Investigation the manageability of patients applied to the diabetes clinic at the primary care level based on their reasons for application

AIM: Although the tiered healthcare delivery aims to provide health services by appropriately trained healthcare professionals for relevant issues and prevent the use of specialized experts for less specialized healthcare services, the burden of patients in higher tiers strains the capacity of the system in our country. In our study, considering the increasing prevalence of diabetes, the aim was to determine the manageability of patients referred to tertiary care institutions at the primary care level based on their reasons for application. MATERIALS AND METHODS: Our study is a single-center descriptive cross-sectional research conducted through face-to-face interviews with patients attending the diabetes clinic of Sakarya University Training and Research Hospital. Patients who were 18 years of age and older and voluntarily agreed to participate in our study were included. A survey form consisting of 27 questions was used as the data collection tool. RESULTS: In our study, it was observed that approximately half of the participants who visited the diabetes clinic (48.5%) did so for control/follow-up purposes. The subsequent reasons for referral were identified as impaired blood sugar regulation (hypoglycemia/hyperglycemia) and complaints that patients believed to be related to diabetes. Approximately half of the participants (50.7%) visited the diabetes clinic without being referred by anyone. It was determined that 52% of the participants could be managed at the primary care level. However, when evaluated in terms of clinical competence, it was found that 25.2% of the participants could be managed by a primary care physician, but the medications they needed were not covered by reimbursement when prescribed at the primary care level, necessitating a specialist consultation. CONCLUSION: We believe that by effectively and efficiently utilizing the primary healthcare system, which is part of the first level of healthcare institutions, the burden of diabetic patients in higher-level healthcare institutions can be reduced by nearly half. Expanding the scope of oral antidiabetic (OAD) and insulin medications that family physicians can prescribe and issue medication reports for will lead to an increase in the manageable patient rate. We believe that informing patients about the healthcare services provided within the scope of family medicine and the competencies of family physicians is necessary. By strengthening primary healthcare services and the family medicine system and implementing a mandatory referral system, we anticipate a decrease in the patient load in higher-level healthcare institutions.