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Hastane Yöneticilerinin Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Yöntemine İlişkin Görüşlerinin Değerlendirilmesi

dc.contributor.advisorŞahin, Bayram
dc.contributor.authorDilmaç, Elife
dc.date.accessioned2019-04-30T06:26:45Z
dc.date.issued2019-04-29
dc.date.submitted2019-03-29
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dc.identifier.urihttp://hdl.handle.net/11655/6898
dc.description.abstractThe Health Technology Assessment (HTA) method, is one of the tools frequently applied in the decisions related to the acquisition of health technologies. The adaptation of HTA to hospitals is the Hospital Based Health Technology Assessment (HB-HTA) method. HTA method has been carried out at the since 2012 in Turkey. But, there is insufficient information on the use of HB-HTA in hospitals. Although the name was not known as HB-HTA in hospitals, several assessment models supporting the decision process are used when acquisition of a medical device or equipment. The aim of this study is to investigate how public and private hospitals benefit the HB-HTA method in the stage of acquiring medical device/equipment, what are the personal and institutional characteristics affecting the use of HB-HTA and how they affect it. In the study, the questionnaire, was developed as the data collection tool, a total of 186 managers from 33 hospitals, 24 of which were Ministry of Health and 9 private hospitals, were reached. The analysis reveals that the evaluation methods applied in the stage of acquiring a medical device/equipment in hospitals were similar to those used in HB-HTA methods and the dimensions of HB-HTA were taken into consideration. The multidisciplinary structure, which is one of the important features of the method is utilized in the assessments and preferred by the managers. It has been revealed that all the managers emphasizes various scales and dimensions of the method such as private hospitals to all dimensions of HB-HTA; branch hospitals to safety; teaching hospitals and all managers to clinical effectiveness; financial services managers and assistants to costs and economic evaluation as well as strategic and political aspects. In addition, HB-HTA method has been found to be affected positively by age variable. However, it has been observed that there is no systematic structure designed and deployed at the national level regarding the use and dissemination of HB-HTA. This study uncovers the current use of HB-HTA methods and applications in hospitals and shows that the development of HB-HTA method throughout the country should be supported at all levels of health system.tr_TR
dc.description.tableofcontentsİÇİNDEKİLER KABUL VE ONAY i YAYIMLAMA VE FİKRİ MÜLKİYET HAKLARI BEYANI ii ETİK BEYAN iii TEŞEKKÜR iv ÖZET v ABSTRACT vi İÇİNDEKİLER vii KISALTMALAR DİZİNİ x TABLOLAR DİZİNİ xi ŞEKİLLER DİZİNİ xiv EKLER xv GİRİŞ 1 1.BÖLÜM: SAĞLIK TEKNOLOJİSİ DEĞERLENDİRME YÖNTEMİ 6 1.1.TEKNOLOJİ VE SAĞLIK TEKNOLOJİSİ 6 1.2. SAĞLIK TEKNOLOJİSİ DEĞERLENDİRME YÖNTEMİ 10 1.2.1. Sağlık Problemi ve Teknolojinin Mevcut Kullanımı 12 1.2.2. Teknolojinin Tanımı ve Teknik Özellikleri 12 1.2.3. Güvenlik Boyutu 12 1.2.4. Klinik Etkililik Boyutu 13 1.2.5. Maliyetler ve Ekonomik Değerlendirme Boyutu 13 1.2.6. Etik Analiz Boyutu 14 1.2.7. Organizasyonel Yönler Boyutu 14 1.2.8. Hastalar ve Sosyal Yönler Boyutu 15 1.2.9. Yasal Yönler Boyutu 15 1.3. Sağlık Teknolojisi Değerlendirme Süreci 15 1.4. Sağlık Teknolojisi Değerlendirme Uygulamalarında İlaç ve Tıbbi Cihaz Arasındaki Farklılıklar 21 1.5. Sağlık Teknolojisi Değerlendirme ve Sağlık Politikası 22 1.6. Sağlık Teknolojisi Değerlendirme, Kanıta Dayalı Tıp ve Karşılaştırmalı Etkililik Araştırması Arasındaki Farklılıklar 26 2. BÖLÜM: HASTANE TABANLI SAĞLIK TEKNOLOJİSİ DEĞERLENDİRME YÖNTEMİ 29 2.1. Sağlık Teknolojisi Değerlendirme ve Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Yöntemlerinin Farkı 32 2.2. Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Sürecinde Hastane Yöneticilerinin Bilgi İhtiyacı 47 2.3.Hastane Tabanlı Sağlık Teknolojisi Uygulamalarının Etkinliğini Arttıracak Faktörler 52 2.4. Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Sonuçlarının Diğer Hastanelere Transferi 54 3. BÖLÜM: SAĞLIK TEKNOLOJİSİ DEĞERLENDİRME VE HASTANE TABANLI SAĞLIK TEKNOLOJİSİ DEĞERLENDİRME YÖNTEMLERİNİN GELİŞİMİ 56 3.1. Sağlık Teknolojisi Değerlendirme Yönteminin Gelişimi 56 3.2. Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Yönteminin Gelişimi 60 3.3. Türkiye’de Ulusal Ve Hastane Tabanlı Sağlık Teknoloji Değerlendirme Yöntemlerinin Gelişimi 64 3.4. Türkiye’de Sağlık Tesislerinde Tıbbi Cihaz ile İlgili Uygulamalar 68 4. BÖLÜM: GEREÇ VE YÖNTEM 70 4.1. Araştırmanın Amacı ve Kapsamı 70 4.2. Problem Cümlesi ve Hipotezler 71 4.3. Evren ve Örneklem 72 4.4. Veri Toplama Aracı 74 4.5. Veri Toplama Aracının (Anketin) Uygulaması 77 4.6. Verilerin Analizi 77 4.7. Soru Kağıdının Geçerlilik ve Güvenirliği 81 4.8. Kısıtlılıklar 90 5. BÖLÜM: BULGULAR 91 5.1 Tanımlayıcı Bulgular 91 5.1.1. Bağımsız Değişkenlerle İlgili Tanımlayıcı Bulgular 91 5.1.2. Bağımlı Değişkenlerle İlgili Tanımlayıcı Bulgular 100 5.2. Hipotezlere İlişkin Bulgular 108 6. BÖLÜM: TARTIŞMA 124 7. BÖLÜM: SONUÇ ve ÖNERİLER 140 KAYNAKÇA 148 EKLER 168tr_TR
dc.language.isoturtr_TR
dc.publisherSosyal Bilimler Enstitüsütr_TR
dc.rightsinfo:eu-repo/semantics/openAccesstr_TR
dc.subjectSağlık teknolojisi değerlendirme
dc.subjectHastane tabanlı sağlık teknolojisi değerlendirme
dc.subjectHastane
dc.subjectTıbbi cihaz
dc.subjectTıbbi ekipman
dc.subjectSağlık politikası
dc.subjectSağlık ekonomisi
dc.titleHastane Yöneticilerinin Hastane Tabanlı Sağlık Teknolojisi Değerlendirme Yöntemine İlişkin Görüşlerinin Değerlendirilmesitr_TR
dc.typeinfo:eu-repo/semantics/doctoralThesistr_TR
dc.description.ozetSağlık Teknolojisi Değerlendirme (STD) yöntemi, sağlık teknolojilerinin edinimi ile ilgili kararlarda sıklıkla başvurulan araçlardan biridir. STD’nin hastanelere uyarlanmış hali ise Hastane Tabanlı Sağlık Teknolojisi Değerlendirme (HT-STD) yöntemidir. Türkiye’de de 2012 yılından itibaren STD ile ilgili faaliyetler yürütülmektedir. Hastanelerde ise HT-STD’nin kullanımı ile ilgili yeterince bilgi mevcut değildir. Ancak hastanelerde adı her ne kadar HT-STD olarak tanımlanmasa da bir tıbbi cihaz ve ekipman edinilirken karar sürecine destek olan değerlendirme modellerinin kullanıldığı bilinmektedir. Bu araştırmanın amacı, kamu ve özel hastanelerin tıbbi cihaz ekipman edinme aşamasında, HT-STD yönteminden ne düzeyde yararlandıkları, HT-STD kullanımını etkileyen kişisel ve kurumsal özelliklerin neler olduğunu ve kullanım düzeyini nasıl etkilediklerini araştırmaktır. Araştırmada, veri toplama aracı olarak geliştirilen soru kâğıdının geçerlilik ve güvenilirlik çalışmaları yapılarak, 24’ü Sağlık Bakanlığı ve 9’u özel hastane olmak üzere toplam 33 hastaneden 186 yöneticiyle görüşülmüştür. Analizler sonucunda, hastanelerde bir tıbbi cihaz/ekipman edinme aşamasında HT-STD yönteminden yararlanıldığı ve HT-STD’nin boyutlarının dikkate alındığı görülmüştür. Yöntemin önemli özelliklerinden biri olan multidisipliner yapı, değerlendirmelerde kullanılmakta, yöneticiler tarafından da tercih edilmektedir. Özel hastanelerin HT-STD’nin tüm boyutlarına, branş hastanelerinin güvenlik boyutuna, eğitim hastanelerinin ise klinik etkililik boyutuna daha fazla önem verdikleri görülmüştür. Tüm yöneticilerin klinik etkililik boyutuna, idari ve mali hizmetler müdür ve yardımcılarının ise maliyetler ve ekonomik değerlendirme boyutu ile stratejik bakış açısı ve politik yönler boyutlarına daha fazla önem verdikleri ve yöneticilerin yaşı arttıkça HT-STD yöntemine karar verme sürecinde çok daha fazla yer verdikleri bulunmuştur. Bununla birlikte, HT-STD’nin kullanımı ve yaygınlaştırılması ile ilgili ulusal düzeyde tasarlanmış sistematik bir yapının olmadığı da görülmüştür. Bu çalışma, hastanelerde HT-STD yöntem ve uygulamalarının varlığını ortaya koymanın yanında, ülke genelinde HT-STD yönteminin gelişiminin sağlık sisteminin her düzeyinde desteklenmesi gerektiğini ortaya koymaktadır.tr_TR
dc.contributor.departmentSağlık Yönetimitr_TR
dc.embargo.terms6 aytr_TR
dc.embargo.lift2019-11-02T06:26:45Z


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