Yerel yönetimin sunduğu sağlık hizmetleri hakkında halkın görüş ve beklentilerinin değerlendirilmesi (Bursa Nilüfer İlçesi kırsal mahalle örneği)
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2018
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Bu çalışmada kırsal alanda yaşayan bireylerin demografik ve sosyal yapılarındaki özelliklere göre yerel yönetimlerden sağlık hizmeti beklentilerinin nasıl farklılaştığı, bu durumun memnuniyet düzeyini nasıl etkilediği ve bireylerde demografik ve sosyal yapının sağlık algısı üzerine etkileri araştırılmıştır. Yapılan çalışmayla yerel yönetimlerin sağlık alanındaki hizmetlerini halkın beklentileri ve ihtiyaçları yönünde sunabilmesi için bilimsel dayanak oluşturmak ve uygulayıcılara farklı bakış açıları göstermek amaçlanmıştır. Kesitsel, çözümleyici bir araştırmadır. Bursa Nilüfer İlçesine bağlı 17 kırsal mahalledeki 2476 hane evren olarak alınmıştır. Örneklem olarak ise 2476 hane listesine olasılıklı örneklem yönteminden sistematik örnekleme işlemi ile her haneye 3 yedek belirlenerek 356 haneye anket uygulaması yapılmıştır. Hane adına bir kişiye anket uygulanmıştır. Araştırmada veri toplama tekniği olarak araştırmacı tarafından yüz yüze görüşme yöntemi uygulanmıştır. Yapılandırılmış görüşme formu ile veri elde edilmiştir. Görüşmeler hanede yaşayan 15 yaş ve üstü birey ile yapılmıştır. Anket, katılımcıların sosyo demografik yapısı, sağlık algısı, yerel yönetimlerden sağlık hizmetleri konusundaki beklentileri ve beklentilerin karşılanma durumunu belirlemek üzere hazırlanan 31 sorudan oluşmaktadır. Anket formu 5'li likert ve açık uçlu soruları içermektedir. İstatistiksel analizler SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) programında yapılmış olup, istatistiksel karşılaştırmalarda tip I hata düzeyi α=0,05 olarak kabul edilmiştir. Bu çalışmada, araştırma yapılan 214 hanede yatalak, engelli ve yaşlı yaşadığı saptanmıştır. Hanede en çok eş-kadının sağlık sorunu yaşadığı anlaşılmıştır. Belediyenin sağlık hizmeti sunmasının halkın gözündeki saygınlığını artıracağı anlaşılmıştır. Belediyelerin sağlık hizmetindeki başarısının siyasi tercihi olumlu yönde etkiler ifadesinde kararsızlık yaşandığı görülmüştür. Erkeklerin, çalışanların, kalabalık hanede yaşayanların, 65 yaş ve üstü olanların, eğitim seviyesi mahalleye göre yüksek olanların, sağlık algısı daha iyi bulunmuştur. Katılımcıların son bir ay içerisinde ilk sırada reçete yazdırma, sonra sırasıyla muayene, laboratuvar, hemşirelik, diş hekimliği ve acil müdahale hizmetlerini aldığı saptanmıştır. 'Belediye öncelikli olarak kime sağlık hizmeti sunmalıdır? ' Soru ifadesine birinci sırada kimsesizler sonra sırasıyla yaşlılar, herkes, maddi durumu kötü olanlar, engelliler ve çocuklar şeklinde bulunmuştur. Belediyelerden sunulması istenen hizmetler incelendiğinde; ilk sırada kişiye yönelik koruyucu sağlık hizmetleri sonra hastane, tıp merkez, poliklinik açılması, hasta nakil hizmeti, sağlık hizmetlerinin hepsi, evde tedavi hizmeti ve eczane açılması veya ilaç temin edilmesi hizmetinin sunulması istendiği anlaşılmıştır. Belediyenin sınırları içerisindeki kimsesiz, yatalak, engelli kişileri tespit ederek sağlık hizmeti sunmalı ifadelerini istedikleri saptanmıştır. Aile hekimliği sisteminin sağlık hizmetleri ile ilgili beklentileri karşılamamasına rağmen aile hekimliği uygulamasından sonra belediyelerden sağlık hizmetleri ile ilgili beklentilerinin artmadığı saptanmıştır. Belediyenin çevre sağlığı hizmetini yeterli verdiği saptanmıştır. Belediyenin yaptığı sağlık hizmetlerinden zamanında haberdar olmadıkları ve sağlık hizmetleri hakkında yeterli bilgilerinin olmadığı anlaşılmıştır. Sağlık hizmetleri konusunda ihtiyaç ve beklentilerini belediye yetkililerine iletmede, sunulan sağlık hizmetlerinden yeterince faydalanabilmede ve belediyenin sağlık hizmeti sunarken halkın beklentilerini göz önünde bulundurmasında en yüksek puanın katılıyorum ve kararsızım arasında olduğu anlaşılmıştır. Katılımcının yerel yönetimden sağlık hizmeti ile ilgili beklentilerine ve beklentilerinin karşılanma durumuna sosyo demografik yapının etkisi olduğu saptanmıştır. Anahtar Kelimeler: Sağlık, Belediye, Halk
By this study, how health service expectations from local governments differ according to the characteristics of demographic and social structures of individuals living in rural areas, how this affects the level of satisfaction, and the effects of demographic and social structure on the health perception of individuals have been investigated. It is aimed to establish a scientific basis and to give different perspectives to practitioners in order that local administrations can present their health services in the direction of expectations and needs of the people. The research is a cross-sectional, analytical investigation.2476 households in 17 rural districts of Bursa Nilüfer District were taken as population. As a sample, by using systematic sampling from Probabilistic Sampling Method with 2476 households, 356 households were conducted questionnaire by being determined 3 backups for each households. A survey was conducted to just one person on behalf of each household.Face to face interview method was applied by the researcher as data collection technique in the research. Data was obtained by structured interview form. Negotiations were made with individuals 15 years of age or older living in the household. The questionnaire consisted of 31 questions, which were prepared to determine participants' socio demographic structure, health perception, expectation of health services from local authorities and satisfaction of expectations. The questionnaire includes 5-point likert and open-ended questions.Statistical analyzes were made on SPSS Program(IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.) and statistical comparisons were accepted as type I error level α=0,05. In this study included 214 of the researched households; bedridden, disabled and aged people have been determined.In the households, it has been understood that wife-woman has the most health problems. It has been understood that the municipality's delivery of health services will increase its respectability in the public eye. Being in a quandary in the statement that the success of the municipalities in healthcare affects positively the political preferences has been observed. It has been observed that men, workers, people living in crowded dwellings, those aged 65 and over, those with a higher educational level in comparison with the neighborhood have a better health perception. In the last one month; participants have been stated to get services of making a prescription in the first place and then receiving examination, laboratory, nursing, dental and emergency treatment, respectively.The orphans in the first place , then respectively elderly people, everybody, the people with bad financial situation, the handicapped people and children has been determined for the question statement 'To whom should the municipality primarily provide health services?'. When the services requested from the municipalities are examined; it has been understood that the first priority is to provide personal protective health services and then the hospital, medical center, outpatient clinic, patient transportation service, all health services, home treatment services and pharmacy opening or drug delivery services. It has been determined that the municipality have been requested to provide health care services by identifying orphans/homeless people, bedridden and disabled people within the boundaries of the municipality.Despite the fact that the family medicine system can not meet the expectations about the health services, it has been determined that after the family medicine application, the expectations about the health services from the municipalities have not increased. The municipality has been appointed to provide adequate environmental health services. It has been understood that the municipality has not been informed of the health services in due time and there is not enough information about the health services and also the highest score has been 'agreed' and 'undecided' in the matter of transmitting the information about the needs and expectations of health services to the municipal authorities, taking full advantage of the health services offered, and considering the public's expectation in providing the municipal health service. The effect of socio-demographic structure on participants' expectations from the local government about health care services and the case of their expectations' meeting has also been stated. Keywords: Health, Municipality, Public
By this study, how health service expectations from local governments differ according to the characteristics of demographic and social structures of individuals living in rural areas, how this affects the level of satisfaction, and the effects of demographic and social structure on the health perception of individuals have been investigated. It is aimed to establish a scientific basis and to give different perspectives to practitioners in order that local administrations can present their health services in the direction of expectations and needs of the people. The research is a cross-sectional, analytical investigation.2476 households in 17 rural districts of Bursa Nilüfer District were taken as population. As a sample, by using systematic sampling from Probabilistic Sampling Method with 2476 households, 356 households were conducted questionnaire by being determined 3 backups for each households. A survey was conducted to just one person on behalf of each household.Face to face interview method was applied by the researcher as data collection technique in the research. Data was obtained by structured interview form. Negotiations were made with individuals 15 years of age or older living in the household. The questionnaire consisted of 31 questions, which were prepared to determine participants' socio demographic structure, health perception, expectation of health services from local authorities and satisfaction of expectations. The questionnaire includes 5-point likert and open-ended questions.Statistical analyzes were made on SPSS Program(IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.) and statistical comparisons were accepted as type I error level α=0,05. In this study included 214 of the researched households; bedridden, disabled and aged people have been determined.In the households, it has been understood that wife-woman has the most health problems. It has been understood that the municipality's delivery of health services will increase its respectability in the public eye. Being in a quandary in the statement that the success of the municipalities in healthcare affects positively the political preferences has been observed. It has been observed that men, workers, people living in crowded dwellings, those aged 65 and over, those with a higher educational level in comparison with the neighborhood have a better health perception. In the last one month; participants have been stated to get services of making a prescription in the first place and then receiving examination, laboratory, nursing, dental and emergency treatment, respectively.The orphans in the first place , then respectively elderly people, everybody, the people with bad financial situation, the handicapped people and children has been determined for the question statement 'To whom should the municipality primarily provide health services?'. When the services requested from the municipalities are examined; it has been understood that the first priority is to provide personal protective health services and then the hospital, medical center, outpatient clinic, patient transportation service, all health services, home treatment services and pharmacy opening or drug delivery services. It has been determined that the municipality have been requested to provide health care services by identifying orphans/homeless people, bedridden and disabled people within the boundaries of the municipality.Despite the fact that the family medicine system can not meet the expectations about the health services, it has been determined that after the family medicine application, the expectations about the health services from the municipalities have not increased. The municipality has been appointed to provide adequate environmental health services. It has been understood that the municipality has not been informed of the health services in due time and there is not enough information about the health services and also the highest score has been 'agreed' and 'undecided' in the matter of transmitting the information about the needs and expectations of health services to the municipal authorities, taking full advantage of the health services offered, and considering the public's expectation in providing the municipal health service. The effect of socio-demographic structure on participants' expectations from the local government about health care services and the case of their expectations' meeting has also been stated. Keywords: Health, Municipality, Public
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Sağlık Kurumları Yönetimi, Belediye hizmetleri, Belediyeler, Health Care Management, Bursa, Municipal services, Municipalities, Bursa-Nilüfer, Bursa, Sağlık hizmetleri, Bursa-Nilüfer, Health services, Yerel yönetimler, Local administrations