Umut KALYONCU, M.Murat ÇELİK, Hakan GÜZELSAĞALTICI

Hatay bölgesindeki romatoid artritli hastaların tedavi sürecini etkileyen motivasyon faktörlerinin araştırılması

Bu çalışmada romatoid artrit (RA) hastalarının romatoloji polikliniğine başvurmalarıyla ilgili motivasyon faktörlerinin araştırılması amaçlanmıştır. Ağustos 2012 ile Ekim 2012 tarihleri arasında Hatay Devlet Hastanesi Romatoloji Polikliniğine başvuran ardışık 95 RA hastası çalışmaya alındı. Son 6 ay içerisinde 1 veya daha fazla poliklinik kontrolüne gelen hastalar düzenli takibe gelen hastalarolarak kabul edildi. Çalışma tarihleri arasında başvuran ve son kontrolü 6 aydan önce olan hastalar ise düzenli takibe gelmeyen hastalar olarak kabul edildi. Hastalardan alınan bilgiler ışığında tedavi sürecinde sağlık kontrollerini düzenli yaptırma ve yaptırmama nedenlerini içeren iki ayrı form oluşturuldu. Düzenli tedavi olan hastalar için hazırlanan formda ifade sayısı 42, düzensiz tedavi olan hastalar için hazırlanan formda ise ifade sayısı 56 idi. Bu çalışmaya 95 RA hastası (63ü kadın) alındı. Hastaların yaş ortalamaları sırasıyla 46.4±13.0 ve 40.6±12.6 idi. Bu hastaların 81i (%85.3) tedavi sürecinde kontrollerini düzenli yaptıran hastalar olup, 14ü (%14.7) ise kontrollerini aksatan hastalardan oluşmaktaydı. Düzenli olarak kontrole gelen 81 hastanın 47sinin (%58.0) ilkokul düzeyi veya altında eğitim aldığı, kontrollerini aksatan 14 hatanın ise tümünün (%100) ilkokul düzeyi veya altında eğitim aldığı görülmüştür (p=0.002). Kontrollerini düzenli yaptıran hastaların 37si (%45.6) steroid kullanıyorken, düzenli kontrollerini yaptırmayan hastaların 12si (%85.7) steroid kullanmaktaydı ve aradaki fark anlamlıydı (p=0.006). RA hastalarını motive eden asıl faktörler sırasıyla doktor ve sağlık çalışanlarıyla, hastanın kendi düşünce, inanç ve beklentileriyle, hastane koşullarıyla, hastanın çalışma koşulları ve maddi gerekçelerle en sonunda da toplumsal etkilerle ilgili bulundu. RA hastalarının düzenli takip edilmeleri hasta ve doktor kaynaklı birçok nedenden etkilenmektedir. Hastaların sosyo-kültürel düzeyi düzenli takip edilmeyi doğrudan etkiliyor gibi görülmektedir.

An investigation of motivational factors affecting treatment process of patients with rheumatoid arthritis in Hatay province

In the present study, it was aimed to investigate factors of motivation concerning referral of the patient with rheumatoid arthritis (RA) to rheumatology department. Ninety-five consecutive patients with RA presented to Rheumatology Department of Hatay State Hospital between August, 2012 and October, 2012 were included to the study. The patients attended to one or more control visit within prior 6 months were considered as patients regularly attending control visits . Those attended to a control visit during study period but not within prior 6 months were considered as patients not regularly attending control visits . In the light of information obtained from patients, two distinct forms were designed including reasons for attending regularly or not regularly to control visits. The form designed for patients regularly attending control visits included 42 items, whereas the form designed for patients not regularly attending control visits included 56 items. Ninety-five patients (63 women) with RA were included to the study. Mean ages were 46.4±13.0 and 40.6±12.6 years. Of these patients, 81 (85.3%) were patients regularly attending control visits , whereas 14 (14.7%) were patients not regularly attending control visits . It was seen that, the educational levels was primary school or below in 47 (58%) of the 81 patients attending regularly to control visits vs. all 14 patients attending not regularly to control visits (p=0.002).While 37 (45.6%) of the patients attending regularly to control visits were on steroid therapy, 12 (85.7%) of the patients attending not regularly to control visits were on steroid therapy. The difference was statistically significant (p=0.006).The main factors motivating patient with RA are found to be related to clinicians and healthcare providers; thoughts, beliefs and expectations of the patients; conditions of hospital; working condition of the patients; economic arguments; and social interactions. Regular follow-up of the patients with rheumatoid arthritis can be affected by several factor originating from patient or clinician. It seems that socio-cultural level of the patients directly affect regular follow-up of these patients.

PDF

___

1. Wagner ED, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving Chronic Illness Care: Translating Evidence Into Action. Health Affairs 2001;20(6):64-78.
2. Johansson H, Eklund M. Helping alliance and early dropout from psychiatric out-patient care: the influence of patient factors. Social Psychiatry and Psychiatric Epidemiology 2006;41:140-147.
3. Killaspy H, Banerjee S, King M, Lloyd M. Prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome. British Journal of Psychiatry 2000;176:160-165.
4. Mitchell AJ, Selmes T. Why don't patients attend their appointments? Maintaining engagement with psychiatric services. Advances in Psychiatric Treatment 2007;13:423-434.
5. Moore PJ, Sickel AE, Malat J, Williams D, Jackson J, Adler NE. Psychosocial factors in medical and psychological treatment avoidance: the role of the doctorpatient relationship. Journal of Health Psychology 2004;9:421-433.
6. Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice 1982;19(3):276-288.
7. Roter D. Hall J. Doctors Talking with Patients/Patients Talking with Doctors. Westport, CT, 1993, Auburn House.
8. Sharp D, Hamilton W. Nonattendance at general practices and outpatient clinics. BMJ 2001;323:1081-1082.
9. Van der Meer G, Loock JW. Why patients miss follow-up appointments: A prospective control-matched study. East African Journal of Public Health 2008;5(3):154-156.
10. Cassileth B. Information and participation preferences among cancer patients. Ann Intern Med 1980;92:832-836.
11. Ende J, Kazis L, Ash A, Moskowitz M. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med 1990;4:24-30.
12. Hooper E, Comstock L, Goodwin JM, Goodwin JS. Patient characteristics that influence physician behavior. Med Care 1982;20:630-838.
13. Strull W, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA 1984;252:2990-2994.
14. Waitzkin H. Information giving in medical care. J Health Soc Behav 1985;26:81-101.
15. Waitzkin H. On studying the discourse of medical encounters. Med Care 1990;28:473-488.
16. Sharpe L, Allard S. Sensky T. Five-year followup of a cognitive-behavioral intervention for patients with recently- diagnosed rheumatoid arthritis: effects on health care utilization. Arthritis Rheum. 2008;59(3):311-316.
17. Sharpe L, Sensky T, Ryan B, Timberlake N. Allard S. Longterm efficacy of a cognitive behavioural treatment from a randomized controlled trial for patients recently diagnosed with rheumatoid arthritis. Rheumatology (Oxford) 2003; 42:435-441.
18. Sharpe L, Sensky T, Timberlake N, Ryan B, Brewin CR, Allard S. A blind, randomized, controlled trial of cognitive-behavioral intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain 2001;89: 275-283.
19. Young LD, Bradley LA, Turner RA. Decreases in health care resource utilization in patients with rheumatoid arthritis following a cognitive behavioral intervention. Biofeedback Self Regul 1995;20,259-268.
20. Gallagher R, Donoghue J, Chenoweth L, Stein-Parbury J. Self- management in older patients with chronic illness. International Journal of Nursing Practice 2008;14:373-382.
21. Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr, EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med 2002;17:243-252.
22. Meier PS, Donmall MC, Mcelduff P, et al. The role of the early therapeutic alliance in predicting drug treatment dropout. Drug and Alcohol Dependence 2006;83:57-64.
23. Gonzalez J, Williams J, Noel P. Lee S. Adherence to mental health treatment in a primary care clinic. Journal of the American Board of Family Practice 2005;18:87-96.
24. Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Counsel 2002;48:51-61.
25. Ataman Ş, Borman P, Evcik D, Aydoğ E, Ayhan F, Yıldızlar D, Bodur H. ve arkadaşları. Romatoid Artritin Tedavisi: Türkiye Romatizma Araştırma ve Savaş Derneği Uzlaşı Önerileri. Turk J Rheumatol 2011;26(4):273-294.
26. Wilder J, Plutchnik R. Conte H. Compliance with psychiatric emergency room referrals. Archives of General Psychiatry 1977;34:930-933.