Turkish Association of Family Physicians
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Digitalization of primary health care services in Türkiye and the integration process between levels of care
As part of ongoing efforts to make the healthcare system in Türkiye more effective, accessible and sustainable, the digitalization of primary healthcare services is gaining increasing importance. This study explores the contribution of digital health technologies to service delivery—particularly through family health centers—along with the integration policies developed between different levels of care. The widespread adoption of systems such as electronic health records, e-Nabız, the Central Physician Appointment System (MHRS), and the Public Health Management System (HSYS) has not only improved patient-service alignment but also facilitated better coordination among healthcare professionals. Following the implementation of the Health Transformation Programme, information management systems have enabled a more holistic approach to patient follow-up, guidance, and monitoring. In 2025, the “Integration between Healthcare Levels” initiative was introduced to streamline patient transitions from primary to secondary and tertiary care in a more systematic and efficient manner. Expanding the scope of the authority of family physicians, enhancing their access to laboratory and imaging services, and promoting reciprocal information sharing with specialist physicians are expected to support a more balanced distribution of the healthcare burden and alleviate patient congestion in hospitals. These initiatives aim to shorten the time citizens wait for care, improve referral accuracy, and increase access to preventive health services. In light of these developments, it is envisioned that the future of Türkiye’s healthcare system will be built upon a more innovative and integrated model, underpinned by a strengthened digital infrastructure and enhanced digital competencies among physicians.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
Investigation of risk factors of autism spectrum disorders in primary care: Aydın City Center sample
Objective: Autism Spectrum Disorder (ASD) is the second most common developmental disability after intellectual disability. The study aimed to determine the prevalence of ASD risk in children aged 18-36 months admitted to Family Health Centers (FHCs) in Aydın city center, considering the role of FHCs as the first point of contact, and to identify the factors increasing ASD risk. Methods: Descriptive and cross-sectional study. Assuming 1% prevalence based on DSM-5 data and a sampling error of 0.05, the sampling size of the study planned with a descriptive cross-sectional design was calculated as 392 using the G*Power program. 431 participants were targeted with a 10% margin of error. The data collection form prepared through a literature review and the Modified Checklist for Autism in Toddlers (M-CHAT) scale were administered to all participants who applied to the 8 FHCs (6 urban and 2 rural) selected through cluster sampling method and agreed to participate in the study. Descriptive analyses for non-categorical variables and chi-square analyses for categorical variables were used. p<0.05 was considered to be statistically significant. Additionally, in order to eliminate its confounding effect, logistic regression analysis was applied to all variables considered to be associated with ASD. Results: In the sampling with a mean age of 27.5±6.5 months, ASD risk was found to be 5.8%, and ASD diagnosis prevalence was found to be 0.92%. Sociodemographic features, such as male gender, having a low-income family, maternal use of medication during pregnancy, low birth weight, being born before 35th week of gestation and not being vaccinated in accordance with the vaccination calendar were found statistically significant associated risk factors for ASD. Conclusion: Continuous follow-up is crucial for individuals identified as being at risk for autism spectrum disorder (ASD) but who do not yet meet the diagnostic criteria. Given the role of early diagnosis in treatment, raising awareness of ASD is a priority in the fight against autism. Furthermore, more research is needed to assess the knowledge levels of both healthcare personnel working at Family Health Centers (often the first point of contact for children aged 18-36 months) and families with children under 36 months.
Purple urine bag syndrome: a benign case in an elderly home healthcare patient
Purple Urine Bag Syndrome (PUBS) is a rare but visually striking phenomenon usually seen in elderly, immobile, and chronically catheterized patients. Although it usually follows a benign course, its alarming appearance may trigger excessive diagnostic and therapeutic interventions, leading to unnecessary increases in healthcare utilization. We report the case of a 95-year-old woman with chronic ischemic heart disease, followed through home healthcare services, who developed PUBS without clinical or laboratory evidence of infection. The condition resolved completely after simple catheter and bag replacement, without antibiotic therapy. This case emphasizes that PUBS does not always indicate active infection and highlights the importance of rational management in primary care and home healthcare practice, preventing overdiagnosis, overtreatment, and unnecessary antibiotic use.
Demographic and clinical characteristics of patients applying to a smoking cessation clinic affiliated with a university hospital and factors affecting their smoking cessation status
Objective: Smoking addiction is a serious public health problem that ranks among the leading preventable causes of death and affects all age groups. Our study aimed to examine the demographic and clinical characteristics of patients attending a smoking cessation clinic affiliated with a university hospital and the factors influencing their cessation status. Methods: This is a retrospective, cross-sectional study. Age, gender, occupation, chronic disease status, treatments given, smoking histories, and Fagerstrom scores of patients who applied to the smoking cessation clinic affiliated to Samsun Training and Research Hospital between August 01, 2020 and August 31, 2024 were obtained using the hospital automation system without sharing their personal information. The data were analyzed using the SPSS package program. Results: A total of 399 patients were included in the study. 63.66% (n=275) of the patients were male. The average Fagerstrom score of the patients was calculated as 5.66±2.43. The patients were interviewed an average of 2.21±1.28 times per person. The average smoking duration of the patients was calculated as 27.38±16.57 pack-years. Combined treatment was initiated in 35.19% of the patients (n=141). As combined treatment, 88.15% of the patients (n=134) were started on a combination of Bupropion and Nicotine Replacement Therapy (NRT). As a result of treatment, 34.09% of patients (n=136) quit smoking. Monotherapy with Bupropion was found to be the least effective drug for smoking cessation (p=0.01). The smoking cessation rate among patients receiving combination therapy was found to be higher than that of other treatment options (p<0.001). Patients who quit smoking had a significantly lower Fagerstrom score (p=0.024) than those who did not quit, while the number of individual consultations per patient (p<0.001) was significantly higher. The proportion of patients who quit smoking and had other smokers in their household was lower than those who did not quit (p=0.003). Conclusion: It was observed that approximately one third of the patients quit smoking. The smoking cessation rate of patients who used combined treatment was found to be higher than other treatment options.
Reflections of digital transformation and integration systems in healthcare: family medicine a cross-sectional study
Objective: Primary healthcare services constitute the initial point of contact within the healthcare system and play a fundamental role in terms of efficiency, evidence-based decision-making, and sustainability. Within the scope of the “Digital Transformation and Integration System in Healthcare,” developed to enhance the effectiveness of the family medicine system in Türkiye and ensure service integration, a contact registration desk and a Family Medicine Convenience Polyclinic have been established at our center. This study aims to evaluate the demographic and clinical characteristics, reasons for presentation, and patient satisfaction levels of individuals presenting to the registration desk located in the Family Medicine Convenience Polyclinic. Methods: This cross-sectional study included 312 patients who presented to the registration desk at the Family Medicine Convenience Polyclinic of Gülhane Training and Research Hospital between January 1, 2025, and June 30, 2025. Data were obtained from the hospital information management system and a questionnaire form prepared in accordance with the literature. The Patient Satisfaction Assessment Short Form (PSASF) consists of seven items on a 5-point Likert scale, with higher scores indicating greater levels of dissatisfaction. Chi-square, Fisher’s exact, and Mann-Whitney U tests were used in the data analysis; significant variables were included in multivariate logistic regression analysis. Based on G*Power analysis (80% power, α=0.05), a minimum of 250 participants was deemed sufficient; 312 patients found suitable during the study period were included in the analyses. Results: The median age of participants was 45 years, and 79.8% were female; 40.7% were university graduates, 44.2% had at least one chronic disease, and 76.6% of applications were for radiological examination purposes. The overall satisfaction rate is 92.6%, with the highest satisfaction related to the respectful attitude of the healthcare staff (66.0%) and the lowest satisfaction related to the time spent with the doctor (33.0%). When comparing satisfied and dissatisfied groups, female gender (p=0.019), advanced age (p<0.001), low education level (p=0.050), and the presence of chronic disease (p=0.024) were found to be significantly related to satisfaction, while no significant difference was found in terms of the reason for referral (p=0.064). In the univariate model of the logistic regression analysis, age (p=0.001), gender (p=0.023), education level (p=0.052), comorbidities (p=0.031), and reason for referral (p=0.070) were found to be associated with satisfaction; while in the multivariate analysis, only being in the ≥45 age group was shown to be independently associated with satisfaction (OR=9.77; 95% CI: 1.80–53.06; p=0.008). Conclusion: The “Digital Transformation and Integration System in Healthcare” model has been demonstrated to increase efficiency in the healthcare system and strengthen patient satisfaction. The findings indicate that expanding digital integration may provide significant contributions to improving accessibility, service quality, and inclusivity in primary healthcare services.
A descriptive study of cytisine treatment in a family medicine smoking cessation clinic: short-term outcomes and experiences
Objective: The aim of this study was to investigate patients’ use of cytisine prescribed as a smoking cessation medication, the frequency of observed side effects, and smoking cessation rates at the Marmara University Family Medicine Smoking Cessation Clinic, thereby laying the groundwork for future research on cytisine use in Turkey. Methods: The descriptive study included 256 participants who applied to the Marmara University Department of Family Medicine’s Smoking Cessation Clinic between May 2024 and March 2025 and underwent cytisine treatment. Participants’ sociodemographic characteristics, smoking status, cytisine use, and treatment processes were retrospectively collected via a questionnaire administered through telephone interviews. Tobacco dependence level was assessed using the Fagerström nicotine dependence test (FNDT). The dependent variable of the study is smoking cessation status; the independent variables are age, gender, education level, smoking burden, medication completion, and attendance at follow-up appointments. Data were analyzed using SPSS 25.0 software, and p<0.05 was considered statistically significant. Results: The average age of participants was 40.7±0.9 years, the average FNDT score was 6.3±2.2, and the average smoking burden (pack/year) was 24.9±1.3. In our study, 31% of individuals who initiated cytisine treatment were not smoking at follow-up. The proportion of participants who remained non-smoking status at assessment was significantly higher among those with lower smoking burden, those who attended follow-up appointments, those with higher perceived income, and those who completed the medication (p=0.027, p=0.035, p≤0.001, p=0.020). In multivariable analysis, higher perceived income independently predicted non-smoking status at follow-up (aOR=1.91, p=0.004), whereas treatment completion showed borderline significance. At least one side effect was observed in 31.5% (n=79) of participants; the most commonly reported were nausea (10.2%), palpitations (3.9%), dizziness (3.5%), and mood changes (3.5%). Conclusion: In this real-world clinical setting, 31% of patients receiving cytisine were classified as non-smokers at follow-up. In the context of limited national data, these results offer exploratory evidence to guide the design of future randomized controlled trials.
The effects of mindfulness levels on menstrual symptoms and irritability in university students
Objective: This study aims to determine the effects of mindfulness levels on menstrual symptoms and irritability among university students. Methods: This descriptive cross-sectional study was conducted between February and March 2025 with 274 female university students aged 18–49 years residing in a women's dormitory in Ankara. Data were collected using a Personal Information Form, the Five Facet Mindfulness Questionnaire (FFMQ), the Menstrual Symptom Questionnaire (MSQ), and the Born–Steiner Irritability Scale (BSIS). Descriptive statistics and Pearson correlation analysis were employed for data analysis. Results: The participants' mean age was 20.82 ± 2.12 years. The mean total scores were 126.25 ± 14.47 for FFMQ, 73.24 ± 18.18 for MSQ, and 26.25 ± 8.23 for BSIS. A moderate positive correlation was identified between menstrual symptoms and irritability. Conclusion: Different subdimensions of mindfulness exert varying effects on menstrual symptoms and irritability. Notably, the Acting with Awareness skill emerged as the most effective factor in reducing both menstrual symptoms and irritability. These findings suggest that mindfulness-based intervention programs can be integrated into primary care services for female patients in family medicine practice, and family physicians can utilize holistic approaches in menstrual symptom management.
How culture and context shape lifestyle medicine: insights from the EYFDM Bridge Project
Bibliometric analysis of publications related to primary health care from Türkiye: 2015–2024
Objective: Primary healthcare is a fundamental component of robust health systems and plays a key role in advancing universal health coverage (UHC) and the Sustainable Development Goals (SDGs). Family physicians and other primary care doctors require current and trustworthy evidence and therefore depend on systematic reviews of the literature. Although the number of primary healthcare–related papers has grown, information on the overall characteristics of this body of work remains limited. Bibliometric analysis combined with visualization techniques is a useful approach for mapping research trends and identifying gaps in knowledge. This study aimed to examine primary health care publications indexed in WoS that had at least one author affiliation in Türkiye (2015–2024) and to describe Türkiye’s contribution in the global context. Methods: Scientific documents indexed in the Web of Science (WoS) under the category “Primary Health Care” and affiliated with Türkiye were retrieved for the years 2015–2024. Descriptive quantitative and qualitative analyses were carried out using standard bibliometric indicators, including publication counts, language of publication, institutional affiliations, most cited articles, authors, and journals. VOSviewer software was employed to generate a keyword co-occurrence network in order to explore research themes and their interrelations. Results: There were 267 scientific publications produced from Türkiye between 2015 and 2024. The highest number of studies was conducted in 2023 (n: 49, 18.35%). All of the publications were in the English language, 22.47% were published in the Primary Care Diabetes, and most publications were in article form (n: 227, 85.02%). “Primary care” was the most frequently used word in the map created with the network analysis of the keywords. Conclusion: The literature review has shown that our study is the first bibliometric study presenting publications related to primary health care from Türkiye. Overall, Türkiye’s contribution to the global PHC literature remains limited. Strengthening research capacity through targeted funding, multicenter collaborations, and diversified study designs is essential to increase both the volume and impact of PHC research from Türkiye.
The relationship between social media use, eating attitudes, and body mass index in young adult women: a cross-sectional study
Objective: Social media use has become increasingly widespread among young adults and may influence eating-related behaviors and body weight outcomes. However, evidence regarding platform-specific social media use, body mass index (BMI), and eating attitudes among young adult women remains limited. Therefore, this study examined associations between social media platform use, BMI categories, and eating attitudes among women aged 19-32 years. Methods: This cross-sectional study was conducted between February and March 2025 among voluntarily recruited women aged 19-32 years through face-to-face interviews conducted in university and community settings in Elazığ, Türkiye. A total of 456 participants completed questionnaires covering sociodemographic characteristics, anthropometric measurements, social media use patterns, and the Eating Attitudes Test-26 (EAT-26). Statistical analyses were performed using R (version 4.4.1), IBM SPSS Statistics (version 26), and MedCalc Statistical Software (version 21). Results: Participants’ mean age was 22.67 ± 3.50 years and mean BMI was 22.58 ± 3.73 kg/m²; 66.2% were normal weight and 76.1% had an associate degree level of education. BMI categories differed significantly by use of Facebook, X (Twitter), and TikTok, and by weekly social media visit frequency (p < 0.05). EAT-26 scores increased significantly across higher BMI categories (p < 0.001). Women in the pre-obese and obese groups had significantly higher EAT-26 scores than those in the underweight and normal-weight groups (p < 0.001). Platform-specific differences were also observed: X (Twitter) use was associated with mean BMI (p = 0.014), while YouTube (p = 0.035) and Snapchat use (p = 0.013) were associated with mean EAT-26 scores. Correlation analyses indicated generally weak associations between social media use measures and both BMI and EAT-26 scores (r = 0.03–0.31). Conclusion: Social media use patterns differed across BMI categories, and higher BMI levels were associated with more impaired eating attitudes among young adult women. These findings highlight the importance of considering social media-related factors in strategies aimed at promoting healthy eating behaviors and reducing disordered eating risk in this population.
The evolving WONCA tree: a conceptual shift toward planetary and sustainable primary care
Association between smartphone addiction and symptoms of depression and anxiety among young adults
Objective: Smartphones, now ubiquitous across the globe, have the potential to contribute to behavioral addiction. Among the psychological concerns linked to such addictions are depression and anxiety. This study aimed to investigate potential associations between smartphone addiction and symptoms of depression and anxiety in a sample of young adults. Methods: This descriptive, cross-sectional study was conducted over a two-month period among 512 university students. Participants completed a questionnaire comprising sociodemographic information and smartphone usage patterns, along with the Smartphone Addiction Scale–Short Version (SAS-SV), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Group comparisons were performed using the Kruskal–Wallis and Mann–Whitney U tests. Spearman and Pearson correlation coefficients were used to assess the strength and direction of associations. Results: The study population consisted of young adults with a mean age of 20.45 ± 1.95 years.A statistically significant relationship was found between depression-based on cut-off values-and smartphone addiction (p=0.001). Moreover, weak but statistically significant positive associations were observed between smartphone addiction and both depression (r=0.232, p=0.001) and anxiety (r=0.209, p=0.001). Participants who self-identified as smartphone addicts reported significantly higher SAS-SV scores compared to those who were unsure or did not consider themselves addicted (p=0.001). Conclusions: The findings demonstrate a significant association between smartphone addiction and symptoms of depression and anxiety. Given that individuals perceiving themselves as addicted exhibited notably higher addiction scores, self-perception may serve as a useful indicator in preventive mental health approaches—particularly within the context of primary care.
Adaptation of the Gosnell Pressure Ulcer Risk Assessment Scale to Turkish: validity and reliability study
Objective: This study aimed to adapt the Gosnell Pressure Ulcer Risk Assessment Scale into Turkish and to evaluate its linguistic validity, content validity, inter-observer reliability, and construct validity through exploratory and confirmatory factor analyses. Methods: This methodological study was conducted with 150 patients treated in a palliative care unit over one year. The adaptation process consisted of two stages: linguistic validation and assessment of validity and reliability. Linguistic validity was assessed using the translation-back translation method and expert reviews. Content validity was evaluated using the Lawshe technique with input from five experts from the Department of Family Medicine. Reliability was assessed by measuring inter-observer agreement using the Kappa coefficient, Cramer’s V coefficient, and Spearman correlation analysis. To evaluate construct validity, Exploratory Factor Analysis (EFA) using Principal Component Analysis and Confirmatory Factor Analysis (CFA) using the Diagonally Weighted Least Squares (DWLS) estimation method were conducted. Results: A total of 150 participants were included, with a mean age of 74.74 years, and 58% were female. The Content Validity Ratio (CVR) for each item was calculated as 1. Regarding reliability, the Kappa coefficient for the Mental Status item was 0.903, and Cramer’s V coefficient was 0.896; for the Continence, Mobility, and Activity items, both the Kappa and Cramer’s V coefficients were 1. For the Nutrition item, the Kappa coefficient was 0.840, and Cramer’s V coefficient was 0.862. A significant and positive correlation was found between the total scores of the two observers (p<0.001). For construct validity, the EFA revealed a single-factor structure explaining 62.039% of the total variance, with a Kaiser-Meyer-Olkin (KMO) value of 0.783 and Bartlett’s test of sphericity being significant (χ²(10)=383.266, p<0.001). The subsequent CFA showed a marginal model fit (χ²/df=5.627), while all factor loadings were statistically significant (p<0.001). The Nutrition item demonstrated a relatively lower loading (0.457), suggesting possible cultural or contextual differences in the Turkish sample. Conclusion: The Turkish version of the Gosnell Pressure Ulcer Risk Assessment Scale was found to be a valid and reliable tool for use by healthcare professionals in Türkiye. The scale showed acceptable content and construct validity.
Challenges in achieving low-density lipoprotein targets: a cross-sectional study in statin users
Objective: Statins are commonly used in the management of dyslipidemia, with their efficacy varying based on type and dose. They are prescribed for both primary and secondary cardiovascular prevention. However, achieving recommended low-density lipoprotein cholesterol (LDL-C) targets remains a challenge in clinical practice. This study aimed to assess achievement of target LDL-C levels in statin users and to identify modifiable factors related to treatment failure. Methods: This cross-sectional study was conducted in a family medicine outpatient clinic and included adults (≥18 years) on statin therapy for at least six months. Data were collected through face-to-face interviews using a sociodemographic questionnaire and the Adherence to Refills and Medications Scale (ARMS-7). Cardiovascular risk levels were classified using the SCORE risk calculator, and LDL-C goal attainment was assessed based on risk categories. Results: Of 334 participants, 51.8% were male. LDL-C levels exceeded 100 mg/dL in 43.1% of patients. According to SCORE classifications, 55.4% were identified as being at very high cardiovascular risk. Overall, 87.1% of participants failed to achieve target LDL-C levels. Target LDL-C levels were achieved by 30.4% of participants in the low-to-moderate risk group, 16.5% in the high-risk group, and only 6.5% in the very high-risk group (p<0.001). In the study population, patients using statins solely for dyslipidemia (without a history of cardiovascular disease) and those with hypertension, were more likely to achieve LDL-C targets (p<0.05). A significantly higher proportion of male participants (16.8%) achieved the target LDL-C level compared to female participants (8.7%) (p<0.05). Conclusion: The majority of patients on statin therapy did not meet their target LDL-C levels, particularly those at high cardiovascular risk, highlighting the impact of clinical inertia and underscoring the importance of individualized statin dosing and regular monitoring based on patients’ cardiovascular risk assessments in primary care settings.
The impact of media influence on pregnant women's perceptions of oral glucose tolerance tests in primary health care settings
Objective: Screening for gestational diabetes mellitus with the oral glucose tolerance test is recommended between the 24th and 28th weeks of pregnancy. In recent years, views opposing the oral glucose tolerance test have gained prominence in the Turkish media, potentially influencing pregnant women's decisions. This study aimed to determine how often the oral glucose tolerance test is used and by which physicians, to examine the relationship between socioeconomic status and test use, and to assess the impact of the media on those who refuse the test. Methods: This descriptive, prospective, cross-sectional study was conducted between May and August 2020 with pregnant women who presented to, and were registered and followed up at, the family medicine outpatient clinics in Çankaya, Ankara. A total of 334 pregnant women who met the inclusion criteria participated in the study. Sociodemographic caracteristics, socioeconomic status, oral glucose tolarence test acceptance status, physician recommendation variability, effect of media influence of various media sources in decision-making process was questioned by a 16-question survey. Results: Of the participants, 68.0% (n=227) had obtained a university degree, and 56.3% (n=188) reported a high income. Overall, 41.6% (n=139) said the didn’t received any information about the oral glucose tolerance test from their primary care physician. Of the informed subjects 58.8% (n=114) received information from their family doctors. 15.6% (n=52) declined the test, while 33.8% (n=113) were undecided. For those who declined the test 53.8% (n=28) pointed at negative media or social media content to be the primary reason for their decision. Pregnant women from a lower socioeconomic background were more likely to decline the test or be undecided, particularly if they had not received information about it from a healthcare professional. Conversely, physician-provided information was associated with higher acceptance rates for the oral glucose tolerance test. Conclusion: A low socioeconomic status, combined with a lack of information provided by physicians and negative media influence, was associated with higher rates of refusal or indecision regarding oral glucose tolerance test. However, providing accurate and clear information about gestational diabetes screening through family physicians was found to significantly increase the likelihood of test acceptance.
Polypharmacy in the elderly populations: frequency, outcomes and prevention approaches
Advancements in medical technologies, expanded access to healthcare services, and improvements in living conditions have significantly increased the average life expectancy worldwide. This demographic shift, coupled with declining fertility rates, has led to a rapid rise in the proportion of elderly individuals within populations. The increase in the prevalence of chronic diseases is leading to the widespread use of multiple medications and making the importance of appropriate medication use more visible in primary health care. Polypharmacy is a natural consequence of the burden of age-related chronic diseases, but it can also introduce additional risks during treatment processes. Studies report that the prevalence of polypharmacy varies widely. Among older adults, polypharmacy is associated with numerous adverse clinical and economic outcomes, including drug interactions, inappropriate medication use, poor treatment adherence, adverse drug reactions, increased risk of falls, functional decline, and higher rates of hospitalization. Prescription review programs, the implementation of guidelines that support appropriate medication use (Beers, STOPP/START, TIME, etc.), and patient-centered education approaches play an important role in preventing polypharmacy. Family physicians working in primary health care play a central role in the early detection and appropriate management of polypharmacy, thanks to their ability to conduct long-term monitoring of elderly individuals and establish continuous physician-patient relationships. Additionally, AI-powered clinical decision support systems can enhance treatment safety by facilitating the detection of drug interactions and potentially inappropriate medication use. Strengthening collaboration between physicians and pharmacists in primary healthcare services, increasing awareness of medication management among older adults, and improving health literacy are among the key elements that support the effectiveness of the process. The aim of this review is to evaluate the frequency of polypharmacy in older adults, its economic and health outcomes, and prevention approaches based on current literature.
Diagnosis of metastatic prostate cancer in patient applying with drug prescription request: window of opportunity in primary care
Family Medicine healthcare centers are the primary point of contact for addressing all health issues of individuals. Comprehensive medical histories and physical assessments are crucial for the prompt identification and treatment of various illnesses. This study presents a case of metastatic malignancy without active symptoms. During the patient's visit to the family medicine outpatient clinic, laboratory tests were conducted, tests from another medical facility were analyzed, and a prescription for a medication that was frequently taken was obtained.
Smoking cessation behaviors of patients who refer to smoking cessation clinics affiliated to family medicine departments
Objective: Tobacco use continues to be one of the most important causes of preventable death and diseases globally. The present study was designed to evaluate the smoking cessation behaviors of patients who referred to smoking cessation clinics operated by family medicine departments at different universities. Methods: The present study was conducted as a cross-sectional study with the participation of 611 individuals who referred to smoking cessation clinics operated by family medicine departments at Bolu Abant Izzet Baysal University Faculty of Medicine Training and Research Hospital, Duzce University Faculty of Medicine Hospital, Suleyman Demirel University Faculty of Medicine Hospital, Balıkesir Atatürk City Hospital and who agreed to participate in the study. The survey form includes questions about the patients’ demographic information and smoking habits. The participants who agreed to participate in the study were contacted by phone six months later to learn about their smoking status along with the treatment they received. The data were analyzed using IBM SPSS Statistics 20, with a significance level set at p<0.05. Results: The study was completed with 611 individuals. Of the participants, 57.9% (n=354) were male, while 42.1% (n=257) were female. The primary reason for starting smoking was reported as friends by 63.7% (n=289). While the mean age of starting smoking was found as 19.69±6.91 (min:10-max:50) years in participants who stated that their reason for starting smoking was friends. It was found that 28.8% (n=176) of the participants who referred to the clinic had not previously attempted to quit smoking. Of the participants who had previously attempted to quit smoking, 39.7% (n=173) had decided to refer to the clinic after their first try. It was found that 20% (n=122) of the participants had previously received professional support at least once. At the end of 6 months, it was found that while 72.2% (n=439) of the participants had received pharmacotherapy, 27.8% (n=170) stated that they preferred non-pharmacological treatment. It was also found that 26.2% (n=160) of the participants had completely stopped smoking at the end of six months. The rate of smoking cessation was significantly higher in participants who had received pharmacotherapy (p=0.01). Conclusion: Smoking cessation programs should be addressed in a multidimensional manner. Smoking cessation clinics operated by family medicine departments offer a holistic approach that evaluates individuals not only biomedically, but also with psychosocial, behavioral and environmental aspects.
Teledermatology in Swedish primary care as a blueprint for Türkiye
Should routine iodine supplementation replace iodine testing in pregnant women in Turkey? A family medicine perspective
Evaluation of family physicians' attitudes to defensive medicine practices and its effect on providing driving licence reports
Objective: To examine the attitude of family physicians practicing at primary care units in İstanbul regarding defensive medicine practices and their effect on providing driving license health report provisions and the frequency of dispatches. Methods: 396 family physicians practicing in primary care units in Istanbul were included in this observational and descriptive study between March and April 2023. Volunteering physicians were invited to participate in an online questionnaire including sociodemographic characteristics, knowledge and experience questions about defensive medical practice (DMP), the number of examinations and driving license provisions they have issued in the last year, and the rate of referrals to secondary or tertiary health centers. Defensive Medicine Practices Attitude Scale (DMPAS) was also performed online through which negative and positive DMP attitudes were assessed. Participants were classified as having very high (55-44 points), high (43-33 points), moderate (32-22 points), and mild (21-11 points) defensive attitude. Participants' attitudes towards providing driving license health reports were scored with a 5-point Likert-type scale. DMPAS scores were compared in terms of all data. Results: Among 396 participants, more than half were female (54.3%; n=215). Mean age was 39.3±8.9 years [Min 24,0-Max 60.0]. According to DMPAS, 94.5% of the participants exhibited a moderate or higher defensive attitude. Participants who were male (p < 0.05), married (p < 0.05), and specialist physicians (p < 0.05) scored significantly higher in DMPAS compared to their counterparts. As the physicians’ age, years of experience, and the number of registered patients increased, DMPAS decreased (r = -0.668, p < 0.001; r = -0.638, p < 0.00; r = -0.154, p = 0.002, respectively). The study shows that physicians who frequently refer patients to secondary or tertiary hospitals for driving reports and who have a high demand for driving reports among those aged 17 and over in their care population exhibited significantly higher defensiveness scores (p < 0.05). In other words, physicians who had more defensive attitudes preferred to consult the provision to the secondary or tertiary hospitals rather than approving the application. Conclusion: Defensive medicine practices in family physicians are relatively high, increasing the dispatch rate in driving license reports. The increasing rate of referrals from primary care units due to defensive medicine practice results in a patient burden on secondary or tertiary healthcare institutions.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitor in primary care: Case report
Bullous pemphigoid is the most common bullous chronic autoimmune skin disease. Recent studies suggest dipeptidyl peptidase-4 inhibitors used in the treatment of type-2 diabetes as possible predisposing agents of bullous pemphigoid. It is thought to be important for primary care physicians, who are the most common referral point of patients and where drug use is examined in detail, to keep in mind that drugs such as dipeptidyl-peptidase-4 inhibitors may cause bullous pemphigoid and to refer to dermatology for early treatment. In this context, a 70-year-old female patient with a diagnosis of type 2 diabetes mellitus presented to our outpatient clinic with pruritic, erythematous bullous lesions diffusely distributed over the body, occurring one week after initiation of a vildagliptin-containing medication. There was no mucosal involvement. The patient initially received treatment with the presumptive diagnoses of allergy and scabies; however, as no improvement was observed, a detailed medical history was obtained. Based on the clinical findings, drug-induced bullous pemphigoid was suspected, and the vildagliptin-containing medication was discontinued. The patient was subsequently referred to the dermatology department. Histopathological examination and direct immunofluorescence findings were consistent with bullous pemphigoid. Following drug withdrawal and a short course of oral corticosteroid therapy, a marked improvement of the lesions was achieved. With this case, we aimed to draw attention to the approach of bullous pemphigoid disease developing as a result of vildagliptin use in a patient with type-2 diabetes who presented to primary care and to increase awareness on this issue.
Rational drug use and associated factors in pulmonology outpatients: a cross-sectional study
Objective: Rational drug use (RDU) refers to administering medications that are appropriate to patients’ clinical needs, in doses that meet their individual needs for a sufficient duration, and at the lowest possible cost. Despite the clinical importance of RDU, irrational drug use remains prevalent, particularly in pulmonology patients. In this context, the objective of this study is to evaluate RDU knowledge and identify associated sociodemographic and clinical factors in pulmonology outpatients. Methods: The sample of this cross-sectional, single-center study consisted of 317 outpatients aged 18 years or older who presented to a secondary chest diseases hospital between February and May 2023. The patients were assessed using a structured questionnaire containing items on their sociodemographic and general health characteristics and the validated 21-item Rational Drug Use Scale (RDUS). The collected data were analyzed using parametric and chi-square tests, as well as correlation and logistic regression analyses. Results: The mean age of the study sample, 59.6% of which were females, was 50.0 ± 13.0 years. Of the 317 patients, 78.9% had chronic diseases, and 38.8% were taking ≥5 medications (polypharmacy). The mean RDUS score of the sample was 29.78±4.77, indicating insufficient knowledge. The mean RDUS score of the patients aged ≤45 years was significantly higher than that of those aged >45 years (p=0.007). The mean RDUS score of the patients living in urban areas was significantly higher than that of those living in rural areas (p=0.031). A strong correlation was found between patients’ education level and RDUS score. Accordingly, the mean RDUS score of patients with higher education was significantly higher than that of patients with other education levels (p=0.001). Multivariate analysis revealed higher education levels ([Odds Ratio (OR)=3.45, p=0.005], living in urban areas [OR=2.46, p=0.031], and young age [<45 years] [OR=0.958 per year, p=0.001]) as independent predictors of having sufficient RDU knowledge. Conclusion: In conclusion, we found that outpatient pulmonology patients’ RDU knowledge was independently associated with age, education level, and place of residence. In light of these findings, targeted educational interventions to improve medication adherence, reduce adverse events, and optimize treatment outcomes should be primarily focused on patients who are elderly, have low educational levels, reside in rural areas, and have respiratory diseases.
Relationship of thyroid hormones and metabolic parameters in euthyroid women
Objective: Thyroid hormones play a role in metabolic regulation, yet their associations with obesity and insulin resistance in euthyroid individuals remain unclear. This study aimed to evaluate the relationship between thyroid-stimulating hormone (TSH), fT3, fT4, and the fT3/fT4 ratio with metabolic parameters in euthyroid women. Methods: In this retrospective cross-sectional study, 236 euthyroid women aged 18–65 were recruited from a tertiary hospital in Istanbul between May and September 2023. Participants were categorized as individuals with normal weight, overweight, or obesity. Thyroid hormones and metabolic parameters (waist circumference, triglycerides, HDL-C, insulin resistance) were analyzed. Statistical analyses included correlation tests and ANCOVA for age adjustment. Results: No significant differences in thyroid hormone levels were found across BMI groups after adjusting for age. TSH was positively correlated with BMI and triglyceride levels. fT3 and the fT3/fT4 ratio were positively associated with insulin resistance and negatively associated with HDL-C. Conclusion: fT3 and the fT3/fT4 ratio may reflect metabolic alterations in euthyroid individuals. These findings highlight the potential relevance of thyroid hormone evaluation in assessing metabolic risk, especially among individuals with obesity or insulin resistance. Further multicenter studies are warranted.
Investigation of atrial fibrillation frequency in relation to possible thromboembolic events in geriatric patients attending family medicine outpatient clinics
Objective: Atrial fibrillation (AF) is the most common type of arrhythmia and is responsible for a large proportion of hospitalizations. In this study, we aimed to investigate the presence of atrial fibrillation(AF) without developing thromboembolic complications in patients who applied to family medicine. Methods: The study included patients over 65 who applied to A University Training and Research Hospital and a State Hospital Family Medicine polyclinic. Those who had previously been diagnosed with AF were excluded from the study. Electrocardiography (ECG) was performed on patients over 65 who applied to our polyclinics to examine the frequency of AF. To assess the risk of thromboembolism, the CHA2DS2-VASc score was utilized. This score is a widely accepted and validated risk stratification system designed to predict stroke in patients with non-valvular AF. Results: In a study involving 146 participants with a mean age of 73.86±7.38 years (61.6% female, 38.4% male), AF incidence was 11%. Isolated hypertension was the most common diagnosis, affecting 58% of patients with chronic diseases linked to AF. While AF was more prevalent in men (14.3%), the difference was insignificant (p=0.310). Most patients with AF (87.5%) had a CHA2DS2-VASc score of 2 or higher. The mean systolic blood pressure was 132.59±22.03 mmHg in non-AF patients compared to 124.00±21.62 mmHg in AF patients. A history of cardiac surgery and arrhythmias was associated with a higher incidence of AF (p=0.010). Conclusion: The prevalence of AF in individuals over 65 years of age was found to be 11%, and the presence of comorbid disease was found to constitute the most important risk group. CHA2DS2-VASc score was two or above in 87.5% of patients and formed the high-risk group for stroke. In the study, patients with AF diagnosed before the development of thromboembolic complications were referred to the cardiology clinic for thromboembolic prophylaxis. This allowed the organization of cost-effective treatments based on bleeding risk scores and clinical indications. In primary health care services, every patient presentation should be evaluated effectively, and patients with symptoms and findings from a physical examination should be examined for AF.
Investigation of the relationship between depression levels and nutritional status in elderly patients receiving home health care services
Objective: The research explores the factors influencing the nutrition levels of people aged 65 years and older enrolled in home health services, focusing on depression levels, functional dependency, existing comorbid conditions and sociodemographic characteristics. Methods: The study is a single-centered, cross-sectional, descriptive, and prospective analysis conducted with patients registered at the Home Health Services at SBÜ Izmir Bozyaka Training and Research Hospital . The sample size was estimated assuming that the prevalence of malnutrition among the elderly was 40%, with a error margin of 0.05% and a 95% confidence interval, and reaching a target of 368 individuals. Sociodemographic data were collected via surveys. Nutrition levels was measured utilizing the Mini Nutritional Assessment Scale- Long Form, functional dependence with the Barthel Index, comorbidities via the Charlson Comorbidity Index, and depression levels using the Yesavage Geriatric Depression Scale. Statistical analysis of the data was performed using IBM SPSS 26 program. Results: Among the respondents, 60.6% (n=223) were female and the mean age was 81.35±7.95 years (range: 65-99). In education terms, 84.8% had completed elementary school or less (n=312), and 79.4% received care from family members (n=292). The average body mass index was 25.4±4.2 kg/m² (min: 16.5 kg/m²; max: 49 kg/m²). Nutritional assessments showed that 29.6% were insufficiently nourished, 44% were at risk of malnutrition. In daily activities, 16.8% were fully dependent, while 47.3% were severely dependent. According to the comorbidity index, 89.1% were at very high risk for mortality. Additionally, 62.5% were confirmed as depressed, with 10.3% likely depressed. A significant association was found between nutrition status and some factors such as caregiver status, gender, dental hygiene and BMI. Conclusion: The study highlights a considerable prevalence of depression and its adverse effect on nutritional health. Depression levels were found to have a strong negative correlation with nutritional status, indicating that high levels of depression may negatively affect the nutritional well-being of older adults and emphasizing the need to address both nutrition and mental health in this demographic group.
Leveraging home healthcare to enhance adult immunization coverage
Attitudes and behaviors of patients with diabetes towards insulin treatment
Objective: Insulin treatment for diabetes helps prevent complications. The views and attitudes of people with diabetes towards insulin have a significant impact on treatment adherence and health outcomes. This study aimed to understand the attitudes of people with diabetes towards insulin treatment and the psychosocial factors associated with them. Methods: The study included 225 patients who applied to the Diabetes-Obesity Outpatient Clinic of a tertiary hospital, who were diabetic, using insulin and/or oral antidiabetic drugs (OAD), over 18 years of age, not pregnant, and able to self-inject. The patient identification form, the DASS-21, and the ITAS scales were used to collect data. Results: In our study, the mean positive attitude of the ITAS was 9.51; the mean negative attitude of the ITAS was 41.28; and the mean total score of the ITAS was 50.80. Anxiety was observed in 54.7% of the participants, depression in 44.4%, and stress in 30.7%. There was a positive correlation between age and ITAS total score (r=0.405; p<0.001). Negative ITAS attitude and ITAS total score were found to be higher in women (p=0.022 and p=0.034), in patients with type 2 diabetes (p<0.001; p<0.001), and in patients who had not received diabetes education (p=0.002; p=0.001). The total and negative attitude scores of patients using only OAD were higher than those using insulin (p<0.001). Conclusion: In our study, we found that being a woman, being older, not having received diabetes education, having a short duration of diabetes, and using only OAD were associated with negative attitudes towards insulin in people with diabetes. We also found that depression, anxiety, and stress levels were significantly higher in women and people with low income.
Night eating syndrome negatively affects the physical and mental quality of life of female university students
Background: Night eating syndrome (NES) is a clinical syndrome, which is related to sleep disturbance and depression. NES may be associated with obesity and may negatively affect quality of life of university students. The aim of this study was to examine the relationship between NES with obesity and health related quality of life in female university students. Methods: A total of 293 female university students aged 18-29 were recruited to study. The demographic characteristics of students were questioned. Students filled out the Night Eating Questionnaire and an instrument determining health related quality of life (SF-36). Anthropometric measurements (height, weight and waist circumference) of participants were taken by professionals. Correlation and linear regression analysis were run to analyze collected data. Results: About 57% of students’ mothers were illiterate or had primary school degrees. The NES prevalence was 6.8% in students. There was no significant relationship between anthropometric measurements (body mass index, waist circumference) and the presence of NES and quality of life scores (p>0.05). However, higher NES scores were associated with lower quality of life sub-scores (physical function, role limitations due to emotional problems, vitality, emotional well-being, social functioning, pain, general health perception) (p<0.05). Simple linear regression analysis results also showed that NES scores were related to lower physical and mental health related quality of life scores (p<0.05). Conclusions: Although night eating syndrome was not associated with obesity in female university students, it directly affects the physical and mental quality of life of students, adversely. Strategies to cope with night eating syndrome should be developed for university students.
The effect of the presence of anemia during and after pregnancy on the development of postpartum depression symptoms
Objective: Postpartum depression is a significant mental health issue that affects mothers in the postpartum period and can be influenced by various biological and environmental factors. This study aims to examine the impact of during pregnancy and the postpartum period on the occurrence of postpartum depression symptoms. Methods: This cross-sectional observational study was conducted at Prof. Dr. Cemil Tascioglu City Hospital Training family health care center. A total of 104 patients within the first 6 months postpartum period were included in the study between September 5 and October 5, 2023. Data were collected through face-to-face interviews using questionnaires and analyzed using SPSS v.25 software. Symptoms of depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS), and the results were evaluated based on this scale. Data obtained from the study were analyzed using IBM SPSS v.25 software, and p <0.05 was considered statistically significant. Results: A total of 104 postpartum women participated in the study. The mean age was 27.1±4.1 years; 50% of participants were university graduates, 53.8% were unemployed, and 94.2% were living with their spouses. Cesarean delivery was reported in 59.6% of cases. Prepartum anemia was observed in 14.4% of participants, while postpartum anemia was present in 43.3%. According to the Edinburgh Postnatal Depression Scale, the prevalence of postpartum depression symptoms was 14.4%. Low postpartum hemoglobin levels, living separately from the spouse, and the presence of postpartum anemia were found to be statistically significantly associated with depressive symptoms (p<0.05). Conclusion: This study suggests that anemia and certain sociodemographic factors may be associated with depressive symptoms in the postpartum period. In primary care settings, conducting not only physical but also psychosocial assessments during postpartum follow-up is crucial for early identification and timely provision of appropriate support services.