Ahmet KARABULUT, Kadir TOPÇU, Bülent UZUNLAR, Mahmut ÇAKMAK

Akut miyokard infarktüsünde ilk tercih edilen sağlık kuruluşunu etkileyen demografik ve klinik faktörler

Amaç: Bu çalışmayla akut miyokard infarktüsü (AMİ) hastalarının sağlık kuruluşlarına ilk başvurudaki tercih sebeplerini etkileyen demografik ve klinik değişkenleri araştırmayı amaçladık. Materyal ve Metot: Toplam 251 ardışık AMİ hastası çalışmaya dahil edildi. Hastalarla ilk başvurdukları kurum, tercih sebepleri, demografik ve klinik özelliklerini sorgulayan görüşmeler yapıldı. Hastalar ilk başvurdukları merkezlere ve tercih sebeplerine göre sınıflandırıldı ve istatistiksel olarak demografik özellikler, eğitim ve gelir düzeyi ile klinik özelliklere göre karşılaştırıldı. Bulgular: Hastaların %65’inde başvuru sebebi en yakın kurum iken, sadece %25‘i direk perkütan koroner girişim (PKG) merkezine başvurmuştu. Kadın hastalarda ve eğitim seviyesi düşük hastalarda yönlendirme ile başvuru daha fazlaydı. Hipertansiyon (HT) ve geçirilmiş AMİ olan hastalar takip edildikleri kuruma daha fazla başvurmuştu (p:0,002 ve p:0,003). Meslek, eğitim düzeyi, sosyal güvenlik kurumu ve aylık gelirin başvuru tercihi üzerinde belirgin bir etkisi saptanmadı. İlköğretim mezunları ve aylık geliri

Demograpic and clinical factors that affect the preference of first health center in the acute myocardial infarction

Background: We aimed to investigate the demographic and clinical variables that affect the preference of first admitted health center in the acute myocardial infarction (AMI). Materials and Methods: A totally 251 consecutive patients with AMI included to study. Patients were interviewed including first admission health center, cause of preference, demographic and clinical characteristics. Patients were classified according to first admission site and causes of preference. All the groups compared statistically according to demographic characteristics, educational levels, incomes and clinical features. Results: A 65% of the patients were admitted to closest health center initially and only 25% of patients were admitted to primary coronary intervention (PCI) capable centers directly. Admission to health center with a suggestion of relatives were more common in the women and in patients with low educational level. Patients with hypertension (HT) or previous AMI admitted to former health center more commonly (p:0.002 and p:0.003). There were no impact of occupation, educational level, insurance system and monthly income on admission preference. Patients graduating from primary school and with income<700 TL were applicated to daily clinics more commonly, on contrary, high school or college graduaters and patients with high incomes prefered public hospital or PCI capable centers more frequently. In the multivariate regression analysis, monthly income and presence of diabetes and HT were the major predictors for first admitted health center (p:0.003, p:0.014 and p:0.007). Conclusion: Despite of presence of numerous PCI capable centers, preference of these center as a first admission site is inadequate. Educational level, monthly income and presence of chronic disease could affect these preference directly.

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