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1 Morbidity Patterns in Family Practice Prof. Zekeriya Aktürk 14.09.2010 Atatürk University Medical.

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1 1 Morbidity Patterns in Family Practice Prof. Zekeriya Aktürk Atatürk University Medical Faculty

2 Be able to explain the current status of family medicine in Turkey Be able to discuss reasons for the difference of family practice morbidity patterns from hospitals Be able to count frequently encountered health problems in family practice Accept the importance of family medicine as a specialty in the provision of health services Objectives

3 3

4 Turkey Health Pyramid 4

5 Changes in Fertility 5 TNSA 2008

6 Profile of Monthly Visits Population under risk Having symptoms Applying to physician Referred to hospital Referred to other doctor Referral to teaching hos. McWhinney I. Textbook of family Practice

7 Health Needs Healthy 25% Sick but doesn’t go to doctor 50% Primary care 24% Sec. care 1% Tertiary level 0.01% Health promotion Facilitation, screening Giving health service

8 Health Personnel in Turkey 8

9 Primary care offices and personnel 9 TC Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Çalışma Yıllığı

10 Family Medicine Specialists Family medicine departments present in 45 medical faculties in Turkey Around 2000 family medicine specialists and 500 residents In USA: family medicine specialists as to December

11 Health Transformation ADIYAMAN 2.BOLU 3.DENİZLİ 4.DÜZCE 5.EDİRNE 6.ELAZIĞ 7.ESKİŞEHİR 8.GÜMÜŞHANE 9.ISPARTA 10.İZMİR 11.SAMSUN 12.ADANA 13.AMASYA 14.BARTIN 15.BAYBURT 16.BURDUR 17.ÇORUM 18.ERZURUM 19.KARABÜK 20.KARAMAN 21.MANİSA 22.SİNOP 23.YALOVA 24.KIRŞEHİR 25.KONYA 26.KÜTAHYA 27.MALATYA 28.MERSİN 29.NEVŞEHİR 30.NİĞDE 31.RİZE 32.SAKARYA 33.SİİRT 34.TEKİRDAĞ 35.TOKAT 36.TRABZON 37.TUNCELİ 38.UŞAK 39.VAN 40.ZONGULDAK 41.AFYONKARAHİSAR 42.AKSARAY 43.ARDAHAN 44.ARTVİN 45.BALIKESİR 46.BATMAN 47.BİLECİK 48.BİNGÖL 49.BURSA 50.ÇANAKKALE 51.ÇANKIRI 52.ERZİNCAN 53.IĞDIR 54.KARS 55.KASTAMONU 56.KAYSERİ 57.KIRIKKALE 58.KIRKLARELİ

12 Family medicine training (USA) 12 AAFP. Facts About Family Medicine.

13 Occupancy of the programs 13

14 Number of residents (USA) 14

15 Fellowships, USA January Fellowship TypeNumberPercent Total Number of Institutions Faculty Development Geriatrics Obstetrics Preventive Medicine20.7 Research258.8 Rural Medicine41.4 Sports Medicine Substance Abuse00 Other3813.5

16 Some services given by health offices 16 TC Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Çalışma Yıllığı

17 Health Office Services Outpatient visits Referral Urine Blood Feces Serology Malaria blood sampling Pregnancy test Pregnancy follow up Postpartum follow up Child (0-11 months) follow up Delivery in hospitals Physician assisted delivery Midwife assisted delivery Delivery without health profess Minor surgical intervention Forensic report Forensic autopsy Death certificate

18 Health office services 18

19 Immunizations 19

20 Vizit frequeny and morbidity patterns Number of yearly visits to the family physician is between 2.5 and 7. –The GP sees his/her patients at least twice yearly This gives an excellent opportunity to detect the real prevalences of diseases in the population. 20 Platts A, Mitton R, Boniface D, Friedli K. Can self-care health books affect amount of contact with the primary health care team? A randomized controlled trial in general practice. Scand J Prim Health Care Sep;23(3):142-8.

21 Outpatient visit/ referral 21 TC Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Çalışma Yıllığı

22 Visits at MoH Hospitals (million) 22 TC Sağlık Bakanlığı Yataklı Tedavi kurumları İstatistik Yıllığı 2007

23 FM weekly visits (USA 2008) 23 Total: (daily 5 patients) Office Visits Hospital Visits Nursing Home Visits House Calls Supervised Under Home Health Care Nursing Home Patients Supervised Hospice Patients Supervised Patients with Free or Discounted Care Total Location Urban Rural Completion of FP Residency FP Residency Graduate Not FPR Graduate

24 Reason for encounter (USA 1999) 24 # of visits (x1000)% General medical exam59, Follow-up visit28, Cough25, Routine pregnancy follow up22, Post-operative follow up18, Throat symptoms17, Healthy child exam15, Vision problems13, Earache, infection13, Back problems12, Knee problems12, Fever12, Rash12, Stomach ache, cramps12, Hypertension10, Nose symptoms10, Depression10, Headache9, Prescription9, Upper respitatory infection8, Rakel RE, Textbook of Family Medicine Table 1.1

25 Diagnoses (USA 1999) # of visits (x1000)% Acute URTI31, Essential hypertension29, Routine child exam27, Normal pregnancy22, Arthropathies20, General medical exam20, Otitis20, Diabetes mellitus17, Malign tumours16, Rheumatic disease16, Back problems15, Chronic sinusitis13, Ischemic heart disease10, Follow-up exam10, Asthma9, Chronic bronchitis9, Non-ischemic heart disease9, Cataract9, Health risks8, Allergic rhinitis7,

26 26 tistikleri2008.pdf

27 Health institutions and treatments 27 TUİK Türkiye İstatistik Yıllığı,

28 Different factors effect encounter 28 Engholm G, Dyhr L, Andersen JS. The pattern of contact with general practice and casualty departments of immigrants and non-immigrants in Copenhagen, Denmark Dan Med Bull 2007;54:226-9

29 Notifiable diseases 29

30 Chronic diseases: Netherlands 30

31 Chronic diseases: S. Arabia 31 AL-SHAMMAN SA, NASS M, AL-MAATOUQS MA, AL-QUAIQ JM. Family Practice in Saudi Arabia: Chronic Morbidity and Quality of Care International Journal for Quality in Health Care. 1996;8(4):

32 Mortality reasons in Turkey 32

33 Mortality reasons in Turkey 33 Türkiye Ulusal Düzeyde Ölüm Sayılarının Temel Hastalık Grupları ve Cinsiyete Göre Dağılımı (UHY-ME Çalışması, 2000,Türkiye)

34 Top 50 mortality reasons (TR-2007) 34 Türkiye İstatistik Kurumu

35 Mortality reasons in urban areas 35 Türkiye Kentsel Alanda Ölüm Sayılarının Temel Hastalık Grupları ve Cinsiyete Göre Dağılımı (UHY-ME Çalışması, 2000,Türkiye)

36 Mortality reasons in rural areas 36 Türkiye Kırsal Alanda Ölüm Sayılarının Temel Hastalık Grupları ve Cinsiyete Göre Dağılımı (UHY-ME Çalışması, 2000, Türkiye)

37 Mortality as to regions NorthMiddleWestEastSouth 1 Ischemic heart disease23,822,624,414,222,1 2 Cerebrovascular disease16,515,416,411,415,1 3 COPD6,56,15,95,05,8 4 Perinatal reasons4,05,33,513,14,3 5 Lower respiratory infections3,73,93,36,63,8 6 Hypertensive heart disease3,33,13,02,13,0 7 Trachea, bronchus, lung cancer2,72,83,02,02,8 8 Inflamatory heart disease2,72,52,31,72,5 9 Diabetes mellitus2,42,31,91,82,3 10 Traffic accidents1,31,71,62,71,8 11 Diarrheal diseases1,2 0,83,51,2 37 TC SAĞLIK BAKANLIĞI ULUSAL HASTALIK YÜKÜ VE MALİYET-ETKİLİLİK PROJESİ 2004

38 Morbidity according to sex (<5 years) 38 V. P. Chaudhari, R. K. Srivastava, M. Moitra & V. K. Desai : Domestic environment & morbidity of under five children. The Internet Journal of Epidemiology Volume 7 Number 1 environment-amp-morbidity-of-under-five-children.html

39 Primary health care vs specialists When compared with internists –Patients applying to family physicians are older and sicker –Morbidity and mortality is similar to specialists –Health expenses are lower 39 McGann KP, Bowman MA: A comparison of morbidity and mortality for family physicians’ and internists’ admissions. J Fam Pract 31:541, 1990


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