Publication: Samsun'da Çalışan Aile Hekimlerinin Obezite Yönetimi Hakkında Bilgi, Tutum ve Uygulamaları
Abstract
AMAÇ: Bu çalışmada, Samsun'da çalışan aile hekimlerinin fazla kilolu ve obez hastanın yönetimine ilişkin bilgi, tutum, öz yeterlilik ve uygulamalarının incelenmesi ve uygulamada karşılaşılan sınırlamaların değerlendirilmesi amaçlanmıştır. GEREÇ VE YÖNTEM: Bu çalışma Samsun ilinde bulunan aile sağlığı merkezlerinde aktif olarak aile hekimliği yapan hekimler ile yapılmıştır. Kesitsel, açık kontrolsüz tipte bir anket çalışmasıdır. Araştırmanın evrenini, Samsun'da aile sağlığı merkezlerinde 25.02.2020-01.05.2020 tarihleri arasında aktif olarak çalışan 409 aile hekimi oluşturmaktadır. Çalışmaya 273 aile hekimi dahil edilmiştir. Çalışmada veri toplama aracı olarak anket kullanılmıştır. Verilerin analizinde IBM SPSS 21.0 kullanılmıştır. p<0,05 değeri istatistiksel olarak anlamlı kabul edilmiştir. BULGULAR: Çalışmaya katılan hekimlerin %35,9'u (n=98) kadın, %64,1'i (n=175) erkektir. Yaş ortalaması 44,5±8,19 yıldır. Birinci basamakta ortalama çalışılan süre 15,92±9,23 yıl, ortalama mesleki deneyim 19,68±8,44 yıldır. Nüfusa kayıtlı ortalama hasta sayısı 3138±770 hasta, haftalık ortalama muayene sayısı 304±114 muayenedir. Aile hekimlerinin bilgi sorularından aldıkları ortalama puan 8,64±1,03'tür. Kadın hekimlerin bilgi düzeylerinin, erkek hekimlere göre anlamlı düzeyde daha yüksek olduğu bulunmuştur (p=0,039). Aile hekimlerinin %73,3'ü aile hekimlerinin kilo yönetiminde önemli bir rol üstlenebileceğini düşünmekte, ancak sadece %34,4'ü aile hekimlerinin fazla kilolu ve obez hastanın tedavisini üstlenmesi gerektiğini düşünmektedir. Hekimlerin %44,7'si genel nüfusunu, %59'u ise kronik hastalıkları olanları kilo problemleri açısından düzenli olarak taramaktadır. Kilo yönetimi uygulamalarında en düzenli kullandıkları 3 yöntemin sırasıyla; hastalarını gerektiğinde diyetisyene yönlendirmek (%72,5), fiziksel aktivite önerilerinde bulunmak (%70,7) ve beslenme önerilerinde (%67,8) bulunmak olduğu görülmektedir. Hekimlerin, gerektiğinde hastalarını farmakoterapi (%18,7) ve bariyatrik cerrahi (%9,5) için yönlendirme oranlarıysa oldukça düşüktür. Aile hekimlerinin %32,6'sı kendini fazla kilolu ve obez yetişkin tedavisinde, %23,8'i fazla kilolu ve obez çocuk tedavisinde yeterli hissetmektedir. Kendini fazla kilolu ve obez yetişkin-çocuk tedavisinde yeterli hisseden hekimlerin tarama alışkanlıkları ve uygulamalarının birçoğunun kendini yeterli hissetmeyen hekimlere göre anlamlı düzeyde iyi olduğu görülmektedir. Yine hekimlerin öz yeterliliklerine göre tedavileri önerme durumları incelenmiş ve ilgili tedavideki öz yeterlilik arttıkça hekimlerin tedaviyi önerme düzeylerinin anlamlı olarak arttığı görülmüştür. Fazla iş yükü (%96,3), hastaların motivasyon eksikliği ve uyumsuzluğu (%95,2) ve kısa muayene sürelerinin (%93) en sık karşılaşılan üç sınırlama olduğu görülmektedir. Hekimlerin %68,9'unun birinci basamağa ait ulusal bir rehber olmamasını kısıtlama olarak gördükleri ve buradan yayınlanmış mevcut rehberin farkında olmadıkları görülmektedir. Rehber farkındalığı olan hekimlerin fazla kilolu ve obez yetişkin-çocuk tedavisinde öz yeterliliğinin anlamlı derecede yüksek olduğu bulunmuştur. Yine rehber farkındalığı yüksek olan hekimlerin kilo problemleri açısından hastalarını, farkındalığı düşük olan hekimlere göre daha düzenli taradığı görülmektedir. SONUÇ: Aile hekimlerinin obezite yönetiminde yeterli bilgiye sahip oldukları görülmektedir. Hekimler obezitenin öneminin farkındadırlar ve bu süreçte aile hekimlerinin önemli bir rol üstlenebileceğini düşünmektedirler. Ancak fazla kilolu ve obez hastanın tedavisini üstlenmek istemedikleri görülmektedir. Hekimlerin yarısı fazla kilolu ve obez hastalara karşı basmakalıp ve olumsuz düşüncelere sahiptir. Hekimlerin hastalarını kilo problemleri açısından yeterli düzeyde taramadığı görülmektedir. Aile hekimleri kilo yönetimi uygulamalarında çeşitli stratejiler kullanmaktadırlar ancak bunlar yeterli düzeyde değildir. Hekimlerin fazla kilolu ve obez yetişkin-çocuk tedavisinde öz yeterlilikleri düşüktür. Özellikle obezitenin farmakoterapisi ve cerrahisi hakkındaki öz yeterlilikleri oldukça düşüktür. Ancak bütün bunların yanında hekimlerin kilo yönetimi uygulamalarında karşılaştıkları sınırlamalarında fazla olduğu görülmektedir. Anahtar Kelimeler: Obezite yönetimi, kilo yönetimi, aile hekimi, birinci basamak, bilgi, tutum, uygulama, öz yeterlilik, sınırlama
AIM: In this study, it was aimed to examine the knowledge, attitude, self-efficacy and practices of family physicians working in Samsun regarding the management of overweight and obese patients and to evaluate the limitations encountered in practice. MATERIALS AND METHODS: This study was conducted with physicians who actively work as family practitioners in family health centers in Samsun. It is a cross-sectional, open uncontrolled type of survey study. The universe of the study consists of 409 family physicians who work actively in family health centers in Samsun between 25.02.2020-01.05.2020. 273 family physicians were included in the study. Questionnaire was used as data collection tool in the study. IBM SPSS 21.0 was used to analyze the data. A p value of <0.05 was considered statistically significant. RESULTS: Of the physicians participating in the study, 35.9% (n = 98) were women and 64.1% (n = 175) were men. The average age is 44.5±8.19 years. The average time worked in primary care was 15.92 ± 9.23 years, and the average professional experience was 19.68 ± 8.44 years. The average number of patients registered in the population is 3138 ± 770 patients, and the weekly average number of examinations is 304 ± 114. Family physicians had an average score of 8.64 ± 1.03 from knowledge questions. It was found that the knowledge level of female physicians was significantly higher than that of male physicians (p = 0.039). 73.3% of family physicians think that family physicians can play an important role in weight management, but only 34.4% think that family physicians should undertake the treatment of overweight and obese patients. 44.7% of physicians regularly screen their general population and 59% of their patients with chronic diseases in terms of weight problems. The 3 methods they use most regularly in weight management applications are; It is seen that directing their patients to a dietitian when necessary (72.5%), recommending physical activity (70.7%) and providing nutritional advice (67.8%). Physicians' referral rates for pharmacotherapy (18.7%) and bariatric surgery (9.5%) when necessary are very low. 32.6% of family physicians feel sufficient in the treatment of overweight and obese adults, and 23.8% in the treatment of overweight and obese children. It is seen that most of the screening habits and practices of physicians who feel sufficient in the treatment of overweight and obese adults-children are significantly better than physicians who do not feel themselves competent. The status of physicians to recommend treatments according to their self-efficacy was examined and it was observed that the level of recommending the treatment increased significantly as the self-efficacy in the relevant treatment increased. The status of physicians to recommend treatments according to their self-efficacy was examined and it was observed that the level of recommending the treatment increased significantly as the self-efficacy in the relevant treatment increased. Over workload (96.3%), lack of motivation and noncompliance of the patients (95.2%), and short examination times (93%) are the three most common limitations. It is seen that 68.9% of the physicians see the lack of a national guideline for primary care as a restriction and they are not aware of the current guideline published here. Physicians with guideline awareness were found to have significantly higher self-efficacy in the treatment of overweight and obese adults-children. It is also seen that physicians with high awareness of guideline screen their patients more regularly in terms of weight problems than physicians with low awareness. CONCLUSION: It is seen that family physicians have sufficient knowledge in obesity management. Physicians are aware of the importance of obesity and think that family physicians can play an important role in this process. However, it seems that they do not want to undertake the treatment of overweight and obese patients. Half of the physicians have stereotypical and negative thoughts towards overweight and obese patients. It is observed that physicians do not adequately screen their patients in terms of weight problems. Family physicians use various strategies in weight management practices, but these are not sufficient. Physicians' self-efficacy is low in the treatment of overweight and obese adults and children. In particular, their self-efficacy on obesity pharmacotherapy and surgery is very low. However, in addition to all these, it is seen that the limitations that physicians encounter in weight management practices are excessive. Keywords: Obesity management, weight management, family physician, primary care, knowledge, attitude, practice, self-efficacy, limitation
AIM: In this study, it was aimed to examine the knowledge, attitude, self-efficacy and practices of family physicians working in Samsun regarding the management of overweight and obese patients and to evaluate the limitations encountered in practice. MATERIALS AND METHODS: This study was conducted with physicians who actively work as family practitioners in family health centers in Samsun. It is a cross-sectional, open uncontrolled type of survey study. The universe of the study consists of 409 family physicians who work actively in family health centers in Samsun between 25.02.2020-01.05.2020. 273 family physicians were included in the study. Questionnaire was used as data collection tool in the study. IBM SPSS 21.0 was used to analyze the data. A p value of <0.05 was considered statistically significant. RESULTS: Of the physicians participating in the study, 35.9% (n = 98) were women and 64.1% (n = 175) were men. The average age is 44.5±8.19 years. The average time worked in primary care was 15.92 ± 9.23 years, and the average professional experience was 19.68 ± 8.44 years. The average number of patients registered in the population is 3138 ± 770 patients, and the weekly average number of examinations is 304 ± 114. Family physicians had an average score of 8.64 ± 1.03 from knowledge questions. It was found that the knowledge level of female physicians was significantly higher than that of male physicians (p = 0.039). 73.3% of family physicians think that family physicians can play an important role in weight management, but only 34.4% think that family physicians should undertake the treatment of overweight and obese patients. 44.7% of physicians regularly screen their general population and 59% of their patients with chronic diseases in terms of weight problems. The 3 methods they use most regularly in weight management applications are; It is seen that directing their patients to a dietitian when necessary (72.5%), recommending physical activity (70.7%) and providing nutritional advice (67.8%). Physicians' referral rates for pharmacotherapy (18.7%) and bariatric surgery (9.5%) when necessary are very low. 32.6% of family physicians feel sufficient in the treatment of overweight and obese adults, and 23.8% in the treatment of overweight and obese children. It is seen that most of the screening habits and practices of physicians who feel sufficient in the treatment of overweight and obese adults-children are significantly better than physicians who do not feel themselves competent. The status of physicians to recommend treatments according to their self-efficacy was examined and it was observed that the level of recommending the treatment increased significantly as the self-efficacy in the relevant treatment increased. The status of physicians to recommend treatments according to their self-efficacy was examined and it was observed that the level of recommending the treatment increased significantly as the self-efficacy in the relevant treatment increased. Over workload (96.3%), lack of motivation and noncompliance of the patients (95.2%), and short examination times (93%) are the three most common limitations. It is seen that 68.9% of the physicians see the lack of a national guideline for primary care as a restriction and they are not aware of the current guideline published here. Physicians with guideline awareness were found to have significantly higher self-efficacy in the treatment of overweight and obese adults-children. It is also seen that physicians with high awareness of guideline screen their patients more regularly in terms of weight problems than physicians with low awareness. CONCLUSION: It is seen that family physicians have sufficient knowledge in obesity management. Physicians are aware of the importance of obesity and think that family physicians can play an important role in this process. However, it seems that they do not want to undertake the treatment of overweight and obese patients. Half of the physicians have stereotypical and negative thoughts towards overweight and obese patients. It is observed that physicians do not adequately screen their patients in terms of weight problems. Family physicians use various strategies in weight management practices, but these are not sufficient. Physicians' self-efficacy is low in the treatment of overweight and obese adults and children. In particular, their self-efficacy on obesity pharmacotherapy and surgery is very low. However, in addition to all these, it is seen that the limitations that physicians encounter in weight management practices are excessive. Keywords: Obesity management, weight management, family physician, primary care, knowledge, attitude, practice, self-efficacy, limitation
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