorbidite) hem de m\u00fcdahalenin (SMS + yerinde dan\u0131\u015fmanl\u0131k) bu sonu\u00e7lardaki rol\u00fcn\u00fc g\u00f6stermektedir. \u00c7ok merkezli ve g\u00fcncel bir \u00e7al\u0131\u015fmada aile hekimli\u011fi polikliniklerine ba\u015fvuran diyabetli bireylerde a\u015f\u0131 poliklini\u011fi fark\u0131ndal\u0131\u011f\u0131n\u0131n d\u00fc\u015f\u00fck oldu\u011fu; buna kar\u015f\u0131n hekim \u00f6nerisi alanlar\u0131n a\u015f\u0131y\u0131 y\u00fcksek oranda yapt\u0131rd\u0131\u011f\u0131 ve eri\u015fkin a\u015f\u0131 poliklini\u011finin varl\u0131\u011f\u0131n\u0131n \u00f6zellikle KPA13 yapt\u0131ran hasta say\u0131s\u0131n\u0131 anlaml\u0131 \u00f6l\u00e7\u00fcde art\u0131rd\u0131\u011f\u0131 bildirilmi\u015ftir (23). Bizim \u00e7al\u0131\u015fmam\u0131zda da klinik eri\u015fim kolayl\u0131\u011f\u0131, hekim \u00f6nerisi ve zamanl\u0131 SMS bilgilendirmesinin bir araya gelmesinin olumlu sonu\u00e7larla ili\u015fkili olabilece\u011fi g\u00f6r\u00fcld\u00fc. \u00d6yle ki, bir \u00f6nceki y\u0131l\u0131n ayn\u0131 d\u00f6nemine g\u00f6re uygulanan influenza ve pn\u00f6mokok a\u015f\u0131lar\u0131n\u0131n doz say\u0131s\u0131nda yakla\u015f\u0131k 5\u20136 kat art\u0131\u015f tespit edildi.<\/p>\n

Davran\u0131\u015fsal bilim literat\u00fcr\u00fc, sa\u011fl\u0131k hizmetlerine y\u00f6nelimde \u201can\u0131msatma\/tetikleme\u201d (reminder) ve \u201ckolayla\u015ft\u0131rma\u201d (facilitation) ilkelerinin g\u00fc\u00e7l\u00fc belirleyiciler oldu\u011funu bildirmi\u015ftir (24). Bu \u00e7al\u0131\u015fmada tetikleme, risk temelli ve zamanl\u0131 yap\u0131lan bilgilendirme mesajlar\u0131; kolayla\u015ft\u0131rma ise poliklinik d\u00fczeyinde dan\u0131\u015fmanl\u0131k ve uygun a\u015f\u0131ya eri\u015fim olana\u011f\u0131n\u0131n sa\u011flanmas\u0131d\u0131r. Nitekim hastalar\u0131n yakla\u015f\u0131k be\u015fte d\u00f6rd\u00fcn\u00fcn ba\u015fvurusunu hastane bilgilendirme mesajlar\u0131 sayesinde yapt\u0131\u011f\u0131n\u0131 bildirmesi, SMS m\u00fcdahalesinin ba\u015fvuruyu destekleyen bir ara\u00e7 oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmektedir. Buna kar\u015f\u0131l\u0131k poliklinikte tetanos a\u015f\u0131lanma oran\u0131ndaki s\u0131n\u0131rl\u0131 art\u0131\u015f, a\u015f\u0131 uygulamas\u0131n\u0131n hastanemizde b\u00fcy\u00fck \u00f6l\u00e7\u00fcde acil serviste yap\u0131lmas\u0131ndan kaynaklanm\u0131\u015f olabilir. Bu bulgu, SMS hat\u0131rlatmas\u0131n\u0131n yan\u0131 s\u0131ra a\u015f\u0131ya eri\u015fim olanaklar\u0131n\u0131n da a\u015f\u0131lanma \u00fczerinde etkili olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

Bulgular\u0131m\u0131z, 65 ya\u015f ve \u00fczerindeki bireylerde pn\u00f6mokok ve influenza a\u015f\u0131lanma oran\u0131n\u0131n belirgin bi\u00e7imde artt\u0131\u011f\u0131n\u0131; 65 ya\u015f alt\u0131nda ise tetanos, hepatit A ve hepatit B a\u015f\u0131lanma oranlar\u0131n\u0131n g\u00f6rece daha y\u00fcksek oldu\u011funu g\u00f6sterdi. Bu da\u011f\u0131l\u0131m, DS\u00d6 ve ulusal rehberlerin ileri ya\u015ftaki bireylerde influenza ve pn\u00f6mokok a\u015f\u0131lar\u0131n\u0131 \u00f6nceliklendiren \u00f6nerileri ile \u00f6rt\u00fc\u015fmektedir (16\u201318). \u0130leri ya\u015f grubunda influenza a\u015f\u0131lanma oran\u0131n\u0131n daha y\u00fcksek olmas\u0131, bu grupta influenza a\u015f\u0131s\u0131na y\u00f6nelik fark\u0131ndal\u0131\u011f\u0131n daha y\u00fcksek olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Ancak \u00e7al\u0131\u015fmam\u0131zda hasta veya hekim fark\u0131ndal\u0131\u011f\u0131 do\u011frudan de\u011ferlendirilmedi\u011finden, bu bulgu fark\u0131ndal\u0131k d\u00fczeyi ile a\u00e7\u0131klanamaz.<\/p>\n

\u00dclkemizde yap\u0131lan \u00e7al\u0131\u015fmalarda eri\u015fkin d\u00f6nemde a\u015f\u0131 yapt\u0131rmayan bireylerin en s\u0131k dile getirdi\u011fi a\u015f\u0131 yapt\u0131rmama nedenleri aras\u0131nda, doktor \u00f6nerisinin olmamas\u0131 ve a\u015f\u0131 gereklili\u011fi hakk\u0131nda bilgi eksikli\u011fi yer almaktad\u0131r (19,20). Bu durum, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131 konusundaki bilgi d\u00fczeyi ve hastalara a\u015f\u0131y\u0131 \u00f6nermesinin eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131 do\u011frudan etkiledi\u011fini g\u00f6stermektedir. Poliklini\u011fe ba\u015fvuran toplam 921 ki\u015finin yaln\u0131zca 77\u2019si (%8.4) a\u015f\u0131 yapt\u0131rmam\u0131\u015f olup bu grupta en s\u0131k neden a\u015f\u0131 \u00fccretinin devlet taraf\u0131ndan kar\u015f\u0131lanmamas\u0131yd\u0131 (%79.6). Kat\u0131l\u0131mc\u0131lar\u0131n poliklinikte bilgilendirilmesine ra\u011fmen bu gerek\u00e7enin bildirilmesi, bilgiye ra\u011fmen ekonomik ve bireysel \u00e7ekincelerin a\u015f\u0131lanmama ile ili\u015fkili olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. \u00dclkemizde ve d\u00fcnyada, ekonomik fakt\u00f6rlerin eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131 d\u00fc\u015f\u00fcren temel engellerden biri oldu\u011fu bildirilmi\u015ftir (20,22,25). Eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131n art\u0131r\u0131lmas\u0131nda sa\u011fl\u0131k politikalar\u0131n\u0131n \u00f6nemli bir rol\u00fc bulunmaktad\u0131r. Geli\u015fmi\u015f \u00fclkelerde daha y\u00fcksek a\u015f\u0131lama oranlar\u0131n\u0131n; kapsaml\u0131 a\u015f\u0131lama programlar\u0131, sigorta sistemleri ve devlet destekli kampanyalar ile ili\u015fkili oldu\u011fu bildirilmi\u015ftir (26). \u00dclkemizde eri\u015fkin a\u015f\u0131lama politikalar\u0131n\u0131n geli\u015ftirilmesi ve a\u015f\u0131lama maliyetlerinin kar\u015f\u0131lanmas\u0131, eri\u015fim engellerini azaltarak a\u015f\u0131lanma oranlar\u0131n\u0131 art\u0131rabilecektir.<\/p>\n

Yap\u0131lan \u00e7al\u0131\u015fmalar d\u00fc\u015f\u00fck e\u011fitim d\u00fczeyine sahip bireylerin a\u015f\u0131 yapt\u0131rmama davran\u0131\u015f\u0131na daha yatk\u0131n oldu\u011funu ve e\u011fitim d\u00fczeyi artt\u0131k\u00e7a a\u015f\u0131 yapt\u0131rmama oran\u0131n\u0131n azald\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir (27). \u00dclkemizde de e\u011fitim d\u00fczeyinin a\u015f\u0131 kabul\u00fc \u00fczerinde pozitif etkisi oldu\u011fu ve e\u011fitim d\u00fczeyi d\u00fc\u015ft\u00fck\u00e7e a\u015f\u0131 reddetme oranlar\u0131n\u0131n artt\u0131\u011f\u0131 bildirilmi\u015ftir (20\u201322). Bu \u00e7al\u0131\u015fmada a\u015f\u0131 yapt\u0131rmayan 5 bireyden 4\u2019\u00fcn\u00fcn ilkokul ve alt\u0131 e\u011fitim d\u00fczeyinde oldu\u011fu tespit edildi. Bu durum, eri\u015fkin a\u015f\u0131lama uygulamalar\u0131nda e\u011fitim d\u00fczeyinin dikkate al\u0131nmas\u0131n\u0131n yararl\u0131 olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir.<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n retrospektif, tek merkezli olmas\u0131 ve yaln\u0131zca HBYS\/ATS kay\u0131tlar\u0131na dayanmas\u0131 \u00f6nemli s\u0131n\u0131rl\u0131l\u0131klar olu\u015fturmaktad\u0131r. Bir m\u00fcdahale \u00e7al\u0131\u015fmas\u0131 olarak planlanmad\u0131\u011f\u0131ndan SMS hizmetinin tek ba\u015f\u0131na etkisi nedensel olarak de\u011ferlendirilemedi; de\u011ferlendirme Temmuz\u2013Aral\u0131k 2024 d\u00f6nemindeki eri\u015fkin a\u015f\u0131lama oranlar\u0131yla Temmuz\u2013Aral\u0131k 2023 d\u00f6nemindeki eri\u015fkin a\u015f\u0131lama oran\u0131 kar\u015f\u0131la\u015ft\u0131rmas\u0131yla yap\u0131ld\u0131. Bulgular uygulanan a\u015f\u0131lar \u00e7er\u00e7evesinde yorumland\u0131. Gelecekte yap\u0131lacak \u00e7ok merkezli, prospektif ve kontroll\u00fc \u00e7al\u0131\u015fmalar, SMS bilgilendirme uygulamas\u0131n\u0131n etkisine ili\u015fkin daha g\u00fc\u00e7l\u00fc nedensel kan\u0131t sa\u011flayabilir.<\/p>\n

Bu \u00e7al\u0131\u015fman\u0131n bulgular\u0131, eri\u015fkin a\u015f\u0131lar\u0131na y\u00f6nelik bilgilendirme mesajlar\u0131yla desteklenen dan\u0131\u015fmanl\u0131k sonras\u0131nda, 65 ya\u015f ve \u00fczeri ve komorbiditesi bulunan bireylerde influenza ve pn\u00f6mokok a\u015f\u0131lanma oranlar\u0131n\u0131n y\u00fcksek d\u00fczeylere ula\u015ft\u0131\u011f\u0131n\u0131 g\u00f6sterdi. Bu sonu\u00e7lar, bilgilendirme ve hat\u0131rlatma mesajlar\u0131n\u0131n eri\u015fkin ba\u011f\u0131\u015f\u0131klamas\u0131nda ba\u015fvuruyu ve a\u015f\u0131lanmay\u0131 destekleyen ara\u00e7lar olarak kullan\u0131labilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Ancak, eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131 s\u00fcrd\u00fcr\u00fclebilir bir \u015fekilde art\u0131rmak i\u00e7in yaln\u0131zca bireysel bilin\u00e7lendirme \u00e7abalar\u0131 yeterli de\u011fildir. Bulgular, eri\u015fimi kolayla\u015ft\u0131ran kurumsal d\u00fczenlemelerin, uygun finansman mekanizmalar\u0131n\u0131n, hekim \u00f6nerisinin ve a\u015f\u0131 poliklini\u011fi gibi fiziksel altyap\u0131n\u0131n birlikte ele al\u0131nmas\u0131n\u0131n eri\u015fkin a\u015f\u0131lanma oranlar\u0131n\u0131 art\u0131rmaya katk\u0131 sa\u011flayabilece\u011fini g\u00f6stermektedir. Ekonomik ve lojistik engellerin ortadan kald\u0131r\u0131lmas\u0131, bu s\u00fcrecin ayr\u0131lmaz bir par\u00e7as\u0131d\u0131r.<\/p>\n

Sonu\u00e7 olarak, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n e\u011fitimi, hasta bilgilendirme sistemlerinin g\u00fc\u00e7lendirilmesi ve devlet destekli kapsaml\u0131 a\u015f\u0131lama programlar\u0131n\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131, eri\u015fkin a\u015f\u0131lama oranlar\u0131n\u0131 art\u0131rmaya y\u00f6nelik stratejiler aras\u0131nda yer almaktad\u0131r. Bu \u00e7al\u0131\u015fmada de\u011ferlendirilen ve olumlu sonu\u00e7larla ili\u015fkilendirilen modelin, di\u011fer sa\u011fl\u0131k merkezlerinde de uyarlanarak uygulanmas\u0131n\u0131n \u00fclke genelindeki eri\u015fkin a\u015f\u0131lama performans\u0131na katk\u0131 sa\u011flayabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Yeti\u015fkinlerde pn\u00f6mokok, influenza, bo\u011fmaca ve zona gibi a\u015f\u0131yla \u00f6nlenebilir hastal\u0131klar ciddi hastal\u0131k ve \u00f6l\u00fcm y\u00fck\u00fcne neden olmaya devam etmektedir; bu nedenle bir\u00e7ok \u00fclkede ya\u015fam boyu ba\u011f\u0131\u015f\u0131klamay\u0131 g\u00fc\u00e7lendirerek sa\u011fl\u0131kl\u0131 ya\u015flanmay\u0131 desteklemeyi ama\u00e7layan eri\u015fkin a\u015f\u0131 programlar\u0131 geni\u015fletilmektedir (1). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6), ya\u015flanan n\u00fcfus, artan kronik hastal\u0131k y\u00fck\u00fc, g\u00f6\u00e7 hareketleri ve iklim de\u011fi\u015fikliklerinin bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n epidemiyolojisini […]<\/p>\n","protected":false},"author":5,"featured_media":32652,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5758,3379,6356,6129,6355],"class_list":["post-32391","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-asilama","tag-eriskin","tag-hatirlatici-sistemler","tag-koruyucu-hekimlik","tag-yasli"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32391","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=32391"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32391\/revisions"}],"predecessor-version":[{"id":32635,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/32391\/revisions\/32635"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/32652"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=32391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=32391"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=32391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}