Salih HOŞOĞLU, Fatma BOZKURT, Recep TEKİN, Celal AYAZ, Mehmet Faruk GEYİK

Pratisyen hekimlerin üst solunum yolu enfeksiyonları hakkında bilgi ve davranışları üzerine eğitim seminerinin etkileri

Amaç: Bu çalışmayla, iki ilimizde çalışan pratisyen hekimlerin üst solunum yolu enfeksiyonlarında (ÜSYE) antibiyotik kullanım farkındalığı ve sağlık ile ilgili eğitim seminerlerinin etkileri, özel olarak hazırlanan bir anket yardımıyla değerlendirmek amaçlandı. Gereç ve yöntem: Düzenlenen eğitim semineri önce ve sonrasında, pratisyen hekimlere ÜSYE\'nu epidemiyoloji, etyoloji, tanı ve tedavisi hakkında yedi soruyu içeren standart bir anket uygulanarak bilgi ve tutumları değerlendirildi ve cevap oranları karşılaştırıldı. Bulgular: Toplamda 110 pratisyen hekim çalışmaya katıldı. Seminer öncesi katılımcıların %30\'undan fazlası ÜSYE\'larının etyolojisinin en az %50\'sini bakterilerin oluşturduğu ve %88\'i anaerop ve Neisseriaların etyolojide yer almadığını düşünürken, katılımcıların yalnız %14\'ü Streptococcus pyogenes suşunun prokain penisiline tam duyarlı olduğunu, başka bir deyişle % 95\'i Beta-hemolytic - Streptococcus\'un etken olduğu ÜSYE\'ununun tedavisinde penesilinin ilk seçenek olduğu cevabını verdi. Seminer sonrası katılan hekimlerin bilgilerinde önemli bir ilerleme görüldü. .Doğru cevap oranlarında (seminer öncesi %27.7 ve sonrası %92.7) anlamlı bir fark vardı (p< 0.001). Sonuç: Pratisyen hekimlerin bilgi ve davranışlarının, eğitim seminerleriyle geliştirilebileceği sonucuna varıldı.

Anahtar Kelimeler:

Pratisyen hekimler, solunum yolu enfeksiyonları, antibiyotik kullanımı, eğitim.

Impact of an educational meeting on knowledge and awareness of general practitioners on upper respiratory tract infections

Objectives: This study aimed to evaluate knowledge of primary care physicians regarding the use of antibiotics for the upper respiratory tract infections (URTIs) and the specific outcomes of a health educational meeting in two cities using a self -administered questionnaire. Materials and methods: A standard questionnaire was filled by the participants before and after the meeting. The questionnaire had seven questions about definition, epidemiology, diagnosis and treatment of URTIs. The knowledge and approaches of practitioners concern about diagnosis and antibiotic use in URTIs were evaluated. The proportion of overall satisfied answers before and after the meeting was compared. Results: Totally 110 primary care physicians joined into the study. Before the educational meeting, more than 30% of participants stated that the at least 50% of the causative agents of the URTIs are bacteria. Eighty-eight percent declared that anaerobes or Neisseria are not the plausible causative agents in URTIs. Only 14% of them indicated that procaine penicillin is the primary agent for the treatment of Streptococcus pyogenes. On the other hand, 95% of survey participants considered that penicillin is the first choice for URTI with Beta-hemolytic Streptococcus. After the educational meeting, most of participants' knowledge showed a significant improvement in knowledge. There were a significantly more correct answers to all questions after the educational meeting compared to before the meeting. (27.7% of doctors before vs.92.7% after, p

Keywords:

Primary care physicians, respiratory tract infections, use of antibiotics, education,

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McCaig LF, Hughes JM. Trends in antimicrobial drug pre- scribing among office-based physicians in United States. JAMA 2002; 287(12):3096-102.
Linder JA, Stafford RS: Antibiotic treatment of adults with sore throat by community primary care physicians: a na- tional survey, 1989-1999. JAMA.2001;286 (10):1181- 6.
Cantrell R, Young AF, Martin BC. Antibiotic prescribing in ambulatory care settings for adults with colds,upper re- spiratory tract infections, and bronchitis. Clin Ther. 2002; 24(1):170-82.
Trostle J. Inappropriate distribution of medicines by pro- fessionals in developing countries. Soc Sci Med.1996; 42(8):1117-20.
Wolff MJ: Use and misuse of antibiotics in Latin America. Clin Infect Dis 1993; 17(Suppl 2):346- 51.
Acar JF: Resistance patterns of Haemophilus influenzae. J Chemother 1999; 11(Suppl 1):44-50.
Mathai D, Lewis MT, Kugler KC, Pfaller MA, Jones RN: Antibacterial activity of 41 antimicrobials tested against over 2773 bacterial isolates from hospitalized patients with pneumonia: I - results from the SENTRY Antimicrobial Surveillance Program (North America, 1998). Diagn Mi- crobiol Infect Dis 2001;39 (2):105-16.
Jones RN, Croco MA, Kugler KC, Pfaller MA, Beach ML: Respiratory tract pathogens isolated from patients hospital- ized with suspected pneumonia: frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997. Diagn Microbiol Infect Dis 2000;37 (2):115- 25.
Gruneberg RN, Felmingham D: Results of the Alexander Project: a continuing, multicenter study of the antimicro- bial susceptibility of community-acquired lower respira- tory tract bacterial pathogens. Diagn Microbiol Infect Dis 1996;25(4):169-81.
Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N. Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibi- otics for sore throats. BMJ 1998; 317 (7159):637- 42.
Barden LS, Dowell SF, Schwartz B, Lackey C. Current at- titudes regarding use of antimicrobial agents: results from physicians’ and parents’ focus group discussions. Clin Pe- diatr (Phila) 1998 ;37(11):665-71.
Paluck E, Katzenstein D, Frankish CJ, et al. Prescribing practices and attitudes toward giving children antibiotics. Can Fam Physician 2001; 47: 521- 7.
Council of the European Union. Conclusions on Antimi- crobial Resistance (AMR). 2008.http://www.consilium. europa.eu/uedocs/cms_Data/docs/pressdata/en/lsa/101035. pdf (16 April 2010, date last accessed).
Dellit TH, Owens RC, McGowan JE Jr et al. Infectious Dis- eases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an in- stitutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44 (2): 159- 77.
Pulcini C, Cua E, Lieutier F, Landraud L, Dellamonica P, Roger PM. Antibiotic misuse: a prospective clinical audit in a French university hospital. Eur J Clin Microbiol Infect Dis 2007; 26(4):277-80.
Nathwani D. Antimicrobial prescribing policy and practice in Scotland: recommendations for good antimicrobial prac- tice in acute hospitals. J Antimicrob Chemother 2006; 57 (6): 1189- 96.
Davey P, Brown E, Fenelon L et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Co- chrane Database Syst Rev. 2005; 4:8-24.
Wester CW, Durairaj L, Evans AT, Schwartz DN, Husain S, Martinez E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med 2002; 162(19):2210-6.
Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staffphysicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med 2004;164(13):1451-6
Guerra CM, Pereira CA, Neves Neto AR, Cardo DM, Correa L. Physicians’ perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Bra- zilian teaching hospital. Infect Control Hosp Epidemiol 2007;28(12):1411-4.
M. Uygur, T. Kirazlı, C. Bilgen. Akut Tonsillofarenjit Has- talarında Rapid Strep A Testinin Güvenilirliği. Turkish Arc- hives Otolaryngology 2002; 40(1): 36-40.
Mete.B, Akut Tonsillofarenjit I.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Egitimi Etkinlikleri Toplumda Edinilmiş En- feksiyonlara Pratik Yaklaşımlar Sempozyum Dizisi 2008; 61:107- 16.
Leblebicioğlu H, Canbaz S, Peksen Y, Gunaydin M. Phy- sicians’ antibiotic prescribing habits for upper respiratory tract infections in Turkey. J Chemother 2002; 14(2):181- 4.
Karabay O, Özdemir D, Güçlü E. et al. Attitudes and be- haviors of Family Physicians regarding use of antibiotics. Journal Microbiology Infectious Diseases 2011;1(2): 53- 7.
Lam TP, Ho PL, Lam KF, Choi K, Yung R. Use of antibiotics by primary care doctors in Hong Kong. Asia Pacıfıc Famıly Medicine 2009; 8 (1):5. Doi:10.1186/1447-056X-8-5
Bojalil R, Guiscafré H, Espinosa. et al. A clinical training unit for diarrhoea and acute respiratory infections: an inter- vention for primary health care physicians in Mexico. Bull World Health Organ 1999; 77 (11): 936- 45.
Sung L, Arroll J, Arroll B, Goodyear-SmithF, Kerse N, Nor- risP. Antibiotic use for upper respiratory tract infections be- fore and after a education campaign as reported by general practitioners in New Zealand. Journal of the New Zealand Medical Association. 2006; 119 (1233):1956-64.
Razon Y, Ashkenazi S, Cohen A et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J An- timicrob Chemother 2005; 56 (5): 937- 40. doi:10.1093/jac/ dki339.
McCluskey A, Lovarini M. Providing education on ev- idence-based practice improved knowledge but did not change behaviour: a before and after study. BMC Med Educ 2005; 5: 40. http://www.biomedcentral.com/1472- 6920/5/40. Doi: 10.1186/1472-6920-5-40.