Turkiye Klinikleri Journal of Medical Ethics-Law and History

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Tedaviye Uyum: Kavramsal Bir Değerlendirme
Compliance, Adherence and Concordance: A Conceptual Evaluation
Betül SÜMBÜL ŞEKERCİa, Özlem BİLDİKb
aBezmiâlem Vakıf Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık ABD, İstanbul, TÜRKİYE
bBezmiâlem Vakıf Üniversitesi Tıp Fakültesi, Tıp Tarihi ve Etik ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Ethics. 2020;28(2):279-84
doi: 10.5336/mdethic.2019-70795
Article Language: TR
Full Text
ÖZET
 Tedavi uyumuna dair literatürde 'compliance', 'adherence' ve 'concordance' gibi farklı kavramlar kullanılmaktadır. İngilizce literatürde söz konusu kavramlarda görülen değişimin hasta-hekim ilişkisinin yapısındaki farklılaşmaya bağlı olduğu bildirilmektedir. Bu konuda farklı terimlerin bulunması nedeni ile karmaşıklık yaşanmakta, kavramın nitelik ve nicelik olarak kapsamı hususunda muğlaklık bulunmaktadır. Türkçe literatür değerlendirildiğinde ise bu terimler arasında anlam farkı gözetilmeksizin tümünün uyum ve uyunç kelimeleriyle karşılandığı görülmektedir. Bu çalışmanın amacı, literatürümüzde tedavi uyumu konusundaki kavramsal çerçeveyi değerlendirmektir. Bu amaçla öncelikle bahsedilen kavramlar arasındaki farklılıklar ortaya konulmuş ve bu kavramlardaki hasta-hekim ilişkisi, sunulan mevcut modeller ışığında incelenmiştir. Türkçe literatürde uyum kavramının kullanımı incelendiğinde de mevcut kavramsal tartışmanın literatürümüze henüz yansımadığı görülmüştür. Bu bağlamda, öncelikle Türkiye'de mevcut hasta-hekim ilişkisinin gözden geçirilmesi yoluyla bu kavramsal çerçevenin çizilmesi gerekmektedir. Sonuç olarak, hasta-hekim ilişkisinin uyumsuzluğa yol açan etmenlerden biri olmanın ötesinde, bu kavramı şekillendiren temel dinamiklerden biri olduğu görülmektedir. Hastahekim ilişkisine dair sunulan modeller bağlamında bakıldığında, paternalistik bir ilişkiyi yansıtan 'compliance' kavramı için 'tedaviye bağlılık', bilgilendirici bir hasta-hekim ilişkisinde ortaya çıkan 'adherence' kavramına karşılık 'uyum' ve müzakereci bir ilişkiyi vurgulayan 'concordance' kavramı için 'tedavide iş birliği' ifadelerinin literatürümüz için kullanımı önerilebilir.

Anahtar Kelimeler: Uyum; uyunç; kompliyans; hekim-hasta ilişkisi
ABSTRACT
 There are different concepts such as 'compliance', 'adherence' and 'concordance' in the literature on treatment compliance. It is seen that the difference in the concepts in the English literature depends on the change in the structure of the patient-physician relationship. Complexity is experienced due to the use of different terms and there is ambiguity about the quality and quantity scope of the concepts. When the Turkish literature is evaluated, it is seen that all the terms are met with the word 'uyum'/'uyunç' regardless of the meaning difference between these terms. Purpose of this study to evaluate the conceptual framework in our literature on treatment compliance/adherence/concordance. So firstly differences between these concepts have been put forward and the relation to patient- physician relationship in these concepts has been examined in the light of the current models. The conceptual debate on this topic was not reflected on the Turkish literature. Consequently in the context of the patient-physician relationship models, the use of the expressions 'tedaviye bağlılık' for the concept of 'compliance' with a paternalistic relationship, 'uyum' for the concept of 'adherence' with informative relationship and 'tedavide iş birliği" for the concept of 'concordance' with deliberative relationship is suggested for our literatur.

Keywords: Compliance; adherence; concordance; patient physcian relationship
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