Doğum bakımında (maternity care) uygulama bilimi
Özet
Uygulama bilimi, bilimsel araştırma bulgularının rutin sağlık hizmetlerine entegrasyonunu teşvik ederek kanıt ile uygulama arasındaki boşluğu kapatmayı amaçlayan bir çalışma alanıdır. Sağlık hizmetlerinde birçok prosedür bilimsel kanıtlardan yoksun veya bunlara aykırı olabilmekte, bir kanıtın hasta bakımına doğrudan yansıması 17 yılı bulabilmektedir. Bu dönüşüm sürecindeki engelleri aşmak için mikro düzeyde bireysel davranışları inceleyen COM-B sistemi ve Davranış Değiştirme Çarkı; orta düzeyde kurumsal dinamikleri ve müdahalelerin rutinleşmesini değerlendiren Normalleştirme Süreci Teorisi (NPT); makro düzeyde ise geniş çaplı politika, ekonomi ve sistem değişkenlerini analiz eden Uygulama Araştırması için Birleştirilmiş Çerçeve (CFIR) gibi modeller kullanılmaktadır. Yazıda bu yaklaşımlar, ebe liderliğinde sürekli bakım modeli (ELSBM) örneği üzerinden somutlaştırılmıştır. ELSBM'nin düşük maliyet, yüksek anne memnuniyeti ve iyileştirilmiş yenidoğan sonuçları gibi güçlü kanıtları olmasına rağmen, ülkeler arasındaki uygulanırlığı (Yeni Zelanda'da %85, Avustralya'da %8 iken ABD'de çok düşük) büyük çeşitlilik göstermektedir. Bu durum, değişimin başarılı ve sürdürülebilir olması için tek bir boyutun yeterli olmadığını; bireysel istekliğin (mikro), kurumsal hazırlığın (orta) ve yasal/politik altyapının (makro) birbiriyle ilişkili olarak bütünsel bir şekilde ele alınması gerektiğini ortaya koymaktadır.
Implementation science is a field of study that aims to close the gap between evidence and practice by promoting the integration of scientific research findings into routine healthcare services. Many procedures in healthcare may lack scientific evidence or run contrary to it, and it can take up to 17 years for evidence to directly impact patient care. To overcome barriers in this transformation process, models such as the COM-B system and the Behavior Change Wheel, which examine individual behaviors at the micro level; the Normalization Process Theory (NPT), which evaluates institutional dynamics and the routine embedding of interventions at the meso level; and the Consolidated Framework for Implementation Research (CFIR), which analyzes large-scale policy, economic, and systemic variables at the macro level, are utilized. In the text, these approaches are substantiated through the example of the midwife-led continuity of care model (MLCCM). Although MLCCM has strong evidence supporting it, such as low costs, high maternal satisfaction, and improved neonatal outcomes, its implementation across countries varies greatly, reaching over 85% in New Zealand and 8% in Australia, while remaining very low in the USA. This situation demonstrates that a single dimension is insufficient for change to be successful and sustainable; rather, individual willingness (micro), organizational readiness (meso), and legal/political infrastructure (macro) must be addressed holistically in relation to one another.
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