E-ISSN 2651-3455 (Online) | ISSN 2630-5593 (Print)
The Anatolian Journal of Family Medicine - anatol j fm: 7 (3)
Volume: 7  Issue: 3 - 2024
1. Front Matter

Pages I - VIII

EDITORIAL COMMENT
2. From The Editor

Page 1
Abstract |Full Text PDF

ORIGINAL RESEARCH
3. Follow-up Status of Patients Referring to Secondary and Tertiary Hospitals in Family Health Centers
Sonay Gökçeoğlu, Mehmet Reşat Ceylan, Emine Beyaz
doi: 10.5505/ajfamed.2025.81994  Pages 88 - 96
INTRODUCTION: This study aimed to evaluate the frequency of patients' preference for other health care services instead of receiving health care services from Family Health Center (FHC) and the factors affecting this preference.
METHODS: The cross-sectional study involving 1217 patients was conducted between 12 and 22, December 2023. Among the patients who applied to the outpatient clinic, all patients who agreed to participate in the study were included in the study without skipping a line. Thus, the sample group was randomly selected. Data were collected using a structured information form. Face-to-face interviews were conducted with the patients in the study.
RESULTS: The study included 1217 patients who were admitted to the hospital for outpatient treatment, and 729 (59.9%) of the patients were treated in hospitals despite being eligible for diagnosis and treatment at the FHC. When the factors determining the tendency to seek care in FHC were evaluated, being 18 years of age or older 2.133 times (CI: 1.518–2.997; p<0.001), being literate or more educated 2.410 times (CI: 1.713–3.391; p<0.001), having income equal to or more than expenses 2.418 times (CI: 1.712–3.415; p<0.001), having a large family type 418 times (CI: 1. 712–3.415; p<0.001), having a large family type 1.954 times (CI: 1.309–2.917; p=0.001), being satisfied with the FHC 1.515 times (CI: 1.058–2.170; p=0.023), having a complaint duration of 8–90 days 2.368 times (CI: 1.465–3.828; p<0.001) have an effect.
DISCUSSION AND CONCLUSION: In this study, 59.9% of hospital admissions were found to be unnecessary admissions, suggesting that primary health care services are not used effectively.

4. Utilization of Primary Healthcare Services in Türkiye and Its Impact on Health Expenditures: A Study Based on Dermatology Outpatient Clinic Data
Zeynep Karaca Ural, Nuran Merve Sahin, Zeynep Utlu, Sevinç Sütlü
doi: 10.5505/ajfamed.2025.42714  Pages 97 - 101
INTRODUCTION: The aim of this study was to evaluate the effect of examinations on health expenditures in patients who applied to the dermatology outpatient clinic in case of a referral to the appropriate healthcare center.
METHODS: Of the 29.929 patients who applied to the dermatology outpatient clinic between January and December 2023. The patients were administered a 16-question questionnaire, including complaints, sociodemographic characteristics, and treatment access habits. Expert judgment was used to determine the appropriate healthcare service for each patient, and the economic impact of misreferrals was calculated.
RESULTS: The mean age of the participants was 31.5±13.0 years, and only 20 (5.3%) patients needed tertiary healthcare services. One hundred and sixty (42.2%) of the patients could be treated in primary healthcare service and 199 (52.5%) in secondary healthcare service. A total of 154.632 TL was invoiced for all patients who were examined in the dermatology clinic. Since the patients were not treated in the appropriate health service, an overpayment of 109.502,48 TL was made in health expenses. Among the reasons for not applying to a family physician, 98 (25.8%) frequently stated that they did not trust the knowledge and capacity of the family physician and 123 (32.5%) frequently stated that they expected to receive better service at the university hospital.
DISCUSSION AND CONCLUSION: To reduce health expenditures and improve the quality of care, appropriate referral patterns of patients to health centers should be developed, which can significantly improve the cost-effectiveness and functionality of the health system.

5. Evaluation of Knee Functionality and Frailty in Individuals 65 Years and Older in Primary Care: A Cross-Sectional Study
Esranur Yayın, Hasan Esad Yayın
doi: 10.5505/ajfamed.2025.47955  Pages 102 - 107
INTRODUCTION: The aim of this study was to investigate the relationship between knee functionality and frailty in individuals aged 65 years and olde
METHODS: Participants aged 65 years and older registered at the Family Health Center Unit were included in this cross-sectional study. The patients were administered a sociodemographic data questionnaire, the Lysholm knee scoring scale, and the fatigue, resistance, aerobics, illnesses, and weight loss (FRAIL) frailty scale during face-to-face interviews.
RESULTS: The study was conducted with 122 participants whom 74 (60.7%) were male. The frequency of frailty was 32 (26.2%) and the frequency of frailty pre-frail was 43 (35.2%). There was a relationship between FRAIL score with age and body mass index (BMI) (r=0.326 and p=0.001 for age, r=0.202 and p=0.020 for BMI). While 23 (71.9%) of the women were frail and 20 (46.5%) were pre-frail, 9 (28.1%) of the men were frail and 23 (53.5%) were pre-frail (p=0.001). There was a relationship between Lysholm scores and FRAIL total scores (r=−0.819 and p=0.001).
DISCUSSION AND CONCLUSION: Loss of knee functionality may increase frailty. Therefore, evaluating knee joint functionality may be useful in frailty assessment in elderly patients.

6. The Evaluation of the Vaccine Hesitancy among Parents of Children Aged 0-14
Serhat Fatih Keser, İlhami Ünlüoğlu
doi: 10.5505/anatoljfm.2025.03880  Pages 108 - 114
INTRODUCTION: This study aims to assess vaccine hesitancy among parents of children aged 0–14 and its related factors.
METHODS: This study is a cross-sectional study conducted among parents of children aged 0–14 who consulted the Eskişehir Osmangazi University Family Medicine Polyclinic between April 1 and September 30, 2022. The questionnaire form comprises sociodemographic characteristics and questions regarding vaccines. The World Health Organization Vaccine Hesitancy Scale was used to determine the frequency of vaccine hesitancy among the parents.
RESULTS: A total of 375 parents were assessed. In the study, 11 (2.9%) of the parents had at least one child who had not been vaccinated. Parents with unvaccinated children had a vaccine hesitancy score of 41.0 (17.0) and parents with unvaccinated children had a vaccine hesitancy score of 42.0 (8.0) (p=0.201). Parents who used the Internet as a source of information about vaccines had lower vaccine hesitancy scale scores than those who did not (40.0 [8.0] vs. 43.0 [8.0], p<0.001). In addition, the vaccine hesitancy score of parents who received vaccine-related information from health professionals was significantly higher (43.0 [8.0] vs. 40.0 [11.5], p=0.001).
DISCUSSION AND CONCLUSION: Obtaining vaccine-related information from health-care professionals rather than the Internet or other sources could lead to significant progress in combating vaccine hesitancy among parents.

7. Side Effects of Long-Term Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease
Fatma Ceren Gürel, Deniz Bilici, Esra Ertan Yazar, Burcu Arpinar Yigitbas, Coşkun Doğan, Hacer Hicran Mutlu, Mehmet Sargın
doi: 10.5505/ajfamed.2024.43531  Pages 115 - 120
INTRODUCTION: The literature lacks sufficient data on the long-term side effects of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) when used for over a year. In this study, the frequency of potential side effects was investigated in patients with COPD who had been using ICS.
METHODS: This single-center and observational study included stable COPD patients diagnosed with spirom-etry who had been using ICS for at least 1 year. Patient demographic and clinical characteristics and ICS-related side effects were recorded in detail according to the hospital records.
RESULTS: The study enrolled 92 patients, 74 (80.4%) of whom were male, with an mean age of 66.5±8.4 years. The frequency of potential side effects of ICS, including voice changes, oral candidiasis, bruises, and cataracts, was higher after treatment than before treatment (3 [3.3%] vs. 34 [36.9%], p<0.001; 3 [3.3%] vs. 15 [16.0%], p=0.008; 2 [2.2%] vs. 14 [15.2%], p=0.004; and 9 [9.8%] vs. 25 [27.2%], p=0.009, respectively). However, there was no difference in the frequency of adverse events such as pneumonia, mycobacterial infection, osteoporo-sis, and diabetes mellitus before and after treatment (20 [21.7%] vs. 19 [20.7%], p=0.860; 8 [8.7%] vs. 2 [2.2%], p=0.109; 4 [4.3%] vs. 8 [8.7%], p=0.388; and 10 [10.9%] vs. 13 [14.1%], p=0.678, respectively).
DISCUSSION AND CONCLUSION: Recognizing and assessing the side effects of ICS in patients with COPD and evaluating decisions regarding the use of ICS in routine clinical practice based on the benefit-risk ratio may be necessary.

CASE REPORT
8. Clinical Insights and Multidisciplinary Tertiary Prevention in Duchenne Muscular Dystrophy: A Case Report
Alisha Handa, Abhay Gaidhane, Sonali G. Choudhari
doi: 10.5505/ajfamed.2024.46220  Pages 121 - 123
Duchenne Muscular Dystrophy (DMD) is a severe X-linked recessive disorder characterized by progressive muscle atrophy, loss of mobility, and systemic complications, predominantly affecting males. This case report presents a 10-year-old boy with progressive walking difficulties, frequent falls, and hallmark features such as a positive Gower’s sign, waddling gait, lumbar lordosis, calf hypertrophy, and proximal muscle weakness. Symptoms began at age 4, with a notable family history of similar symptoms in an older sibling. Elevated creatine kinase levels and clinical findings strongly suggest DMD, with genetic testing underway for confirmation. Management focused on tertiary prevention strategies, including corticosteroid therapy, physiotherapy, orthotic support, respiratory care, and nutritional counselling. A multidisciplinary approach emphasized the importance of early interventions, assistive devices, and adjunct therapies such as yoga to improve functional outcomes and quality of life. This case highlights the critical role of comprehensive, personalized care and multidisciplinary collaboration in addressing the complex challenges of DMD, ultimately aiming to enhance the well-being and independence of affected individuals.

9. Multidrug-Resistant Microorganism as a Cause of Urinary Tract Infection in Primary Care
Javier Guinea Castañares, Gloria Martínez Iniesta, Irune Natalia Elizondo Pinillos, Jesus Iturralde Iriso
doi: 10.5505/ajfamed.2024.63634  Pages 124 - 125
This case report presented a 71-year-old female patient with a clinical picture compatible with a urinary tract infection (UTI) who did not respond to conventional treatment. The urine culture showed the growth of a bacterium called Providencia rettgeri, which is multidrug-resistant, among other antibiotics, to the one most commonly used in our population, such as fosfomycin trometamol, for uncomplicated UTIs.

SCIENTIFIC LETTER
10. Management of Type 1 Diabetes with Advanced Technology
Gopal Singh Charan, Raman Kalia, Maninderjit Kaur
doi: 10.5505/ajfamed.2025.80664  Pages 126 - 127
The understanding and treatment of type 1 diabetes (T1D) is advancing with technological advances. The discovery of insulin in 1921 revolutionized diabetes treatment and paved the way for the development of insulin pumps (IP) continuous glucose monitors (CGMs) and artificial pancreas (AP) systems, which have significantly improved diabetes management. IP provides continuous insulin delivery, offering benefits, such as adaptability, precise dosing, and improved glycemic control. The CGMs enable real-time glucose monitoring, leading to enhanced glycemic management and reduced hypoglycemia risk. The AP systems combine CGM and IP technologies to automate insulin delivery, resulting in improved outcomes and potential dual hormone systems using insulin and glucagon. Despite the potential of these technologies, challenges exist in utilizing them in India, including cost, insurance coverage, availability, awareness, healthcare infrastructure, trained professionals, cultural barriers, and data management issues. However, ongoing research and advanced research utilizing cutting-edge technologies offer hope for new therapies and ultimately a cure for T1D.

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