Birinci Basamak Sağlık Kuruluşları ve Hastaneler Tarafından Verilen Evde Sağlık Hizmetlerinin Değerlendirilmesi: Ankara ve Eskişehir İlleri Örneği

The delivery and coordination of home healthcare services in Turkey have been transferred from primary health care institutions (Community Health Centers-CHC) to hospitals in 2017. In this study, it was aimed to evaluate the effect of this organizational change on service usage frequency and costs, as well as to determine the opinions of the staff and patients / patient relatives involved in home health services in Eskişehir and Ankara about this change in service provision. The study utilized primary and secondary data sources. As a secondary data source, pre-and post-transfer service usage and costs of 304 patients were compared and it was seen to be more that home health services provided in public hospitals according to home health services provided in primary health care institutions; the average number of visits to a patient (3.64 versus 2.98), the average number of procedures (4.74 versus 3.80) and the average cost per visit (13.71 TL versus 10.14 TL) and this difference was found to be statistically significant (p <0.05). As the primary data source in the study, a questionnaire based on face-to-face interview technique was applied to 74 healthcare workers and 322 patients and their relatives in order to determine the opinions of healthcare professionals, patients and their relatives in home health services about the change in service provision. The validity of the questionnaire was examined with exploratory and confirmatory factor analyzes and its reliability was examined with the Cronbach alpha coefficient, and it was found that the questionnaire was structurally valid and the answers given to the questions were at an acceptable level of reliability (0.766). In the study, multivariate regression analysis was used to test the hypotheses and t test was used in dependent groups. Responding to the questionnaire, the participants stated that, with the transfer of home health services from CHCs to public hospitals, positive developments have been experienced in the dimensions of visit frequency and satisfaction, monitoring and evaluation, access to diagnosis, socio-economic support, personnel and financial support. They stated that there have been negative developments regarding the institutional support dimension, private sector and security support and the equity dimension. It is thought that this study, which evaluates the advantages and disadvantages of providing home healthcare services by primary health care institutions and hospitals, will provide important data and information for policies to be developed to improve home healthcare services.Türkiye’de evde sağlık hizmetlerinin sunum ve koordinasyonu 2017 yılında birinci basamak sağlık kuruluşlarından (Toplum Sağlığı Merkezleri, TSM) hastanelere devredilmiştir. Bu çalışmada yapılan bu organizasyonel değişikliğin hizmet kullanım sıklığına ve maliyetlerine etkisini değerlendirmek ve aynı zamanda Eskişehir ve Ankara illerinde evde sağlık hizmetleri uygulamasında yer alan personel ile hasta ve yakınlarının hizmet sunumu ile ilgili bu değişiklik hakkında görüşlerini tespit etmek amaçlanmıştır. Çalışmada birincil ve ikincil veri kaynaklarından yararlanılmıştır. İkincil veri kaynağı olarak 304 hastanın devir öncesi ve sonrası hizmet kullanımları ve maliyetleri karşılaştırılmış ve kamu hastanelerinde sunulan evde sağlık hizmetlerinin birinci basamak sağlık kuruluşlarında sunulan evde sağlık hizmetlerine göre; bir hastaya yapılan ortalama ziyaret sayısının (3,64’e karşı 2,98), ortalama işlem sayısının (4,74’e karşı 3,80) ve ortalama ziyaret başı giderinin (13,71 TL’ye karşı 10,14 TL) daha fazla olduğu ve bu farklılığın istatistiksel olarak anlamlı (p