Periyodik sağlık muayenesi için başvuran hastaların laboratuvar sonuçlarının değerlendirilmesi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Aile hekimliği polikliniğine PSM (Periyodik Sağlık Muayenesi) amaçlı başvuran ve sağlıklı görünen hastalardan istenen rutin laboratuvar tetkiklerinin değerlendirilmesi ve bu sonuçlara dayanarak konulan tanıların saptanması, rutin periyodik sağlık muayene aralıkları dışında istenen tetkiklerin dördüncül koruma ve aşırı teşhis (over diagnosis) konseptinde incelenmesi amaçlanmıştır. Gereç-Yöntem: Tanımlayıcı kesitsel özellikte olan araştırmamız Ocak 2017-Aralık 2018 tarihleri arasında bir üniversite hastanesindeki aile hekimliği polikliniğine başvuran 18 yaşından büyük, asemptomatik, kronik hastalığı olmayan, gebe olmayan hastaların rutin laboratuvar tetkiklerinin retrospektif olarak değerlendirilmesi şeklinde yürütülmüştür. Bulgular: 1415 kişi çalışmaya dahil edildi. Hastaların büyük bir çoğunluğu kadındı (%75,5). En sık saptanan laboratuvar anomalileri; 890 kişide 25-OH Vitamin D eksikliği (<20ng/mL), 876 kişide LDL yüksekliği (>100mg/dL), 847 kişide ferritin düşüklüğü (<30ng/ml), 524 kişide sınırda Vitamin B12 eksikliği (200-300pg/mL), 491 kişide Vitamin B12 eksikliği (<200pg/mL), 465 kişide total kolesterol yüksekliği (>200mg/dL), 361 kişide 25-OH Vitamin D yetersizliği (20-30ng/mL), 300 kişide trigliserid yüksekliği (>150mg/dL) ve 236 kişide Bozulmuş Açlık Glukozu olarak saptandı. Bir hasta hariç diğer tüm hastalarda en az 1 laboratuvar anomalisi saptandı. Sonuç: Kronik hastalığı ve şikayeti olmayan hastalarda rutin standart (şablon) laboratuvar tetkikleriyle sağlık muayenesi, etkili ve kanıta dayalı bir yöntem değildir. Bu yaklaşım, uygun olmayan tetkik istemleri ve girişimlere sebep olarak hem hastayı hem de sağlık sistemini olumsuz yönde etkiler. Hastalara, risk faktörleri ve sosyodemografik özelliklere göre kişiselleştirilmiş PSM uygulanmalıdır. Yapılandırılmış PSM ile bahsedilen zararların önüne geçebilmek, hastayı yakından tanıyan ve düzenli takip etme imkanına sahip aile hekimlerinin önemli bir görevidir. Ayrıca; sağlıklı görünen bireylerde demir eksikliği, Vitamin B12 eksikliği, 25-OH Vitamin D eksikliği, dislipidemi oranları oldukça yüksektir. Geniş kapsamlı prevalans çalışmalarına ihtiyaç mevcuttur. Bu eksikliklerin tanı ve tedavisinin mortalite ve morbiditeye katkısı olup olmadığını, aşırı teşhis(over diagnosis), etiketlenme(Labeling) ve hastalarda oluşturduğu anksiyete gibi olası zararlarını araştıracak çalışmalara ihtiyaç vardır.
Purpose: The purpose of this study was to determine the frequency of laboratory result anomalies of apparently healthy individuals who applied to the family medicine outpatient clinic for Periodic Health Evaluation(PHE) and diagnoses based on these results, to evaluate the consequences of tests ordered out of PHE intervals in the concept of quaternary prevention and overdiagnosis. Materials-Methods: This descriptive cross-sectional study was conducted through retrospective evaluation of the routine laboratory tests of non-pregnant, asymptomatic patients over the age of 18 who applied to the family medicine outpatient clinic of a university hospital between January 2017 and December 2018. Results: 1415 people were included in the study. The vast majority of patients were women (%75,5). The most common laboratory anomalies were; borderline Vitamin B12 deficiency (200-300pg/ml) in 524 people, Vitamin B12 deficiency (<200pg/mL) in 491 people, low ferritin (<30ml/ng) in 847 people, non-optimal LDL (>100mg/dL) in 876 people, Impaired Fasting Glucose in 236 people, 25-OH Vitamin D deficiency (<20ng/mL) in 890 people and insufficiency (20-30 ng/mL) in 361 people, high triglyceride (>150mg/dL) in 300 people and high total cholesterol (>200mg/dL) in 465 people. At least 1 laboratory abnormality was detected in all patients except 1 patient. Conclusion: General Health Examination with routine laboratory tests applied to patients without chronic diseases and complaints is not an effective and evidence-based method. It has negative effects on both the patient and the health system by causing inappropriate laboratory requests and interventions. Personalized PHE should be applied to patients according to their risk factors and sociodemographic characteristics. It is an important duty of family physicians, who know the patient closely and have the opportunity to follow up patients regularly, to prevent the mentioned harms with structured PHE. Also; the prevalence of iron deficiency, Vitamin B12 deficiency, 25-OH Vitamin D deficiency and dyslipidemia are quite high in apparently healthy individuals. Extensive prevalence studies are needed. There is a need for studies which will investigate whether the diagnosis and treatment of these deficiencies contribute to mortality and morbidity and the possible harms such as overdiagnosis, labeling and anxiety in patients.
Purpose: The purpose of this study was to determine the frequency of laboratory result anomalies of apparently healthy individuals who applied to the family medicine outpatient clinic for Periodic Health Evaluation(PHE) and diagnoses based on these results, to evaluate the consequences of tests ordered out of PHE intervals in the concept of quaternary prevention and overdiagnosis. Materials-Methods: This descriptive cross-sectional study was conducted through retrospective evaluation of the routine laboratory tests of non-pregnant, asymptomatic patients over the age of 18 who applied to the family medicine outpatient clinic of a university hospital between January 2017 and December 2018. Results: 1415 people were included in the study. The vast majority of patients were women (%75,5). The most common laboratory anomalies were; borderline Vitamin B12 deficiency (200-300pg/ml) in 524 people, Vitamin B12 deficiency (<200pg/mL) in 491 people, low ferritin (<30ml/ng) in 847 people, non-optimal LDL (>100mg/dL) in 876 people, Impaired Fasting Glucose in 236 people, 25-OH Vitamin D deficiency (<20ng/mL) in 890 people and insufficiency (20-30 ng/mL) in 361 people, high triglyceride (>150mg/dL) in 300 people and high total cholesterol (>200mg/dL) in 465 people. At least 1 laboratory abnormality was detected in all patients except 1 patient. Conclusion: General Health Examination with routine laboratory tests applied to patients without chronic diseases and complaints is not an effective and evidence-based method. It has negative effects on both the patient and the health system by causing inappropriate laboratory requests and interventions. Personalized PHE should be applied to patients according to their risk factors and sociodemographic characteristics. It is an important duty of family physicians, who know the patient closely and have the opportunity to follow up patients regularly, to prevent the mentioned harms with structured PHE. Also; the prevalence of iron deficiency, Vitamin B12 deficiency, 25-OH Vitamin D deficiency and dyslipidemia are quite high in apparently healthy individuals. Extensive prevalence studies are needed. There is a need for studies which will investigate whether the diagnosis and treatment of these deficiencies contribute to mortality and morbidity and the possible harms such as overdiagnosis, labeling and anxiety in patients.
Açıklama
Anahtar Kelimeler
Aile Hekimliği, Family Medicine, Dördüncül koruma, Quaternary prevention
