Health Care Services and the Elderly: Utilization and Satisfaction in the Aftermath of the Turkish Health Transformation Program

With the implementation of the health transformation program, Turkey has gone through substantial changes in its health system in the last decade. This study relies on two nationally representative data sets to investigate health service utilization and satisfaction of the elderly. In particular, it examines the share of elderly who have an unmet need for medical care and who could not afford a medical examination or treatment over the years 2006 to 2015, using data from the Turkish Survey of Income and Living Conditions. It also examines the utilization of health services and satisfaction from these services by the elderly in years 2004 to 2015 using data from the Turkish Life Satisfaction Survey. This study finds that utilization has increased and, coinciding with the introduction of the family medicine system, the percentage of patients choosing primary care facilities has increased. The share of the elderly with unmet need and those who could not afford health care have declined. Notwithstanding, overall satisfaction increased only until 2011-2012. Understanding the utilization and satisfaction of the elderly is important, because along with many other countries, the population is aging in Turkey. In the near future, health care needs of the elderly will have a higher priority on the agenda of policy makers

A follow-up study on the effects of an educational intervention against pharmaceutical promotion.

BackgroundThe promotion strategies of pharmaceutical companies create many problems including irrational prescribing, diminished trust in the patient-physician relationship and unnecessary increases in pharmaceutical costs. Educating prescribers is known to be one of the few potentially effective measures to counteract those impacts. However such educational programs are limited in the literature, and their effectiveness against the effects of hidden curriculum in the long term is unknown. This study aims to evaluate the effectiveness of an education program both in the short term and the long term after the students have been exposed to informal and hidden curriculum and various pharmaceutical promotion methods.MethodsA longitudinal and controlled study was carried out in a school of medicine in Turkey where there are no restrictive policies for pharmaceutical promotion. A survey was applied to 123 students who attended the class throughout the terms of 2011-12, 2012-13, and 2013-14, evaluating the pre-educational status of students' opinions of promotion and any post-educational changes. A follow-up study four years later asked those three cohorts to fill out the same survey to see the possible effects of the clinical environment and various promotion methods. Also, the opinions of all 518 sixth-year students who had not taken the class in those three terms were compared to the educated students.ResultsThe program was significantly effective in the short term in changing students' opinions and attitudes positively towards recognizing companies' discourse and promotion strategies. But in the long term, the education lost its ability to convince students of the importance of not getting financial support for scientific activities from pharmaceutical companies (p:0.006) and carrying out research (pConclusionsThe education program could be used for creating awareness of, increasing skepticism towards, and inculcating disapproval about pharmaceutical promotion practices. However, the effectiveness of the educational intervention is susceptible to erosion after exposure to the informal and hidden curriculum together with exposure to promotion. The impact of role-models, organizational culture, and institutional policies could be important aspects to be addressed for sustaining the effectiveness of such education programs

For What Reasons Do Patients File a Complaint? A Retrospective Study on Patient Rights Units’ Registries

Background: In 2004, Patient Rights Units were established in all public hospitals in Turkey to allow patients to voice their complaints about services. Aims: To determine what violations are reflected into the complaint mechanism, the pattern over time, and patients’ expectations of the services. Study Design: Descriptive study. Methods: A retrospective study performed using the complaint database of the Istanbul Health Directorate, from 2005 to 2011. Results: The results indicate that people who are older than 40 years, women, and those with less than high school education are the most common patients in these units. A total of 218,186 complaints were filed. Each year, the number of complaints increased compared to the previous year, and nearly half of the applications were made in 2010 and 2011 (48.9%). The three most frequent complaints were “not benefiting from services in general” (35.4%), “not being treated in a respectable manner and in comfortable conditions” (17.8%), and “not being properly informed” (13.5%). Two-thirds of the overall applications were found in favour of the patients (63.3%), and but this rate has decreased over the years. Conclusion: Patients would like to be treated in a manner that respects their human dignity. Educating healthcare workers on communication skills might be a useful initiative. More importantly, health policies and the organisation of services should prioritise patient rights. It is only then would be possible to exercise patient rights in reality

Modern medicine is losing its humanistic essence: 'Patients no more, but diseases' is the new motto now.

For medicine, which is as old as history of humanity, the virtue of helping has always been a priority. However, the way medicine see diseases and human being changed from time to time, and the treatment approaches were shaped accordingly. Ancient Greek's Knidos and Kos Schools of Medicine reflecting one of the earliest schools of systematic medical education show us two distinct perspectives. School of Kos carries the characteristics of Hippocratic medicine and reach a diagnosis not considering the disease symptoms but through the disease itself, and the prognosis of the patient is taken into consideration as well. The disease and the patient are handled with a holistic view without focusing on an organ and the treatment is planned accordingly, while the School of Knidos focuses mainly on the disease not to the patient and reach a clinical diagnosis based on the specifications presented from the symptoms. Today's modern medicine mentality has significant similarities with the School of Knidos approach. This model ignores the cases specific to the patient while diagnosing and applying treatment methods. The physicians who get more specialised every day are becoming implementers of an alienated medicine in contrast to Hippocrates's 'There is no disease, but the patient' aphorism. Nowadays, with the rapidly developing technology and ever-growing accumulation of knowledge, it is possible to say that we moved away from the 'humanistic' medicine concept. In addition, in today's medicine, embedding the business concepts into medicine and commercialization of medicine have significant effects on this phenomenon. The establishment and assessment of the relationship of patient-physician on the basis of ‘customer satisfaction' is changing physicians' opinions on their profession and patients, which leads to a worrisome transformation such as moving away from traditional medical virtues. In this process, respect and trust for the physician are shaken and patients tend to look for various alternative methods for their health problems. In view of this worrisome development, returning to the ‘humanistic medicine' seems vital for social existence of medicine, rights related health and professional values, instead of today's modern medicine which ignores the holistic approach to complicated nature of human being, and prioritizes business world concepts, such as cost-effectiveness, profit, productivity and competition

The anxieties of medical students related to clinical training

High levels of anxiety and stress during medical education may have negative effects on students' learning and may also influence students' performance, decision-making and caring capabilities

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey.

BACKGROUND:Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. METHODS:Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. RESULTS:Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. CONCLUSION:Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes