Family Physicians In Turkey Research Articles

Impact of COVID-19 Pandemic on Family Medicine Clinical Practices During the Second Wave

Background/Aims: It is seen that there are various changes brought by the process within the legislation and in various practices in primary health care services in extraordinary health situations such as pandemics. In this study, it was aimed to determine the effects of the COVID-19 pandemic on some clinical practices of family physicians in Turkey.
 Methods: The descriptive study was applied to family physicians working actively in family health centers between February 15, 2021 and April 1, 2021. Family physicians working actively in family health centers formed the universe. Physicians were asked through online-survey questions regarding specific follow-ups and changes they made in some clinical practices, the changes in the number of applications, and the arrangements they made in this regard.
 Results: 912 people participated in the study. 59.9% were male, 60.2% had been practicing family medicine for more than 10 years. 63.9% had PCR test and 26.8% had antibody test. 16.1% were diagnosed with COVID-19. 84% of them went to Family Health Center (FHC) every day during the pandemic. While 48.2% of them were doing triage, 53.6% of the participants stated that the number of applications decreased. 65.2% of them did their pregnant-baby-child follow-ups during the COVID-19 pandemic as before the pandemic, 24.7% carried out by appointment. 54.3% made a change in the FHC layout and terms. 50.2% stated that they did not follow up on chronic diseases during the COVID-19 period, 59.2% stated that there was a decrease in the number. 66.7% of them made their childhood vaccinations during the COVID-19 pandemic as before the pandemic, 24.7% carried out by appointment, and the number of applications for 73.6% did not change. 63.6% of them made adult vaccines during the COVID-19 pandemic as before the pandemic, the number of applications increased by 58.2%, and 73% were encouraging individuals. The number of those who came for general health status reports (driver's license, mental ability, job security, etc.) did not change by 53%, but increased by 23.6%.
 Conclusion: The pandemic period has caused serious changes in family medicine clinical practices; family physicians have made various arrangements to carry out their current work in this period and have made an effort to convey this situation to the public.

Knowledge, attitudes and behaviors of family physicians about childhood vaccinations that are not in the routine vaccination schedule: a cross-sectional study.

In our country, there are childhood vaccinations that are not included in the routine vaccination schedule and that families have to buy and have for a fee. In addition to income level, family physicians' recommendations also play a major role in getting these vaccines.Our study was planned to determine the level of knowledge, attitudes and behaviors of family physicians about rotavirus, HPV and meningococcal vaccines, which are not included in the routine vaccination scheme of the Ministry of Health. Our cross-sectional and descriptive study was carried out between May and July 2019. The population of our study consists of approximately 30000 family physicians working as Family Physicians in Turkey. When the sample size is calculated with 5% margin of error and 95% confidence interval, it turns out to be 381. A 15-question questionnaire prepared by scanning the literature and including socio-demographic characteristics was presented to the participants. The Likert scale, which includes 12 questions about rotavirus, meningococcus, HPV and vaccines developed for these microorganisms, was administered to physicians either face-to-face or via the internet. In our study, the statistical significance level was accepted as P < 0.05, and the SPSS statistical package program was used in the calculations. 81 Research Assistants, 62 Family Medicine Specialists and 234 Family Physicians participated in our study, and the participants were determined by simple random sampling method. The mean age of the participating physicians was 37.96 ± 9.3 (min: 25 and max: 68). 50.9% of the physicians were women, 79.8% were married, 85.1% were in the city center, and 62.1% were practicing family medicine as general practitioners. 74.82% of the participating physicians recommend rotavirus and 56.2% HPV vaccines to their patients. 10.6% (40 people) of the physicians participating in our study did not recommend any of the rotavirus, HPV, meningococcal, influenza and adult pertussis vaccines to their patients. In the evaluation of the reason for this, 58.7% (27 people) of physicians who did not recommend special vaccines state that they did not recommend vaccines because they are not included in the routine vaccination schedule of the Ministry of Health. Another important reason was that the vaccines are paid (30.4%, 14 people). To the question of having sufficient information about special vaccines that are not included in the routine vaccination schedule, 26% of the participants stated that they have sufficient knowledge, and 56.5% stated that they have partial knowledge. The Likert knowledge questions total score of those who recommended at least one vaccine to their patients was significantly higher than those who did not recommend it at all. Likert knowledge questions total score of those who had at least one vaccination was significantly higher than those who never had it (P = 0.001). In general, as the level of knowledge about private vaccines decreases, the rates of self-vaccination, recommending it to their patients, and asking it to be included in the national vaccine schedule decrease. For this reason, increasing the knowledge of physicians about vaccines not included in the national vaccination schedule will contribute to the dissemination of vaccines, thus increasing immunity and reducing mortality and morbidity.

Current Recommendations on the Management of Pediatric Asthma and Allergic Rhinitis during the COVID-19 Pandemic versus Real-Life Practice

Introduction: Several statements and position papers on the management of childhood asthma and allergies during the COVID-19 pandemic have been published of late. The aim of this study was to evaluate the knowledge and awareness of pediatricians and family physicians regarding the management of asthma and allergic rhinitis during the pandemic according to recently published updated guidelines. Method: We conducted an online survey among pediatricians and family physicians in Turkey, using a questionnaire designed to evaluate 4 items: (1) the relationship between COVID-19 infection risk and pediatric asthma/allergic rhinitis and medications used in treatment; (2) the follow-up and management of asthma/allergic rhinitis according to published updated recommendations; (3) pediatricians’ and family physicians’ observations and perceptions of treatment compliance and the attitudes of their pediatric asthma patients; and (4) pediatricians and family physicians’ attitudes to using telehealth in the follow-up and management of pediatric asthma patients during the pandemic. Results: A total of 346 participants responded to the survey. The relationship between the risk of COVID-19 and asthma was known by less than 25% of the participants. More than 33% of family physicians and 20% of pediatricians were unaware that asthma medication does not lead to a susceptibility to COVID-19 infection; 55% of family physicians and 48% of pediatricians thought that patients showed better compliance with asthma controller medication; over 33% of pediatricians and approximately 50% of family physicians stated that they could not distinguish between an asthma attack and lung involvement in COVID-19 infection; of the respondents, over 75% stated that they prefer face-to-face visits with patients, even in situations that do not require a physical examination. Conclusion: The overall knowledge and awareness of pediatricians and, especially, family physicians regarding the management of pediatric asthma/allergic rhinitis during the pandemic is not at a satisfactory level. There is an urgent need to inform them about updated recommendations appearing in recent guidelines published by allergy organizations.

Educational Level Inequalities in Cardiovascular Outcomes and All-Cause Mortality in Turkey: A Cohort

Abstract Background Recent decades witnessed an increase in the burden of non-communicable diseases including adverse cardiovascular outcomes in low- and middle income countries and the burden was not equal across socioeconomic strata. This study aimed to define educational level inequalities in cardiovascular outcomes and all-cause mortality in a six-years cohort in Turkey. Methods Non-communicable Diseases and Risk Factors Cohort randomly sampled two adults (&amp;gt;14) from each of the registered family physicians in Turkey in July 2011 (n = 18,477). The family physicians collected demographic data. Incident coronary heart disease (CHD), cardiovascular and all-cause deaths were obtained from electronic health records in the end of 2017. Ridit score transformation was applied to the educational level by gender (illiterate, primary school, secondary school, high school or higher) and then Relative Index of Inequalities by educational level were estimated using Poisson Regression for morbidity and Cox Regression for mortality. Results There were 17,847 participants in CHD and 18,461 in the mortality cohort. During six-years 1,026 cases were diagnosed with CHD, 185 cardiovascular and 769 all-cause deaths occurred respectively. The inequalities were not significant for all outcomes however Relative Index of Inequalities were close to be significant for CHD incidence among men and all-cause mortality among women (0.721 (0.507 to 1.025) and 1.721 (0.969 to 3.057), respectively). Conclusions This is the first-ever cohort in Turkey with the aim to define educational level inequalities in cardiovascular outcomes and all-cause mortality. The inequalities may not have been observed due to the low number of outcomes. Key messages In Turkey, there were no educational level inequalities in our cohort. The possible inverse inequalities among men and inequalities among women may arise with a longer follow up.

Approaches and awareness of family physicians on diabetes management during Ramadan.

This study aimed to determine the approaches of family physicians in Turkey towards the fasting of diabetic patients and whether they used international treatment guidelines when making recommendations. In addition, this study also aimed to increase the awareness of family physicians about this issue before Ramadan, which is a month of fasting. The study herein comprised cross-sectional, observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared based on the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gather via social media and mail groups, and sent to family physicians in Turkey via a link using an electronic questionnaire preparation and application programme. Moreover, the total knowledge level, attitude, and approach scores were calculated from the questions prepared from the relevant guidelines. Participating in the survey were 262 family physicians. Only 22% of the family physicians stated that they were aware of the international guidelines for Ramadan and diabetes management, and only 10% said that they had read them. The mean knowledge level, attitude, and approach scores were determined to be lower than expected, and a significant difference was found between the scores and academic titles. The lack of international guidelines on the subject, and of knowledge and experience about Diabetes Mellitus (DM) patient management during the month of fasting, stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased, in addition to that of fasting before, during, and after Ramadan in patients with DM, which has increasing prevalence in Turkey.

Understanding the approach of family physicians in Turkey to the problem of vaccine rejection

ABSTRACT Vaccines not only protect individuals, but also prevent the spread of vaccine-preventable diseases in the community. Vaccine rejection in Turkey increased 125-fold between 2012 and 2019. Thus, this cross-sectional study aimed to investigate the level of knowledge of family physicians about vaccination, which can be the keystone of vaccine rejection. Evaluations were also made of vaccine recommendations, practice, and confidence in vaccine safety. The study was conducted using a 41-item questionnaire, completed by 804 (3.3%) family physicians serving in Turkey. The most common reasons for vaccine rejection were found to be fear of disease from the vaccine substance at the rate of 53.7% (n = 298), religious reasons at 32.3% (n = 179), disbelief of protection at 9.9% (n = 55), and fear of infertility at 4.1% (n = 23). Logistic regression analysis was applied to determine the factors affecting the power of the family physician’s recommendation. The results showed that age >41 years (OR = 1.625 (1.129–2.34)), having self-efficacy (OR = 1.628 (1.183–2.24)) and belief in the usefulness of the vaccine made a positive contribution to the power to recommend vaccines (OR = 1.420 (1.996–1.012)). The results of this study demonstrated that training on vaccines and vaccine-preventable diseases has a positive effect on self-efficacy (p < .0001). This study can be considered of value as the first to demonstrate the beliefs and attitudes of family physicians in Turkey. Further training courses to increase knowledge of vaccines, vaccine-preventable diseases, and communication skills would be of benefit for family physicians.

Daily Workload And Service Profile Of Family Physicians In Turkey: A Snapshot Of One-Day Work

Objective: The study aims to determine the daily workload and to analyze the content of workload, to describe the service profile of FPs working in primary care in Turkey. Methods: The study design is descriptive and cross-sectional. A total of 28 FPs from 17 different cities were enrolled into the study. Two surveys, one inquiring the demographic properties of FPs participated and a second encounter form with 43 items inquiring all aspects of FPs’ workload were filled by the participants. Results: A total of 1,215 visits were reported. The average daily workload of FPs participating was 45.7± 16.8 visits. 92.5% of all patients were family physicians’ own registered patients while 7.5% of them were guests. A total of 1,610 RFEs were reported. We categorized them as prescription requests (451, 28%), clinical complaints (447, 27.8%), preventive medicine services (436, 27%), administrative reasons (161, %10) and other reasons (115, 7.2%). Essential hypertension and diseases of musculoskeletal system were the most common diagnoses in prescription requests. Sore throat and cough were the top two clinical complaints. Conclusions: FPs in Turkey are under severe pressure. Prescription requests account for an important percentage of this workload. Measures should be taken to lessen this burden.

Diabetic retinopathy knowledge and management approaches of primary care physicians

Aim: We evaluated the level of knowledge on diabetic retinopathy (DR) and management approaches of primary care physicians with important roles in preventive health services.Material and Methods: Using a Google form, a 14-item questionnaire was prepared to the family physicians’ knowledge about DR and the examination tools they use and their management approach. This questionnaire was sent to 92 family physicians in Turkey via the What’s App Messenger.Results: According to the questionnaire responses, 90 (97.8%) of the family physician centers had a Snellen chart and 91 (98.9%) a direct ophthalmoscope. Among the physicians, 79 (85.9%) did not perform visual acuity examinations for diabetic patients, and 39 (42.4%) did not use an ophthalmoscope. While 34 (37.0%) of the surveyed physicians did not refer diabetic patients to an ophthalmologist for DR examinations at all, only 22 (23.9%) referred patients to an ophthalmologist at the time of initial diagnosis and 19 (20.7%) referred patients at 1 year after the initial diagnosis. 10 (10.8%) of the surveyed physicians referred patients to an ophthalmologist at 2-year intervals, 4 (4.3%) at 6-month intervals, and three (3.3%) at over 2-year intervals. Among the physicians, 64 (69.6%), 57 (62.0%), and 63 (68.5%) were not familiar with the stages of DR, fundus fluorescein angiography, and laser treatment for DR, and 60 (65.2%) did not know how to perform intraocular injection treatment methods. A total of 87 (94.6%) physicians stated a need for training programs in DR.Conclusion: DR, an eye complication of diabetes mellitus, is not well understood by family physicians, and more than half of physicians referred their patients to an ophthalmologist either late after diagnosis or not at all. It is therefore important for family physicians to undergo training programs on DR to increase their effectiveness in primary health care services.

Burnout among family physicians in Turkey: A comparison of two different primary care systems.

The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS). The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS. The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study. Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.

Attitudes toward the elderly among young family physicians in Turkey.

Introduction:General practitioners’(GPs) role is important as they are easily accessible especially for elderly. Young GPs need to improve their attitudes toward the elderly so that they can be a part of solution for health problems of elderly in the future. The aim of this study is to determine attitudes of young GPs toward elderly by the University of California at Los Angeles Geriatrics Attitude Scale (UCLA-GAS).Methods:It is a cross-sectional study performed with questionnaires including UCLA-GAS. The study population was 260 young doctors (GP residents and GPs in their first 5 years after qualification). Statistical evaluation of the data included percentage, mean, and Kolmogorov–Smirnov test and analysis of variance test.Results:Of the participants, 58.1% (n = 151) were women, 35.4% (n = 94) of them were GPs, and the remaining were GP residents. The mean age was 31.30 ± 5.40 years (range = 24–55 years). The mean score of UCLA-GAS was 46.85 ± 5.63 (range = 30–61). Participants ≤30 years of age had significantly higher scores (47.70 ± 5.99) than age above 30 years (45.68 ± 4.89) (P = 0.003). There was no statistically significant difference between GP residents and GPs (P = 0.989) and between participants who had rotation in elderly healthcare service (n = 63) or not (n = 197) (P = 0.383). However, as the duration of work increased, the score of UCLA-GAS decreased significantly (r = −0.216, P < 0.001).Conclusion:Young doctors who were interested in elderly showed more positive attitude as expected. However, the ones who were older and worked longer had less positive attitude. It seems important to understand and prevent this unfavourable attitude with formal education system about elderly healthcare during residency.

Assessment of antibiotic including prescriptions prescribed by family physicians in Turkey in 2015

Background Irrational antibiotic use is an important problem in Turkey’s health system. This problem causes antibiotic resistance, inefficient treatment and increase in medical expenses. Evaluation of family physicians’ prescriptions may contribute to determine the situation over antibiotic use. In this study, we aimed to investigate antibiotic prescriptions of family physicians in primary care health services and compare the figures among provinces and regions …

The Approaches Taken by Family Physicians in Turkey Regarding Prostate Patients and Prostate Specific Antigen

The Approaches Taken by Family Physicians in Turkey Regarding Prostate Patients and Prostate Specific Antigen

An Educational Intervention to Prevent Irrational Prescribing By Primary Care Physicians: Results from Turkey from the OTC-SOCIOMED Project Second Phase

Objective: The misuse of over-the-counter (OTC) medications is a serious issue in primary healthcare, leading to the need for better education of general physicians on appropriate prescribing behavior. This study discusses the findings from the OTC-SOCIOMED project (Assessing the Over-the-Counter Medications in Primary Care and Translating the Theory of Planned Behavior into Interventions) in Turkey. Methods: During November 2011, the implementation of intervention was done in Bursa, which was selected as the study region in Turkey. The participants were 28 family physicians in Turkey who were assigned to two study groups; a three-step training intervention—a 1-day intensive course on rational drug prescription, 4 weeks of reminder messages, and face-to-face interviews—was provided for the intervention group. Four different data collection tools were used before and after the intervention: a training assessment questionnaire, a complementary questionnaire on OTC medicines, the theory of planned behavior questionnaire, and a patient medication form. Results: Participants were satisfied with the quality of the training, the delivery of the topics, and the subsequent reminder messages. There was a significant difference in only one item (“The decision to prescribe belongs completely to me”), which evaluated behavior control in the intervention group after training. The lack of time most often explained why physicians could not inform patients about OTC medicines. Conclusion: Physicians were aware of their own need for training in rational prescribing, and this training model was quite acceptable to them. However, the short study duration was an obstacle for observing attitude changes among the doctors.

Discretionary Use of Family Practice Information Systems: An Empirical Examination in Turkey

This study examined the antecedents and consequences of the discretionary use of the family practice information systems (FPIS) by family physicians in Turkey. A structured survey was conducted among family physicians located in Kahramanmaras, a southern province in Turkey. The partial least squares (PLS) method was used to analyse the survey data. Findings showed that (1) physicians' discretionary use of FPIS is positively related to their perceived value of patient care; (2) physicians' computer self-efficacy is positively related to their discretionary use of FPIS; (3) physicians' innovativeness in information technology (IT) is positively related to their computer self-efficacy; and (4) physicians' innovativeness in IT does not significantly impact on their discretionary use of FPIS. The present study's findings revealed that physicians should be adequately informed about the discretionary use of FPIS, and policies should be established to improve family physicians' understanding and competence of information systems, including computer self-efficacy.

Restructuring the primary health care services and changing profile of family physicians in Turkey.

A new health-reform process has been initiated by Ministry of Health in Turkey. The aim of that reform is to improve the health status of the Turkish population and to provide health care to all citizens in an efficient and equitable manner. The restructuring of the current health system will allow more funds to be allocated to primary and preventive care and will create a managed market for secondary and tertiary care. In this article, we review the current and proposed primary care services models and the role of family physicians therein.