Meral Türk

The influence of a market-oriented primary care reform on family physicians’ working conditions: A qualitative study in Turkey

Background: Turkey has undergone a ‘Health transformation programme’ putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system. Objectives: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions. Methods: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews. Results: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician–patient relationship in PC (into a provider–customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion. Conclusion: By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Assessment of the effects of breast cancer training on women between the ages of 50 and 70 in Kemalpasa, Turkey.

BACKGROUND In both developed and developing countries; breast cancer is the major cancer observed in women. The aim of this study was to assess the effect of nursing and mammographic intervention on women with breast cancer between the ages of 50 and 70. MATERIALS AND METHODS A training program, which was quasi- experimental and had a pretest-protest design, was applied in Kemalpas?a district of Izmir, between October 2008 and August 2010. The target population was women between the ages of 50 and 70, who were registered in the list of 3rd Family Medicine Unit in Izmirs Kemalpas?a metropolis. A total of 106 women who were in conformity with the study criteria participated in the study. Research data were collected through home visits that included face-to-face interviews; Ministry of Health education material and video films were modified and used for the training. Data analysis was performed through 82 women who were paired at the first and the second phase. RESULTS It was observed that although the rate of breast self examination significantly increased after the training (p=0.022), the rate of clinical breast examination (p=0.122) and mammographic screening (p=0.523) did not. Differences in the stages of change after training were found to be statistically significant (p<0.001) and the group showed a progression in the stages of change in general (46.3%). In women mean scores of breast cancer awareness (p<0.000), severity (p<0.000), health motivation (p<0.000) and perception of the benefits of mammography (p<0.000) increased significantly and mean score of perception of mammography barriers decreased significantly (p<0.000) after the training. CONCLUSIONS After the training on breast cancer and mammography it was determined that nursing interventions provided positive progression of stages of change of women, affected health beliefs positively and significantly increased BSE incidences. However, it did not have a significant effect on CBE and mammographic screening.

0269 Occupational risks and health problems of anaesthesia technicians and doctors in operating room, a university hospital study

Health effects caused by occupational risks are commonly ignored. We aimed to find out relation between working conditions and health problems. Cross-sectional study targeted anesthesiologists (114) working in Ege University Faculty of Medicine Hospital between 2016 October –2017 January. 81,5%(93) of anesthesiologists accepted to join this study.For data collection we use questionnaire (89 question) and periodical examination for 2016. Participants were divided into 41 anaesthesia technicians, 52 doctors according to their profession. The average age of the study group is 34. Anesthesiologists(63 person) have an average of 4 night shifts per month. Only 28% of employees use their annual leave regularly. 69.9% of the employees have used leave for 5 days or less annually. 61% of the employees are free overtime. The average time spent in daily operations is 7.9±2 hours.There were 16 ‘abortion x persons’ in the study group. There are 4 people who have infertility treatment. In the study group, there were 76.3% (71) presence of any disease, 66.7% (62) of work related disease, 45.2% (42) of work related psychiatric problem, 25.8% (24) of work related musculoskeletal problem expressed. Immature granulocyte levels were high in 29 (35.8%) workers. There are 81 people who have periodic hemogram examinations;%38,3 of them was anaemic. Haemoglobin values determined lower in women, in less than two hours a day sitting workers, those had high levels of exposure to chemical and psychosocial risks(p<0,05).Anesthesiologists face risks often. Annual periodic examinations are very important in terms of protection and improvement of employee health.