Engelli Bireylere Sunulan Sağlık Hizmetleri ve Rehabilitasyonda Multidisipliner Ekip Yaklaşımı
Özet
Bu bölüm, engelli bireylerin sağlık hizmetlerine erişimi ve rehabilitasyon süreçlerinde multidisipliner ekip yaklaşımının kritik rolünü bütüncül bir perspektifle ele almaktadır. Engelliliğin yalnızca bireysel bir sağlık durumu değil; sosyal, ekonomik ve yapısal eşitsizliklerle iç içe geçmiş bir olgu olduğu vurgulanmakta, bu nedenle sağlık hizmetlerinin kapsayıcı ve erişilebilir biçimde yeniden yapılandırılması gerektiği belirtilmektedir. Engelli bireylerin sağlık hizmetlerine erişiminde farkındalık eksikliği, ulaşılabilirlik sorunları, mali engeller ve hizmetlerin kabul edilebilirliği gibi çok boyutlu bariyerler öne çıkmaktadır. Bu bağlamda multidisipliner ekip yaklaşımı; hekim, hemşire, sosyal hizmet uzmanı ve diğer sağlık profesyonellerinin koordineli çalışmasını sağlayarak birey merkezli, entegre ve etkili bakım sunumunu mümkün kılmaktadır. Özellikle rehabilitasyon süreçlerinde ekip içi iletişim, rol netliği ve ortak hedef belirleme hizmet kalitesini doğrudan etkilemektedir. Evde bakım hizmetleri, dijital sağlık uygulamaları ve yapay zekâ destekli teknolojiler ise erişimi artıran yenilikçi araçlar olarak öne çıkmaktadır. Sonuç olarak, engelli bireylerin yaşam kalitesini artırmak ve sağlıkta eşitsizlikleri azaltmak için disiplinler arası iş birliğine dayalı, erişilebilir ve teknoloji destekli sağlık hizmeti modellerinin güçlendirilmesi kaçınılmazdır.
Referanslar
Africa, L., Frantz, J., & Mlenzana, N. B. (2025). Guidelines for interprofessional practice in rehabilitation at primary health care level. African Journal of Primary Health Care & Family Medicine, 17(1), 5079.
Ali, A., & Hassiotis, A. (2008). Illness in people with intellectual disabilities. Bmj, 336(7644), 570-571.
Arul, U. (2020). ‘Access to healthcare facilities among the disabled people towards the public healthcare institution’, Int. J. Sci. Technol.
Ashton, C. M., Haidet, P., Paterniti, D. A., Collins, T. C., Gordon, H. S., O’Malley, K., ... & Street Jr, R. L. (2003). Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication?. Journal of general internal medicine, 18(2), 146-152.
Barr, O. (1997). Interdisciplinary teamwork: consideration of the challenges. British Journal of Nursing, 6(17), 1005-1010.
Baru, R., Acharya, A., Acharya, S., Kumar, A. S., & Nagaraj, K. (2010). Inequities in access to health services in India: caste, class and region. Economic and political Weekly, 49-58.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
Branigan, M., Stewart, D. E., Tardif, G. S., & Veltman, A. (2001). Perceptions of primary healthcare services among persons with physical disabilities; Part 2: Quality issues. Medscape General Medicine, 3(2), 19.
Byron, M., Howell, C., Bradley, P., Bheenuck, S., Wickham, C., & Curran, T. (2006). Different Differences: Disability equality teaching in healthcare education.
Copley, J., Martin, R., Dix, C., Forbes, R., Hill, A., Mandrusiak, A., ... & Collins, C. (2024). Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students. Journal of Interprofessional Care, 38(3), 534-543.
Dassah, E., Aldersey, H., McColl, M. A., & Davison, C. (2018). Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis. Global health research and policy, 3(1), 1-13.
Diab, M. E., & Johnston, M. V. (2004). Relationships between level of disability and receipt of preventive health services. Archives of physical medicine and rehabilitation, 85(5), 749-757.
Galvin, R. (2004). Challenging the need for gratitude: Comparisons between paid and unpaid care for disabled people. Journal of Sociology, 40(2), 137-155.
Genet, N., Boerma, W. G., Kringos, D. S., Bouman, A., Francke, A. L., Fagerström, C., ... & Devillé, W. (2011). Home care in Europe: a systematic literature review. BMC health services research, 11, 1-14.
Gibson, J., & O'Connor, R. (2010). Access to health care for disabled people: a systematic review. Social care and Neurodisability, 1(3), 21-31.
Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., & Hudson, M. (2002). What does' access to health care'mean?. Journal of health services research & policy, 7(3), 186-188.
Güler, E.K., (2005), Tıbbi Ortamların ve İlişkilerin Engelli Kişilere Uygunluğunun Etik Yönden Değerlendirilmesi, Çukurova Üniversitesi, Adana.
Heath, G. N., & Fentem, P. H. (1997). 8 Physical Activity among Persons with Disabilities—A Public Health Perspective. Exercise and sport sciences reviews, 25(1), 195-234.
Hughes, S. L., Weaver, F. M., Giobbie-Hurder, A., Manheim, L., Henderson, W., Kubal, J. D., ... & Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care. (2000). Effectiveness of team-managed home-based primary care: a randomized multicenter trial. Jama, 284(22), 2877-2885.
Hwang, K., Johnston, M., Tulsky, D., Wood, K., Dyson-Hudson, T., & Komaroff, E. (2009). Access and coordination of health care service for people with disabilities. Journal of Disability Policy Studies, 20(1), 28-34.
Jones, M., DeRuyter, F., & Morris, J. (2020). The digital health revolution and people with disabilities: perspective from the United States. International journal of environmental research and public health, 17(2), 381.
Kavanagh, A., Dickinson, H., Carey, G., Llewellyn, G., Emerson, E., Disney, G., & Hatton, C. (2021). Improving health care for disabled people in COVID-19 and beyond: lessons from Australia and England. Disability and health journal, 14(2), 101050.
Kobeissi, M. M., & Manning, C. A. (2025). Access enabled: More equitable telehealth for people with disabilities. The Journal for Nurse Practitioners, 21(8), 105451.
Kroll, T., Jones, G. C., Kehn, M., & Neri, M. T. (2006). Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health & social care in the community, 14(4), 284-293.
Kuper, H., Gatta, D. R., Rotenberg, S., Banks, L. M., Smythe, T., & Heydt, P. (2024). Building disability-inclusive health systems. The Lancet Public Health, 9(5), e316-e325.
Kürklü, S., & Kılıç, B. (2026). Geçmişten günümüze hemşirelikte etik konulara ilişkin çalışmaların incelenmesi. Sağlık Akademisyenleri Dergisi, 12(4), 674-682.
Kürklü, S., & Yurdakul, E.S. (2025). Afet Etiği. ISBN: 978-625-375-599-7. Akademisyen Kitabevi.
Lawthers, A. G., Pransky, G. S., Peterson, L. E., & Himmelstein, J. H. (2003). Rethinking quality in the context of persons with disability. International Journal for Quality in Health Care, 15(4), 287-299.
Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., & Pandeya, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International journal of epidemiology, 36(1), 139-146.
Maart, S., & Jelsma, J. (2014). Disability and access to health care–a community based descriptive study. Disability and rehabilitation, 36(18), 1489-1493.
Mackintosh, S., & Leather, P. (2016). The disabled facilities grant: Before and after the introduction of the better care fund. Foundations: Derbyshire, UK.
Murphy, J. (2006). Perceptions of communication between people with communication disability and general practice staff. Health Expectations, 9(1), 49-59.
Rohrer, J. E., Wilkinson, J. M., Barnes, D. E., & Adamson, S. C. (2008). Physical limitations and perceived quality of care among family medicine patients. Clinical Rehabilitation, 22(3), 283-287.
Rong, G., Mendez, A., Assi, E. B., Zhao, B., & Sawan, M. (2020). Artificial intelligence in healthcare: review and prediction case studies. Engineering, 6(3), 291-301.
Sapancı, F., (2013), Sağlık Hizmetlerinde Engellilik Kavramı ve Engellilerin Sağlık Hizmetlerinden Yararlanmaları, Beykent Üniversitesi Sosyal Bilimler Enstitüsü Hastane ve Sağlık Kurumları Yönetimi Bilim Dalı, Yüksek Lisans Tezi, İstanbul.
Seyhan, F. (2023). Sağlık Turizmi ve Geronteknoloji İlişkisi, Orhan, F., Uzunhasanoğlu, G. & Özgök, Y. (Ed.); Geronteknoloji:Multidisipliner Yaklaşımlar, İksad Publishing House.
Seyhan, F. & Şen, H. (2024). Sağlık kurumlarında Toplam Kalite Yönetimi ve Akreditasyon, Korkmaz, S. & Seyhan, F. (Ed.), Sağlık Kurumları İşletmeciliğinde Temel Konular ve Uygulamalar, Siyasal Kitabevi.
Smythe, T., Rotenberg, S., Moyo-Chilufya, M., Wilbur, J., & Kuper, H. (2026). Health inequalities among people with disabilities: an umbrella review and evidence synthesis. EClinicalMedicine, 91.
Soltani, S., Takian, A., Sari, A. A., Majdzadeh, R., & Kamali, M. (2017). Cultural barriers in access to healthcare services for people with disability in Iran: A qualitative study. Medical Journal of the Islamic Republic of Iran, 31, 51.
Steel, N., Bachmann, M., Maisey, S., Shekelle, P., Breeze, E., Marmot, M., & Melzer, D. (2008). Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England. Bmj, 337.
Şen, H., Kaplan, E. T., & Sağlık, S. (2023). Sağlık sektöründe toplam kalite yönetimi ve insan kaynakları ilişkisi. İksad Publishing House.
Şen, H., & Üstün, V. (2024). Engelli yaşlı bireylerin sosyal izolasyon ve yalnızlık durumlarının değerlendirilmesi. Sosyal Beşeri ve İdari Bilimler Dergisi, 7(7), 529–544.
Tezzoni, L. I., McCarthy, E. P., Davis, R. B., Harris-David, L., & O'Day, B. (2001). Use of screening and preventive services among women with disabilities. American Journal of Medical Quality, 16(4), 135-144.
Thomé, B., Dykes, A. K., & Hallberg, I. R. (2003). Home care with regard to definition, care recipients, content and outcome: systematic literature review. Journal of clinical nursing, 12(6), 860-872.
Turner-Stokes, L., Williams, H., Abraham, R., & Duckett, S. (2000). Clinical standards for inpatient specialist rehabilitation services in the UK. Clinical Rehabilitation, 14(5), 468-480.
United Nations. (2023). Convention on the rights of persons with disabilities.https://www.un.org/development/desa/disabilities/convention-on- the-rights-of-persons-with-disabilities.html
Waterworth, C. J., Smith, F., Kiefel-Johnson, F., Pryor, W., & Marella, M. (2024). Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low-and middle-income countries: a scoping review. Disability and rehabilitation, 46(25), 5965-5976.
Whittle, R. (2002). The Framework Directive for equal treatment in employment and occupation: an analysis from a disability rights perspective. European Law Review, 27(3), 303-326.
World Health Organization, (2011). The World Report on Disability. 2011. Availableonline: http://www.who.int/disabilities/world_report/2011/en/
World Health Organization. (2024). Health equity for persons with disabilities: guide for action. World Health Organization.
Yeung, C. K., Cheng, K. M., Wong, P. K., Wong, S. S., Cheng, H. Y., Cheung, W. Y., ... & Lee, C. C. (2026). An ICF-Based Interdisciplinary Case Management Improves Functioning, Participation, and Well-being for People with Disabilities in Community Rehabilitation: A Protocol for a Randomised Controlled Trial. Frontiers in Rehabilitation Sciences, 7, 1745671.
Zhao, C., Yu, X., Yang, S., & Shao, S. (2021). Utilization of home-based medical services in disabled elderly people in Beijing: a mixed-method study. Chinese General Practice, 24(13), 1676.
Referanslar
Africa, L., Frantz, J., & Mlenzana, N. B. (2025). Guidelines for interprofessional practice in rehabilitation at primary health care level. African Journal of Primary Health Care & Family Medicine, 17(1), 5079.
Ali, A., & Hassiotis, A. (2008). Illness in people with intellectual disabilities. Bmj, 336(7644), 570-571.
Arul, U. (2020). ‘Access to healthcare facilities among the disabled people towards the public healthcare institution’, Int. J. Sci. Technol.
Ashton, C. M., Haidet, P., Paterniti, D. A., Collins, T. C., Gordon, H. S., O’Malley, K., ... & Street Jr, R. L. (2003). Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication?. Journal of general internal medicine, 18(2), 146-152.
Barr, O. (1997). Interdisciplinary teamwork: consideration of the challenges. British Journal of Nursing, 6(17), 1005-1010.
Baru, R., Acharya, A., Acharya, S., Kumar, A. S., & Nagaraj, K. (2010). Inequities in access to health services in India: caste, class and region. Economic and political Weekly, 49-58.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
Branigan, M., Stewart, D. E., Tardif, G. S., & Veltman, A. (2001). Perceptions of primary healthcare services among persons with physical disabilities; Part 2: Quality issues. Medscape General Medicine, 3(2), 19.
Byron, M., Howell, C., Bradley, P., Bheenuck, S., Wickham, C., & Curran, T. (2006). Different Differences: Disability equality teaching in healthcare education.
Copley, J., Martin, R., Dix, C., Forbes, R., Hill, A., Mandrusiak, A., ... & Collins, C. (2024). Fostering collaborative practice through interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students. Journal of Interprofessional Care, 38(3), 534-543.
Dassah, E., Aldersey, H., McColl, M. A., & Davison, C. (2018). Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis. Global health research and policy, 3(1), 1-13.
Diab, M. E., & Johnston, M. V. (2004). Relationships between level of disability and receipt of preventive health services. Archives of physical medicine and rehabilitation, 85(5), 749-757.
Galvin, R. (2004). Challenging the need for gratitude: Comparisons between paid and unpaid care for disabled people. Journal of Sociology, 40(2), 137-155.
Genet, N., Boerma, W. G., Kringos, D. S., Bouman, A., Francke, A. L., Fagerström, C., ... & Devillé, W. (2011). Home care in Europe: a systematic literature review. BMC health services research, 11, 1-14.
Gibson, J., & O'Connor, R. (2010). Access to health care for disabled people: a systematic review. Social care and Neurodisability, 1(3), 21-31.
Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R., & Hudson, M. (2002). What does' access to health care'mean?. Journal of health services research & policy, 7(3), 186-188.
Güler, E.K., (2005), Tıbbi Ortamların ve İlişkilerin Engelli Kişilere Uygunluğunun Etik Yönden Değerlendirilmesi, Çukurova Üniversitesi, Adana.
Heath, G. N., & Fentem, P. H. (1997). 8 Physical Activity among Persons with Disabilities—A Public Health Perspective. Exercise and sport sciences reviews, 25(1), 195-234.
Hughes, S. L., Weaver, F. M., Giobbie-Hurder, A., Manheim, L., Henderson, W., Kubal, J. D., ... & Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care. (2000). Effectiveness of team-managed home-based primary care: a randomized multicenter trial. Jama, 284(22), 2877-2885.
Hwang, K., Johnston, M., Tulsky, D., Wood, K., Dyson-Hudson, T., & Komaroff, E. (2009). Access and coordination of health care service for people with disabilities. Journal of Disability Policy Studies, 20(1), 28-34.
Jones, M., DeRuyter, F., & Morris, J. (2020). The digital health revolution and people with disabilities: perspective from the United States. International journal of environmental research and public health, 17(2), 381.
Kavanagh, A., Dickinson, H., Carey, G., Llewellyn, G., Emerson, E., Disney, G., & Hatton, C. (2021). Improving health care for disabled people in COVID-19 and beyond: lessons from Australia and England. Disability and health journal, 14(2), 101050.
Kobeissi, M. M., & Manning, C. A. (2025). Access enabled: More equitable telehealth for people with disabilities. The Journal for Nurse Practitioners, 21(8), 105451.
Kroll, T., Jones, G. C., Kehn, M., & Neri, M. T. (2006). Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health & social care in the community, 14(4), 284-293.
Kuper, H., Gatta, D. R., Rotenberg, S., Banks, L. M., Smythe, T., & Heydt, P. (2024). Building disability-inclusive health systems. The Lancet Public Health, 9(5), e316-e325.
Kürklü, S., & Kılıç, B. (2026). Geçmişten günümüze hemşirelikte etik konulara ilişkin çalışmaların incelenmesi. Sağlık Akademisyenleri Dergisi, 12(4), 674-682.
Kürklü, S., & Yurdakul, E.S. (2025). Afet Etiği. ISBN: 978-625-375-599-7. Akademisyen Kitabevi.
Lawthers, A. G., Pransky, G. S., Peterson, L. E., & Himmelstein, J. H. (2003). Rethinking quality in the context of persons with disability. International Journal for Quality in Health Care, 15(4), 287-299.
Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., & Pandeya, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International journal of epidemiology, 36(1), 139-146.
Maart, S., & Jelsma, J. (2014). Disability and access to health care–a community based descriptive study. Disability and rehabilitation, 36(18), 1489-1493.
Mackintosh, S., & Leather, P. (2016). The disabled facilities grant: Before and after the introduction of the better care fund. Foundations: Derbyshire, UK.
Murphy, J. (2006). Perceptions of communication between people with communication disability and general practice staff. Health Expectations, 9(1), 49-59.
Rohrer, J. E., Wilkinson, J. M., Barnes, D. E., & Adamson, S. C. (2008). Physical limitations and perceived quality of care among family medicine patients. Clinical Rehabilitation, 22(3), 283-287.
Rong, G., Mendez, A., Assi, E. B., Zhao, B., & Sawan, M. (2020). Artificial intelligence in healthcare: review and prediction case studies. Engineering, 6(3), 291-301.
Sapancı, F., (2013), Sağlık Hizmetlerinde Engellilik Kavramı ve Engellilerin Sağlık Hizmetlerinden Yararlanmaları, Beykent Üniversitesi Sosyal Bilimler Enstitüsü Hastane ve Sağlık Kurumları Yönetimi Bilim Dalı, Yüksek Lisans Tezi, İstanbul.
Seyhan, F. (2023). Sağlık Turizmi ve Geronteknoloji İlişkisi, Orhan, F., Uzunhasanoğlu, G. & Özgök, Y. (Ed.); Geronteknoloji:Multidisipliner Yaklaşımlar, İksad Publishing House.
Seyhan, F. & Şen, H. (2024). Sağlık kurumlarında Toplam Kalite Yönetimi ve Akreditasyon, Korkmaz, S. & Seyhan, F. (Ed.), Sağlık Kurumları İşletmeciliğinde Temel Konular ve Uygulamalar, Siyasal Kitabevi.
Smythe, T., Rotenberg, S., Moyo-Chilufya, M., Wilbur, J., & Kuper, H. (2026). Health inequalities among people with disabilities: an umbrella review and evidence synthesis. EClinicalMedicine, 91.
Soltani, S., Takian, A., Sari, A. A., Majdzadeh, R., & Kamali, M. (2017). Cultural barriers in access to healthcare services for people with disability in Iran: A qualitative study. Medical Journal of the Islamic Republic of Iran, 31, 51.
Steel, N., Bachmann, M., Maisey, S., Shekelle, P., Breeze, E., Marmot, M., & Melzer, D. (2008). Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England. Bmj, 337.
Şen, H., Kaplan, E. T., & Sağlık, S. (2023). Sağlık sektöründe toplam kalite yönetimi ve insan kaynakları ilişkisi. İksad Publishing House.
Şen, H., & Üstün, V. (2024). Engelli yaşlı bireylerin sosyal izolasyon ve yalnızlık durumlarının değerlendirilmesi. Sosyal Beşeri ve İdari Bilimler Dergisi, 7(7), 529–544.
Tezzoni, L. I., McCarthy, E. P., Davis, R. B., Harris-David, L., & O'Day, B. (2001). Use of screening and preventive services among women with disabilities. American Journal of Medical Quality, 16(4), 135-144.
Thomé, B., Dykes, A. K., & Hallberg, I. R. (2003). Home care with regard to definition, care recipients, content and outcome: systematic literature review. Journal of clinical nursing, 12(6), 860-872.
Turner-Stokes, L., Williams, H., Abraham, R., & Duckett, S. (2000). Clinical standards for inpatient specialist rehabilitation services in the UK. Clinical Rehabilitation, 14(5), 468-480.
United Nations. (2023). Convention on the rights of persons with disabilities.https://www.un.org/development/desa/disabilities/convention-on- the-rights-of-persons-with-disabilities.html
Waterworth, C. J., Smith, F., Kiefel-Johnson, F., Pryor, W., & Marella, M. (2024). Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low-and middle-income countries: a scoping review. Disability and rehabilitation, 46(25), 5965-5976.
Whittle, R. (2002). The Framework Directive for equal treatment in employment and occupation: an analysis from a disability rights perspective. European Law Review, 27(3), 303-326.
World Health Organization, (2011). The World Report on Disability. 2011. Availableonline: http://www.who.int/disabilities/world_report/2011/en/
World Health Organization. (2024). Health equity for persons with disabilities: guide for action. World Health Organization.
Yeung, C. K., Cheng, K. M., Wong, P. K., Wong, S. S., Cheng, H. Y., Cheung, W. Y., ... & Lee, C. C. (2026). An ICF-Based Interdisciplinary Case Management Improves Functioning, Participation, and Well-being for People with Disabilities in Community Rehabilitation: A Protocol for a Randomised Controlled Trial. Frontiers in Rehabilitation Sciences, 7, 1745671.
Zhao, C., Yu, X., Yang, S., & Shao, S. (2021). Utilization of home-based medical services in disabled elderly people in Beijing: a mixed-method study. Chinese General Practice, 24(13), 1676.
