Ankara'da çalışan hekimlerin toplum kökenli pnömonilerde tanı ve tedavi yaklaşımları
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info:eu-repo/semantics/openAccess
Özet
Ankara merkezinde çalışan hekimlerin toplum kökenli pnömonide (TKP) tanı ve tedavi yaklaşımları anket yöntemi ile değerlendirildi. Toplam 328 hekimin 161'i (%49,1) pratisyen, 80'i (%24,4) uzman, 87'si araştırma görevlisiydi (%26,5). Kurumlara göre dağılım; tıp fakültesi hastanesi %26,4, çeşitli kurumlar %24,8, devlet hastaneleri %19,6, sağlık ocağı (SO) ve Ana Çocuk Sağlığı Polikliniği (AÇSAP) %17,4 ve diğer %11,8 şeklindeydi. Hekimlerin TKP'den şüphelendikleri hastalarda ideal laboratuvar koşullarında en sık istedikleri tetkikler sırası ile postero-anterior akciğer (PA AC) grafisi %95, lökosit sayımı %87, balgam gram boyama %77 idi. Tedavide tek antibiyotik kullananlar arasında en sık penisilin tercih edilmişti (%49,1). Bunu %32 ile makrolidler, %12,4 ile b-laktam/b-laktamaz inhibitörleri izliyordu. Kariyer ile hekimlerin antibiyotik seçimleri arasında fark yoktu. Branşlarına göre hekimlerin antibiyotik seçimleri karşılaştırıldığında pratisyen hekimlerin iç hastalıkları uzmanlarına oranla daha fazla penisilin tercih ettikleri görüldü (p=0,02). Tıp fakültesinde çalışan hekimler ise diğer meslekdaşlarına oranla daha fazla makrolid tercih etmekteydiler (p< 0.005). Hekimlerin %16,2'si ikili antibiyotik tercih etmişlerdi. Tedaviyi sonlandırma kriterlerinden en sık kullanılanlar ateş takibi %27,7, PA AC grafisi %13,7, fizik muayene (FM) bulguları %7,3 idi. Hastayı kontrol etme şansı olmayan hekimlerin %63'ü 10 günlük tedavi vermekteydiler. Çalışma grubundaki hekimlerin antibiyotik tercihleri Toraks Derneği Pnömoniler Tanı ve Tedavi Rehberi (TDPTTR) ile uyumlu bulundu.
The main diagnostic and therapeutic approaches of the physicians who were working in Ankara city to community acquired pneumonia were evaluated by questionnarie method. Of the 328 physicians, 161 (49.1%) were general practitioners, 80 (24.4%) were specialists, 87 (26.5%) were residents. Distribution of physicians according to instutions was as follows: 26.4% at the medical school hospitals, 24.8% at various other medical centers, 19,6% at state hospitals, and 17.4% at primary health centers and mother and child health care units. The most required laboratory investigations by physicians at the ideal laboratory conditions when the community acquired pneumonia was the presumed diagnosis were posteranterior chest roentgenogram (95%), white cell blood count (87%), sputum gram stain (77%). Penicillins were the most prefered antibiotics in therapy (49.1%) and were followed by macrolides and b-lactam/b-lactamase inhibitors 32% and 12.4% respectively. The antibiotic preferences were not significantly correlated with physicians' careers. When antibiotic preferences according to physicians' branches were considered, it was seen that general practitioners prefered penicillins more compering internists (p=0.02). The medical school physicians prefered macrolide statistically more than other colleagues (p< 0.005). Of the 328 physicians, 16.2% prefered combined antibiotic therapy. The most used criteria for cessation of therapy by the physicians were fever follow-up (27.7%), chest roentgenogram (13.7%) and physical examination findings (7.3%). Of the physicians who were unable to control their patients, 63% declared that they prefered average 10- days therapy. Antibiotic preferences of our study group were found well correlated with the diagnosis and therapy guides of Thorax Association for Community Acquired Pneumonia.
The main diagnostic and therapeutic approaches of the physicians who were working in Ankara city to community acquired pneumonia were evaluated by questionnarie method. Of the 328 physicians, 161 (49.1%) were general practitioners, 80 (24.4%) were specialists, 87 (26.5%) were residents. Distribution of physicians according to instutions was as follows: 26.4% at the medical school hospitals, 24.8% at various other medical centers, 19,6% at state hospitals, and 17.4% at primary health centers and mother and child health care units. The most required laboratory investigations by physicians at the ideal laboratory conditions when the community acquired pneumonia was the presumed diagnosis were posteranterior chest roentgenogram (95%), white cell blood count (87%), sputum gram stain (77%). Penicillins were the most prefered antibiotics in therapy (49.1%) and were followed by macrolides and b-lactam/b-lactamase inhibitors 32% and 12.4% respectively. The antibiotic preferences were not significantly correlated with physicians' careers. When antibiotic preferences according to physicians' branches were considered, it was seen that general practitioners prefered penicillins more compering internists (p=0.02). The medical school physicians prefered macrolide statistically more than other colleagues (p< 0.005). Of the 328 physicians, 16.2% prefered combined antibiotic therapy. The most used criteria for cessation of therapy by the physicians were fever follow-up (27.7%), chest roentgenogram (13.7%) and physical examination findings (7.3%). Of the physicians who were unable to control their patients, 63% declared that they prefered average 10- days therapy. Antibiotic preferences of our study group were found well correlated with the diagnosis and therapy guides of Thorax Association for Community Acquired Pneumonia.
Açıklama
Anahtar Kelimeler
Toplum Kökenli Pnömoni, Tanısal Yaklaşım, Tedavi Yaklaşımı, Community-acquired Pneumonia, Diagnostic Approaches, Therapeutic Approaches
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Toraks Dergisi
WoS Q Değeri
Scopus Q Değeri
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1
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