{"id":34533,"date":"2024-11-26T16:44:33","date_gmt":"2024-11-26T16:44:33","guid":{"rendered":"https:\/\/bnssghealthiertogether.org.uk\/?page_id=34533"},"modified":"2025-01-16T22:29:49","modified_gmt":"2025-01-16T22:29:49","slug":"rapid-respiratory-microbiological-point-of-care-testing-in-primary-care-a-randomised-controlled-trial-with-internal-pilot-and-qualitative-and-quantitative-investigation-of-microbial-behavioural-and","status":"publish","type":"page","link":"https:\/\/bnssghealthiertogether.org.uk\/tr\/integrated-care-board\/research-and-evidence\/our-research-portfolio\/nihr-funded-projects\/rapid-respiratory-microbiological-point-of-care-testing-in-primary-care-a-randomised-controlled-trial-with-internal-pilot-and-qualitative-and-quantitative-investigation-of-microbial-behavioural-and\/","title":{"rendered":"Birinci basamak sa\u011fl\u0131k hizmetlerinde h\u0131zl\u0131 solunum yolu mikrobiyolojik yerinde test uygulamas\u0131: mikrobiyal, davran\u0131\u015fsal ve antibiyotik mekanizmalar\u0131n\u0131n nitel ve nicel olarak incelenmesini i\u00e7eren, dahili pilot \u00e7al\u0131\u015fma ile randomize kontroll\u00fc bir \u00e7al\u0131\u015fma (RAPID-TEST RCT)"},"content":{"rendered":"
Mod\u00fcl-1 ba\u015fl\u0131kl\u0131 b\u00f6l\u00fcm<\/span><\/a>
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Birinci basamak sa\u011fl\u0131k hizmetlerinde h\u0131zl\u0131 solunum yolu mikrobiyolojik yerinde test uygulamas\u0131: mikrobiyal, davran\u0131\u015fsal ve antibiyotik mekanizmalar\u0131n\u0131n nitel ve nicel olarak incelenmesini i\u00e7eren, dahili pilot \u00e7al\u0131\u015fma ile randomize kontroll\u00fc bir \u00e7al\u0131\u015fma (RAPID-TEST RCT)<\/h1>\n
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Finansman<\/h2>\n<\/article>\n

Ulusal Sa\u011fl\u0131k ve Bak\u0131m Ara\u015ft\u0131rma Enstit\u00fcs\u00fc (NIHR) Ara\u015ft\u0131rmac\u0131 Liderli\u011findeki Etkinlik ve Mekanizma De\u011ferlendirme Program\u0131 (EME) Ref. NIHR131758.<\/p>\n

Sorun nedir?<\/h2>\n

Her y\u0131l milyonlarca insan \u00f6ks\u00fcr\u00fck, so\u011fuk alg\u0131nl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs enfeksiyonlar\u0131, bo\u011faz a\u011fr\u0131s\u0131 ve kulak a\u011fr\u0131s\u0131 gibi solunum yolu enfeksiyonlar\u0131 i\u00e7in yard\u0131m ar\u0131yor. Ortalama olarak, pratisyen hekimler ve hem\u015fireler bu hastalar\u0131n yar\u0131s\u0131na antibiyotik veriyor. Bu, gerekenden fazla ve antibiyotik direncine yol a\u00e7\u0131yor, ancak kimin antibiyotik ihtiyac\u0131 oldu\u011funu her zaman bilemiyorlar, bu y\u00fczden genellikle "her ihtimale kar\u015f\u0131" veriyorlar.<\/p>\n

Solunum yolu enfeksiyonlar\u0131n\u0131n \u00e7o\u011funun vir\u00fcslerden kaynakland\u0131\u011f\u0131n\u0131 ve antibiyotiklerin yaln\u0131zca bakterilere etki etti\u011fini biliyoruz. E\u011fer hekimler hangisinin vir\u00fcs, hangisinin bakteri oldu\u011funu bilselerdi, antibiyotikleri daha iyi hedefleyebilirlerdi.<\/p>\n

Hekimler \u00f6rnekleri hastanelere g\u00f6nderebilirler, ancak laboratuvar testleri 3 g\u00fcn s\u00fcrer ve bu s\u00fcre zarf\u0131nda \u00e7o\u011fu hasta iyile\u015fir ve antibiyotiklere gerek olmad\u0131\u011f\u0131 anla\u015f\u0131l\u0131r.<\/p>\n

Birle\u015fik Krall\u0131k h\u00fck\u00fcmeti, antibiyotik kullan\u0131m\u0131n\u0131 iyile\u015ftirmek i\u00e7in s\u00fcr\u00fcnt\u00fc testlerinin sonu\u00e7lar\u0131n\u0131n daha h\u0131zl\u0131 al\u0131nmas\u0131n\u0131n kritik \u00f6nem ta\u015f\u0131d\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcn\u00fcyor. \u00dcreticiler, s\u00fcr\u00fcnt\u00fc \u00f6rneklerinde birden fazla vir\u00fcs\u00fc 45 dakika i\u00e7inde tespit edebilen "hasta ba\u015f\u0131nda testler" (POCT'ler) geli\u015ftiriyor; bu da ayn\u0131 g\u00fcn karar vermeyi sa\u011flayacak kadar h\u0131zl\u0131.<\/p>\n

POCT'lerin kullan\u0131lmas\u0131n\u0131n bariz oldu\u011fu d\u00fc\u015f\u00fcn\u00fclebilir, ancak d\u00f6rt neden var. Birincisi, teknoloji geli\u015fme a\u015famas\u0131nda ve makinelerin ve testlerin fiyat\u0131 y\u00fcksek; bir sistem i\u00e7in s\u0131ras\u0131yla 40.000 \u00a3 ve 100 \u00a3, ayr\u0131ca NHS'nin bunlar\u0131 \u00e7al\u0131\u015ft\u0131rmak ve yorumlamak i\u00e7in harcad\u0131\u011f\u0131 zaman da cabas\u0131.<\/p>\n

\u0130kinci olarak, mevcut cihazlar \u00e7o\u011funlukla nezle, grip ve COVID gibi hastal\u0131klara neden olan vir\u00fcsleri test ediyor. Ancak bir vir\u00fcs tespit edildi\u011finde, bu enfeksiyona neden oldu\u011fu anlam\u0131na gelmez, \u00e7\u00fcnk\u00fc vir\u00fcsler burun ve bo\u011faz\u0131m\u0131zda zarars\u0131z bir \u015fekilde ya\u015fayabilir. Bu nedenle, hekim bakteriyel bir enfeksiyonun mevcut olup olmad\u0131\u011f\u0131 konusunda kendi de\u011ferlendirmesini yapmal\u0131d\u0131r.<\/p>\n

\u00dc\u00e7\u00fcnc\u00fcs\u00fc, hi\u00e7bir test 0% oran\u0131nda do\u011fru sonu\u00e7 vermez. \u00d6nemli bir vir\u00fcs mevcutken "vir\u00fcs yok" diyebilir. Bu da hastalara zararl\u0131 tavsiyeler veya tedaviler verilebilece\u011fi anlam\u0131na gelir.<\/p>\n

Son olarak, hekimin antibiyotik re\u00e7ete etme karar\u0131 ve hastan\u0131n antibiyotik kullanma karar\u0131n\u0131n hasta-hekim etkile\u015fimi ve hastan\u0131n antibiyotiklere ili\u015fkin beklentilerinden etkilendi\u011fini biliyoruz. Dolay\u0131s\u0131yla, bir POCT'nin nas\u0131l \u00e7al\u0131\u015ft\u0131\u011f\u0131n\u0131 bilmek, 'vir\u00fcs varl\u0131\u011f\u0131 = antibiyotik gerekmez' kadar basit de\u011fildir.<\/p>\n

Ara\u015ft\u0131rman\u0131n amac\u0131 nedir?<\/h2>\n

POCT (nokta bak\u0131m testi) fiyatlar\u0131 d\u00fc\u015fecek, ancak NHS kaynaklar\u0131n\u0131 bunlara harcaman\u0131n mant\u0131kl\u0131 olup olmad\u0131\u011f\u0131n\u0131 yine de bilmemiz gerekecek.<\/p>\n

E\u011fer POCT'ler (nokta bak\u0131m testleri) hastalar\u0131n kendilerini daha iyi hissetmelerini sa\u011flasa ve rutin bak\u0131mda makul bir fiyata antibiyotik re\u00e7ete edilmesini azaltsa, bunlara 'maliyet etkin' derdik.<\/p>\n

Ancak, POCT'ler antibiyotik re\u00e7eteleme oran\u0131n\u0131 d\u00fc\u015f\u00fcrmez veya hastalar\u0131n kendilerini daha iyi hissetmelerine yard\u0131mc\u0131 olmazsa, maliyet etkinli\u011fini kontrol etmenin bir anlam\u0131 yok. Bu t\u00fcr bir \u00e7al\u0131\u015fma hen\u00fcz yap\u0131lmad\u0131. Bug\u00fcne kadar yap\u0131lan iki k\u00fc\u00e7\u00fck \u00e7al\u0131\u015fma, klinisyenlerin POCT'leri be\u011fendi\u011fini ve kullanacaklar\u0131n\u0131 g\u00f6stermi\u015ftir.<\/p>\n

Bu \u00e7al\u0131\u015fmalardan birini ger\u00e7ekle\u015ftirdik ve sonu\u00e7lar, POCT'lerin antibiyotik re\u00e7eteleme oran\u0131n\u0131 azalt\u0131p azaltamayaca\u011f\u0131n\u0131 ve azaltabiliyorsa nas\u0131l azaltabilece\u011fini g\u00f6rmeyi ama\u00e7layan mevcut \u00e7al\u0131\u015fmay\u0131 tasarlamam\u0131za yard\u0131mc\u0131 oldu. Ayr\u0131ca POCT'lerin hastalar\u0131n daha h\u0131zl\u0131 iyile\u015fmesine yard\u0131mc\u0131 olup olmad\u0131\u011f\u0131n\u0131 da inceleyecek. Bu sorulara olumlu yan\u0131tlar al\u0131rsak, gelecekteki bir \u00e7al\u0131\u015fma maliyet etkinli\u011fini kontrol edecektir.<\/p>\n

Bu nas\u0131l ba\u015far\u0131lacak?<\/h2>\n

Solunum yolu enfeksiyonu nedeniyle aile hekimlerinden yard\u0131m isteyen ki\u015fileri davet edece\u011fiz. Onlar\u0131 rastgele (benzer olmalar\u0131 i\u00e7in) iki gruba ay\u0131raca\u011f\u0131z; bir grubun hekimleri POCT sonu\u00e7lar\u0131n\u0131 alacak, di\u011fer grup ise ola\u011fan bak\u0131ma devam edecek. Hekimler uygun g\u00f6rd\u00fckleri \u015fekilde antibiyotik re\u00e7ete edecek ve kat\u0131l\u0131mc\u0131lar semptomlar\u0131n ne kadar s\u00fcrd\u00fc\u011f\u00fcn\u00fc g\u00f6rmek i\u00e7in takip edilecek.<\/p>\n

PPI dan\u0131\u015fma grubumuz, antibiyotiklerin en \u00e7ok ihtiya\u00e7 duyan ki\u015filere ula\u015ft\u0131r\u0131lmas\u0131n\u0131n \u00f6nemli oldu\u011funu belirtti ve COVID s\u0131ras\u0131nda i\u015fe al\u0131m ve takip i\u00e7in pratik hususlar sundu. Bir \u00fcyemiz ortak ba\u015fvuru sahibi olarak kat\u0131ld\u0131 ve bu ba\u015fvurunun tasar\u0131m ve tasla\u011f\u0131n\u0131n haz\u0131rlanmas\u0131nda \u00f6nemli rol oynad\u0131.<\/p>\n

Ara\u015ft\u0131rmay\u0131 kim y\u00fcr\u00fct\u00fcyor?<\/h2>\n

Profes\u00f6r Alastair D Hay<\/a>,\u00a0Birinci Basamak Sa\u011fl\u0131k Hizmetleri Profes\u00f6r\u00fc<\/span>,Bristol T\u0131p Fak\u00fcltesi.<\/p>\n

Daha fazla bilgi:<\/h2>\n

Daha fazla bilgi almak veya bu projeye kat\u0131lmak i\u00e7in l\u00fctfen e-posta g\u00f6nderin. bnssg.research@nhs.net<\/a>.<\/p>\n

Burada ifade edilen g\u00f6r\u00fc\u015fler yazar(lar)a aittir ve NIHR veya Sa\u011fl\u0131k ve Sosyal Bak\u0131m Bakanl\u0131\u011f\u0131'n\u0131n g\u00f6r\u00fc\u015flerini yans\u0131tmayabilir.<\/p>\n <\/div>\r\n <\/section><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"

Section titled module-1 Rapid respiratory microbiological point-of-care-testing in primary care: a randomised controlled trial with internal pilot and qualitative and quantitative investigation of microbial, behavioural and antibiotic mechanisms (the RAPID-TEST RCT) Funding National Institute for Health and Care Research (NIHR) Researcher Led Efficacy and Mechanism Evaluation Programme (EME) Ref. NIHR131758. What is the problem? Every […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":32881,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"tags":[],"class_list":["post-34533","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/pages\/34533","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/comments?post=34533"}],"version-history":[{"count":3,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/pages\/34533\/revisions"}],"predecessor-version":[{"id":36173,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/pages\/34533\/revisions\/36173"}],"up":[{"embeddable":true,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/pages\/32881"}],"wp:attachment":[{"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/media?parent=34533"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bnssghealthiertogether.org.uk\/tr\/wp-json\/wp\/v2\/tags?post=34533"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}