Kaya Çiğdem Apaydın, Akman Mehmet, Ünalan Pemra Cöbek, Çifçili Serap, Uzuner Arzu, Akdeniz Esra
Department of Family Medicine, Marmara University Medical School, Istanbul, Turkey.
Department of Medical Statistics, Marmara University Faculty of Medicine, Istanbul, Turkey.
Prim Health Care Res Dev. 2019 Jul 24;20:e119. doi: 10.1017/S1463423619000069.
To investigate the changes in the provision of preventive health services in terms of woman and child health after reorganization of the primary health care services.
The primary care system in Turkey has undergone fundamental changes as a part of Health Transformation Program during last decade. But there was no community-based study to evaluate these changes.
This community-based and cross-sectional study was conducted in 2010, just before the reorganization of primary care services and in 2015, five year after the reforms. The 30×7 cluster sampling method was used in Zümrütevler quarter of Maltepe District. The socio-demographic characteristics of the participants, the presence of the physician who can be consulted for any health problem, the presence of smokers at home were questioned. The women aged 18 years or older and gave consent provided information about history of pregnancy and birth, the number of follow-ups during pregnancy, family planning method usage, cervical and breast cancer screening, breastfeeding duration, vaccinations, and prophylactic iron and vitamin D supplementation for their children.
After the reorganization of primary care, more people stated that they had physicians to whom they could consult for all kinds of health problems (27.8 versus 44.7%; P<0.001) and that physician was the primary care physician (30.2 versus 64.7%; P<0.001). The reported frequency of at least one smoker at home was decreased after reorganization of primary care (63.6 versus 53.1%; P=0.034). There were no significant differences in terms unplanned pregnancy, the use of family planning method, the number of pregnancy follow-ups and the frequency of Pap smears and mammography. There are no significant differences in terms of healthy children follow-ups, vaccination, vitamin D and iron supplementation (P>0.05). It was found that the duration of total breastfeeding increased after reorganization of primary care (P<0.001).
调查初级卫生保健服务重组后妇幼保健方面预防性卫生服务的提供情况变化。
在过去十年中，作为健康转型计划的一部分，土耳其的初级保健系统发生了根本性变化。但尚无基于社区的研究来评估这些变化。
这项基于社区的横断面研究于2010年（就在初级保健服务重组之前）和2015年（改革五年后）进行。在马尔泰佩区的祖姆吕特夫勒街区采用30×7整群抽样方法。询问了参与者的社会人口学特征、是否有可就任何健康问题咨询的医生、家中是否有吸烟者。18岁及以上且同意参与的女性提供了怀孕和分娩史、孕期随访次数、计划生育方法使用情况、宫颈癌和乳腺癌筛查、母乳喂养持续时间、疫苗接种以及为其子女补充预防性铁剂和维生素D的信息。
初级保健重组后，更多人表示他们有可就各类健康问题咨询的医生（27.8%对44.7%；P<0.001），且该医生为初级保健医生（30.2%对64.7%；P<0.001）。初级保健重组后，报告家中至少有一名吸烟者的频率有所下降（63.6%对53.1%；P=0.034）。在意外怀孕、计划生育方法使用、孕期随访次数以及巴氏涂片和乳房X线摄影频率方面无显著差异。在健康儿童随访、疫苗接种、维生素D和铁剂补充方面也无显著差异（P>0.05）。发现初级保健重组后纯母乳喂养的总持续时间增加（P<0.001）。
