Mehtap Tatar

Women’s perceptions of caesarean section: reflections from a Turkish teaching hospital

Caesarean section as a contentious topic has attracted attention world-wide and different dimensions of the issue has been investigated. The primary reason behind these initiatives have been the upsurge of caesarean sections both in the developed and developing world and the realisation that the operation may not always contribute positively to the mothers and babys health. By contrast, several studies have demonstrated both the short and long term negative effects. Research has also revealed that factors other than medical necessity play an important role in the decision to perform a caesarean section. Turkey, although reliable data does not exist, can be classified among the countries experiencing the caesarean epidemic, at least among highly educated and wealthy mothers. This research, exploring the perceptions of mothers in a teaching hospital with a high caesarean rate, is a rare example of its kind in Turkey. The main finding is the dissatisfaction of the mothers undergoing caesareans during their stay in the hospital.

Predictors of Informal Health Payments: The Example from Turkey

Little is known about the factors that can affect informal health payments in Turkey, which is pertinent given that Turkey has been undergoing and considering a series of reforms in the health sector. This paper aims to examine the predictors of informal payments in Turkey. The study surveyed a random sample of 3,727 people in a medium-sized city, of whom 706 received medical care for illness and/or non-illness related reasons, using a Turkey-specific version of a model questionnaire focused exclusively on informal out-of-pocket payments. Using multivariable logistic model, household health expenditure, health insurance, service type and provider ownership were found to be statistically significant predictors of informal payment. The findings suggest the supply side factors as the main drivers of informal payments and thus a need for radical changes in the supply side as well as actions to rebuild lost confidence in the health care system of Turkey.

Community participation in health care : The Turkish case

World Health Organizations global goal of Health for All by the Year 2000 (HFA) and achievement of this laudable goal through the Primary Health Care (PHC) approach has been accepted unanimously by participant countries of the Alma-Ata Conference in 1978. Turkey is also among the countries that showed their approval to the concept. However, that approval of the policy did not generate particular attention among the policy-makers until the 1990s. The year 1990 can be regarded as a watershed in the Turkish health policy-making environment as attempts at producing a National Health Policy document that centred around the global goal of HFA and PHC commenced. This paper aims at discussing the commitment of Turkey to one of the prerequisites of the approach, or heart of the PHC as regarded by some: community participation. After a brief presentation of community participation the Turkish commitment to the concept is analyzed based on a research carried out among Turkish health policy-makers. It is concluded that the prospect for community participation in Turkey does not look good mainly because of the medical approach adopted by the policy-makers. The need for more discussion of the topic among the academic circles has been emphasized.

Colorectal cancer in Turkey: current situation and challenges for the future

Cancer is foremost among one of the major public health problems in Turkey. Projections for the year 2030 estimate that cancer will take the highest death toll for both males and females. In line with the dynamic health care reform process commencing in 2003, the national cancer policy of Turkey has also changed radically. Cancer became more visible as a public health problem and improvements have been made in early diagnosis and treatment of the disease. In addition, major steps have been taken to improve the cancer registry system in order to improve cancer statistics. Colorectal cancer (CRC) incidence is approximately 7 per 100,000, with approximately 5,000 new cases and 3,200 deaths annually. Although cancer treatment expenditures are widely covered in Turkey, there are still problems related to the general accessibility of the health care system. This paper addresses the case of cancer in Turkey with special focus on CRC. Specifically, detailed information is provided about the health care and cancer policies, improvements since 2003 and challenges for the future.

Analysis of Factors Affecting Patient Satisfaction Focus on Asthma Patients

BackgroundPatient satisfaction is regarded as an important indicator in assessing the quality of care. Over the past 20 years, in particular, there has been increasing interest in patients’ perceptions about the provision of healthcare. Although asthma is a disease that increases the burden on health expenditure and has high cost requirements, there have been few studies evaluating the views of asthma patients about their treatment. The aims of this study were to identify factors affecting the satisfaction of asthma patients and to contribute to the sparse literature on this topic.MethodsThe study sample consisted of 387 asthma patients who were referred to Hacettepe University’s Chest Diseases Polyclinic and Allergy Unit in Ankara, Turkey, between August 2000 and March 2001. A questionnaire consisting of 66 questions was developed to explore demographic characteristics (11 questions), quality of life (32 questions), severity of disease (2 questions), and patient satisfaction with the care received (21 questions). The items for the satisfaction part of the questionnaire were selected from three separate questionnaires used in three independent studies, including the Patient Satisfaction Questionnaire. Factor analysis was performed on the satisfaction items, which revealed five dimensions in which the items were grouped: (i) doctor competency; (ii) provision of information; (iii) quality of care; (iv) waiting time; and (v) hospital quality. The general reliability coefficient was 0.87. Regression analyses were carried out to determine how patient’satisfaction with their medical treatment was affected by the following variables: demographic characteristics (age, other diseases, sex, education, duration of treatment), severity of disease, quality of life, whether medical tests were performed, and whether treatment was received from academic physicians (professors and associate professors) or from consultants and assistants.ResultsThe results of the regression analyses revealed that patients who had undergone medical tests or who had received treatment from academic physicians (rather than from consultants or assistants) had higher satisfaction levels than their counterparts. Furthermore, female patients had higher levels of satisfaction than their male counterparts. In addition, it was found that the five satisfaction dimensions were all significantly correlated with each other and that patients’ general satisfaction was also significantly correlated with all five satisfaction dimensions. The percentages of patient satisfaction that were likely to be explained by the variables used in the study were 22.7% for doctor competency, 25.6% for provision of information, 46.2% for quality of care, 13.7% for waiting time, and 9% for hospital quality. Overall, 32.4% of satisfaction was explained by the variables used in the study.ConclusionThe fact that only 32.4% of general patient satisfaction was explained by the variables used in the study indicates that there are still very important gaps in our understanding of factors affecting patient satisfaction. This study found that the levels of patient satisfaction with care were influenced by provider characteristics (academic status) rather than patient characteristics. After controlling for patient characteristics, patients of professor and associate professor physicians were more satisfied than patients of assistant physicians, especially in regard to doctor competency, quality of care, provision of information, waiting time, and overall satisfaction. Medical education should continue to emphasize the importance of these aspects of the physician-patient encounter. A qualitative approach could be used in further research to investigate the variance that cannot be explained by other models.

Factors Affecting Use of Resources for Asthma Patients

Objective: This study aims at exploring the variance in resources used for management and treatment of asthma disease and analyzing the impact of patient and physician characteristics on total test expenditures and the number of drugs prescribed as resource utilization variables.Study setting: The study was undertaken in Hacettepe University Chest Diseases Polyclinic and Allergy Unit. 387 asthma patients visiting the unit between August 2000 and March 2001, were included in the study.Results: The regression analysis showed that patient characteristics did not have a statistically meaningful impact on total test expenditures (p > 0.05). The laboratory test expenditures for patients who referred to academicians (professors and associate professors) were higher compared to patients who referred to their counterparts (p < 0.05). Similarly, the laboratory test expenditures for patients referred to two physicians in the allergy unit were higher and statistically meaningful (p < 0.05) than patients who referred to 8 physicians in the chest diseases polyclinic. When factors affecting the number of drugs prescribed is analyzed it was found that duration of treatment, severity of disease, quality of life, frequency of referral to a physician in the last 6 months were meaningful (p < 0.05).Conclusions: The variances in total test expenditures for different academic careers and specialties indicate the need to standardize the treatment process for asthma and to reconsider medical education.

Management of diabetes and diabetes policies in Turkey

BackgroundDiabetes and its complications are among the present and future challenges of the Turkish health care system. The objective of this paper is to discuss the current situation of diabetes and its management in Turkey with special emphasis on the changing policy environment.MethodsA literature review in databases such as PUBMED was performed from 2000 to 2011. This synthesis was complemented by grey literature, personal communication and contact with national and provincial health authorities and experts in diabetes from Turkey.ResultsThe literature review and expert consultations indicated a growing policy emphasis on diabetes. Both the public and private sectors, non-governmental organizations have initiated policy papers to shape the outlook of diabetes care in the future. This is in line with the current dynamics of the healthcare system.ConclusionsDiabetes care will be high on the agenda in future. Evidence based policy-making is the key to implement the policies adopted so far and a supportive environment is needed.

Benign Prostatic Hyperplasia: Cost and Effectiveness of Three Alternative Surgical Treatment Methods Used in a Turkish Hospital

The purpose of this study was to compare three alternative surgical therapies for Benign prostatic hyperplasia (BPH) in terms of their cost and effectiveness in a general hospital setting in Turkey. BPH is an important potential burden on health care resources in developing countries like Turkey, not only because of the increasing incidence of the disease, but also because of the differences in cost and effectiveness that exist among the various available treatment technologies. In this study, three alternative surgical treatments for BPH, namely open prostatectomy, transurethral resection of the prostate (TURP), and laser prostatectomy were compared in terms of their cost and effectiveness. Effectiveness was measured through the use of the International Prostate Symptom Score (IPSS) before the operation and at 3 months after. Laser prostatectomy was found to be the most costly and least effective way of treating BPH. This conclusion was valid both in terms of cost per prostate symptom score and cost per improvement of quality of life index. This study shows how a rough estimate can be made of the potential burdens that alternative treatment methods would impose on a countrys health budget.

Cost Effectiveness of Sodium Oxybate In Treatment of Cataplexy In Patients With Narcolepy In Turkey

Cataplexy is a frequently observed symptom of narcolepsy that adversely affects the social, emotional and physical health of the patients. Narcolepsy is a rare disease with low prevalence differing among countries and ethnic origins ranging from 2.1 in 10.000 to 4.7 in 10.000. Currently narcolepsy is treated mainly with antidepressants but as their success rate is very low, the unmet need in this field is considerable. Sodium Oxybate is a novel treatment and is the first product developed to treat cataplexy in patients with narcolepsy. This study aims at providing evidence about the cost effectiveness of sodium oxybate in Turkey.

Epidemiology of colchicine resistant Familial Mediterranean Fever disease (CrFMF) in Turkey.

Familial Mediterranean fever disease (FMF) is an autosomal recessively inherited disease characterized by recurrent, self-limited febrile episodes (attacks) with serositis, synovitis, and occasionally skin involvement. The disease primarily affects people of eastern Mediterranean descent, typically presenting at age <20. AA amyloidosis is the most serious complication of FMF and can be life-threatening. Daily colchicine is considered standard of care, and is expected to prevent attacks and amyloidosis in most patients. Turkey has the highest prevalence with 0.1% in general population.