Özge BALCI, Tuğba RAMASLI GÜRSOY, İlgi ERTEM, Pelin ÇELİK, E Bahar BİNGÖLER PEKCİCİ, İclal AYRANCI SUCAKLI

Üçüncü Basamak Sağlık Hizmeti Veren Bir Merkezde İzlenen Prematüre Bebeklerin Sağlık, Eğitim, Rehabilitasyon ve Sosyal Alanlardaki Karşılanmamış Gereksinimleri

Amaç: Antenatal ve neonatal bakım koşullarındaki iyileşmelere bağlı olarak prematüre bebeklerin mortalite oranları azalmıştır. Mortalitedeki azalmaya rağmen, kısa ve uzun dönemde bebeklerin morbiditelerinin arttığı; sağlık sorunları ve gelişimsel riskleri açısından sağlıklı yaşıtlarına göre farklı hizmet modelleri ile izlenmeleri gerekliliği ortaya çıkmıştır. Riskleri ya da özel gereksinimleri nedeniyle izlemde olan prematüre bebeklerin sağlık, eğitim-rehabilitasyon ve sosyal hizmetler alanlarında gereksinimlerinin olduğu bilinmektedir. Bu araştırmada, en iyi koşulların sağlandığı üçüncü basamak sağlık hizmeti veren bir merkezde izlenen bebeklerin sağlık, eğitim, rehabilitasyon ve sosyal gereksinimlerinden karşılanmamış gereksinimlerinin ve "hizmet açığının" saptanması araştırılmıştır.Gereç ve Yöntemler: Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Gelişimsel Pediatri Bilim Dalı polikliniğine başvuran prematüre bebekler ve çocuklar, uzmanlar tarafından değerlendirildi. Bu değerlendirmede çocukların var olan sağlık, eğitim-rehabilitasyon ve sosyal hizmetler gereksinimleri ve bu gereksinimlerin karşılanıp karşılanmadığı "hizmet gereksinimi uzman formu" ile saptandı. Bulgular: Araştırmaya yaşları 4-39 ay (%25-75 aralığı: 9-22.5) olan 42 prematüre bebek dahil edildi. Birinci basamak sağlık hizmetlerinden %55'inin, eğitim-rehabilitasyon ve sosyal hizmetlerden % 36'sının ve üçüncü basamak sağlık hizmetlerinden %14'ünün karşılanmadığı ve hizmet açığı olduğu saptandı. Sonuç: Araştırmada, prematüre bebeklerin, üçüncü basamak bir sağlık merkezinde, "bütüncül izlem modeli" ilkelerine göre izlenmelerine ve ülkemiz koşullarına göre en iyi bakımı ve izlemi almalarına karşın gerek sağlık gerekse eğitimrehabilitasyon, sosyal hizmetler yönünden "hizmet açığı" olduğu saptanmıştır. Bu açığın devam etmesine neden olan koşulların belirlenmesi ve önlenmesine yönelik stratejilerin geliştirilmesi gereklidir.

Unmet Needs of Premature Babies in Health, Education, Rehabilitation and Social Services: A Tertiary Center Experience

Objective: The mortality rate of premature infants has decreased with the improvements in antenatal and neonatal care. Despite this decrease, the short- and long-term morbidity is increasing and requires specialized follow-up models for health and developmental risks. It is already known that premature infants at risks or with special needs have specific health, education, rehabilitation and social services requirements. The aim of the study was to determine the rate of unmet needs of premature infants in the health, education, rehabilitation and social services fields in a tertiary care situation with optimum conditions. Material and Methods: Premature infants and children that presented to Ankara University School of Medicine's Pediatrics and Developmental Pediatrics Outpatients Department were evaluated by specialists. During the assessment, the health, education-rehabilitation and social services needs and unmet needs were determined using the "Children with unmet needs Evaluation Form".results: Forty-two premature infants aged 4-39 months were enrolled. The percentage of unmet needs was 55%, 36%, and 14% in the primary health care, education-rehabilitation and social services, and tertiary health care needs fields respectively. conclusion: There were unmet needs in the health care, education-rehabilitation and social services fields even when premature infants were followed by means of a medical home model and a tertiary care unit with optimum conditions. More studies are needed to determine the causes of continuing unmet needs in these fields and to develop preventive strategies to decrease the rate of unmet needs.

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