Birinci basamak sağlik hizmetlerinde kurum düzeyinde kişiye yönelik hizmet kapsayiciliğinin değerlendirme ölçeği

Objective: Our main objective is development a new assessment tool for our primary care health system (family practice unit) comprehensiveness. Methods: Target population of this research is made up of 400 Family Medicine Unit's(FMU) that work under 162 Family Health Center(FHC).(n=400). One FMU consist of a family doctor and family medicine personnel. No specific sampling method is used. Our goal is to reach the whole population (FMU). The survey's were given to doctors by two ways: The first way was making the survey into an online one with the help of a site (surveey.com). After taking the required permissions from Manisa Province Public Health Department the survey was published (by announcing 2 times between 01.10.2014-01.12.2014 for 2 months and by announcing it 2 times) on Family Medicine Information System (AHBS) used by FMU's all around Manisa. In our second step the family doctors were called one by one and asked for their participation. In our first step after announcing 2 times 180 family doctors and in the second step 81 family doctors, a total of 261 family doctors participated and the participation rate is %65.25. To evaluate the effectiveness of the tool the first goal was to establish the content validty. To do this firstly the ''wide service range'' which is an internal part of comprehensiveness and '' awareness of service needs'' which is an operative component of comprehensiveness were decided to be configured. After literature evaluation 6 different sub-dimensions were made theoriticly. These dimensions are: Routine risk group monitoring, health development services, health scanning services , rehabilitation services, technical equipment used in diagnosis and treatment, acute and chronic disease managment. The dimensions are actually created by using the three main features of health systems (protective services, treatment services, rehabilitation services). The question pool of the dimensions was made using a wide range literature scan consisting of 169 questions. Expert opinions were taken to evaluate the content validity of the tool. Specialists working on first step medical service academically and Specialists working on the field that are assigned to first step were chosen, a total of 25 Specialists are chosen. 18 of the Specialists responded.(participation rate %72). Davis method was used to evaluate the content validity of the scale. To do this content validity index was calculated and the ones below 0.80 were not accepted. To how well the questions were understood and to increase their understandability a group of 7 family doctors that work in Manisa made a pilot study. To evaulaute the structural validity of the scale first explanatory factor analysis was done and the data o 252 family doctors were included to the analysis. By using explanatory factor analysis the factor loadings of the questions are found out. By using this our aim is to divide main dimensions to sub dimensions and make more detailed dimensions. Some questions were removed according to these factor loadings. XIII To see the reliability of the study , %27 sub group-super group comparison, to detect the dimensional internal consistency Cronbach α change, the correlation between questions and total dimension, correlation between questions and linear regretion β values were used. To evaluate the construct validity of the scale the data from 242 family doctors was used. Also confirmatory factor analysis was done. In this step on a theoretical basis a model was made with implicit variables. In our model we used 6 implicit (Routine risk group monitoring, health promoting services, health scanning services, rehabilitation services, technical equipment used in diagnosis and treatment, acute and chronic disease managment.) and 120 observable variables. SPSS 15 and AMOS 22 statistical package programs were used fort he analysis. Results: After specialist evaluation, 31 questions were removed because their validity index were to low. The last form of the model made up of 5 dimensions (Routine risk group monitoring, health promoting services, health scanning services, rehabilitation services, technical equipment used in diagnosis and treatment, acute and chronic disease managment.). After doing the last models confirmatory factor analysis if we look at fit indices the x2/df value;1,716, RMSEA %90 confidence interval(square root of he mean of proximate lines) value is between 0,052-0,057, CFI= 0,885 and SRMR = 0,068. It is seen that the constructed model is well compatible. Also implicit variable level representation of observed variables in standardized regression coefficients ranged from 692 to 930. Conclusion: The scale which we developed to assess comprehensiveness of Turkey's primary care services has acceptable validty and reliability. Scale ratings methodolgyies were used in this study is arithmetic mean of dimensions. This methods is generally used by scale development studies. But must be considered to scale dimensions may have different weighted score in further studies. After the validty analyses of the scale, techniqal equipment used in the diagnosis and treatment services dimension has been removed .Nevertheless, further studies should be included the questions that evaluate to access laboratuary and radiologic services.