eqimTa informaciuli moTxovnilebebis dakmayofilebis mcdeloba

Richard Smith, britanuli samedicino Jurnalis redaqtori www.bmj.com/talks

gansaxilveli sakiTxebis nusxa

• ra viciT eqimTa informaciuli

moTxovnilebebis Sesaxeb?

• rogor vakmayofilebT Cven am

moTxovnilebebs?

• rogor SeiZleba informaciis

miwodebis gaumjobeseba?

raze metyveleben eqimTa informaciul moTxovnilebebze Catarebuli gamokvlevebi?

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell, 1985

• sul Sinagan medicinaSi momuSave 47 eqimi, 12

zogadi praqtikis da 35 eqim-specialisti;

• TiToeulma maTganma naxevari dRis

ganmavlobaSi gasinja 1-dan 16 avadmyofamde;

• konsultaciebis Catarebamde eqimebma upasuxes

daxuruli saxis kiTxvars ( A closed questionnaire );

• yoveli konsultaciis Semdeg eqimTan tardeboda

interviu im kiTxvebis gamosavlenad, romelic wamoiWra avadmyofis gasinjvisas da romelzedac eqims pasuxi ar moepoveboda.

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell, 1985

• eqimebma dasawyisSi ganacxades, rom maT

damatebiTi informacia sWirdebodaT daaxloebiT erTxel kviraSi;

• sinamdvileSi ki 269 kiTxva wamoiWra 409

avadmyofis vizitis dros – daaxloebiT 2 kiTxva 3 avadmyofze; kiTxvebi exeboda:

• specifikuri daavadebebis mkurnalobas – 1/3 • diagnozs – 1/4 • medikamentebs - 14%

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell, 1985

• samedicino saxis informacia - faqti, romelic

rogorc wesi, sadavo ar aris. magaliTad, "ra gverdiTi movlenebia dakavSirebuli bromokriptinis gamoyenebasTan?" – 40%;

• samedicino sakiTxi, romelic rogorc wesi, iwvevs

azrTa sxvadasxvaobas. magaliTad, "rogor vumkurnaloT labiluri hipertenziis mqone avadmyofs?" - 45%;

• arasamedicino saxis informacia ("rogor

ganvaxorcieloT avadmyofis movla binaze?") – daaxloebiT 15-16%.

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell, 1985 mravali kiTxva Tavisi xasiaTiT iyo ara zogadi, aramed konkretuli. ara "ra SemTxvevebSia saWiro plazmaSi prokainamidis donis gansazRvra?", aramed "saWiroa Tu ara am konkretul avadmyofSi plazmaSi prokainamidis donis gansazRvra?"

informaciis wyaro eqimTa gancxadebiTa da dakvirvebis mixedviT informaciis wyaro beWdviTi gamocemebi specialuri an zogadi saxis saxelmZRvaneloebi farmacevtuli saxelmZRvaneloebi samedicino Jurnalebi medikamentebis Semqmneli kompaniebis mier mowodebuli informacia sakuTari Canawerebi adamianebi eqim-specialistebi zogadi praqtikis eqimebi sakuTari ofisis TanamSromeli (eqimi) farmacevti sxva 18 1 3 6 5 eqimTa gancxadebiT 62 25 14 18 1 4 33 24 1 4 3 21 9 7 1 7 dakvirvebis mixedviT 27 3 53

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Osheroff et al, 1991

• pitsburgSi universitetTan arsebuli zogadi medicinis

klinikaSi momuSave 24 eqimi da studenti.

• damkvirvebeli iyo anTropologi. anTropologis mier

gakeTebuli Canawerebis safuZvelze zogadi medicinis specialistebma gamoavlines kiTxvebi, romlebic wamoiWra avadmyofTa gasinjvisa da mkurnalobis dros.

• dakvirvebis 17 saaTis ganmavlobaSi stacionarsa da

ambulatoriaSi daaxloebiT 90 avadmyofis gamo wamoiWra 519 kiTxva.

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Osheroff et al, 1991

• 454 iyo "mkacrad klinikuri" saxis

SekiTxva – saSualod 5 TiToeul avadmyofze;

• 75% exeboda daavadebaTa

diagnostikas;

• 60% - specifikur avadmyofebs; • 25% - mkurnalobas; • 16% - medikamentebis

gamoyenebas.

gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Forsythe et ganmavlobaSi; verbalizacia; al, 1992

• wina dakvirvebis msgavsi, mxolod 35 saaTis • mravali informaciuli saWiroeba ar vlindeba kiTxvebis

saxiT, ufro metic, zogjer saerTod ar xdeba maTi

• informaciis moZiebasTan dakavSirebuli mesijebis

interpretacia xSirad SesaZlebelia mxolod konkretuli situaciis gaTvaliswinebiT;

• eqimebsa da studentebs zogjer sWirdebaT specifikur

klinikur informaciaze meti. saqme exeba mxardaWeras, maTi saqmianobis warmarTvasa da dasturs am saqmianobisaTvis.

ramdeni kiTxva wamoiWreba eqimisa da avadmyofis urTierTobisas?

gamo gamo kvl evi s Cat ar ebi s gamo kvl evi s meT o d i ki T xvebi s saS. kvl eva Covell et ad gi l i eqi mT a o f i sebi subi eqt i 47 eqi mi i nt er vi u vi z i t i s Semd eg r ao d eno ba er T ko nsul t ac i az e 0.66 al 1985 Timpka et al 1990 j anmr T el o bi s 4 c ent r i Svec i aSi 12 z o gad i pr aqt i ki s eqi mi ko nsul t ac i ebi s vi d eo gad aReba 1.85 Osheroff et al 1991 Ely et al 1992 Gorman et al 1994 Guise et al 1994 uni ver si t et T an ar sebul i z o gad i samed i c i no kl i ni ka (st ac i o nar i +ambul at .) eqi mT a o f i sebi eqi mT a o f i sebi ambul at o r i a Si d si s avad myo f T aT vi s 24 eqi mi d a st ud ent i 34 o j axi s eqi mi 49 o j axi s eqi mi 7 eqi mi - spec i al i st i anT r o po l o gi ur i d akvi r veba d akvi r veba ko nsul t ac i i s d r o s i nt er vi u vi z i t i s Semd eg avad . i st o r i aSi gakeT . Canawer ebi s ganxi l va 5.77 0.07 0.57 2.22

eqimTa informaciuli moTxovnilebebis Sesaxeb Catarebuli gamokvlevebidan gamomdinare daskvnebi

• damatebiTi informaciis saWiroeba warmoiqmneba

regularulad roca eqimebi naxuloben avadmyofebs;

• kiTxvebis umravlesoba exeba mkurnalobis

sakiTxebs, kerZod medikamentebs;

• kiTxvebi xSirad rTuli da mravalwaxnagovania; • eqimTa moTxovnilebani mxolod informaciiT ar

Semoifargleba. eqimebi eZeben fsiqologiur mxardaWerasa da TanagrZnobas, maT sWirdebaT rCeva, dasturi ama Tu im moqmedebisaTvis, am moqmedebebis gansja-garCeva da azrTa gaziareba.

eqimTa informaciuli moTxovnilebebis Sesaxeb Catarebuli gamokvlevebidan gamomdinare daskvnebi

• konsultaciebis dros wamoWrili kiTxvebis

umravlesoba rCeba upasuxod;

• rogorc Cans, eqimebi yvelaze metad cdiloben

TavianT kiTxvebze pasuxi miiRon kolegebisagan;

• kiTxvebis umravlesobas moepoveba pasuxi,

magram maTi moZieba did TanxebTan da drois danakargebTanaa dakavSirebuli;

• rogorc Cans, eqimebi waleka informaciis

nakadma.

rogor vakmayofilebT Cven eqimTa informaciul moTxovnilebebs?

arsebuli problemebi

• gTxovT, ifiqroT yvela im

informaciaze, risi gacnobac dagexmarebaT Tqveni movaleobebis ukeTesad SesrulebaSi.

• am informaciis ramdeni procentis

wakiTxvas axerxebT?

40% 40% 9% 10% 1% 1% -z e na kl eb i i 1% -1 0% 11 % -5 0% 51 % -9 0% 90 % -z e me t waki T xul i s mo c ul o ba

T avs gr Zno bT d amnaSaved i mi s gamo , r o m c o t as ki T xul o bT ?

d i ax ar a

arsebuli problemebi

gTxovT, ifiqroT im samedicino informaciaze, romelsac Tqven RebulobT da ecadeT es informacia erTi sityviT daaxasiaToT.

41 eqimis mier maTTvis miwodebuli samedicino informaciis dasaxasiaTeblad gamoyenebuli sityvebi

• SeuZlebeli SeuZlebeli SeuZlebeli

SeuZlebeli SeuZlebeli SeuZlebeli

• wamlekavi wamlekavi wamlekavi

wamlekavi wamlekavi wamlekavi

• rTuli rTuli rTuli rTuli • SiSis momgvreli SiSis momgvreli

SiSis momgvreli

• momabezrebeli • maxrCobela • depresiis gamowvevi • sasowarkveTilebis gamomwvevi • SemaSfoTebeli • damakmayofilebeli • usazRvro • damxmare • gamomfitavi • imedgacruebis gamomwvevi • drois didi danakargebiT

mimdinare

• Semzaravi • saSineli • brZolasTan asocirebuli • damafrTxobeli • ararealuri • stresis gamomwvevi • gamowveva gamowveva

gamowveva

• amaRelvebeli • sasicocxlo mniSvnelobis mqone

informaciuli paradoqsi

“informaciam eqimebi waleka, magram amasTanave isini ver pouloben sasurvel informacias saWiroebis SemTxvevaSi." Muir Gray

informaciuli paradoqsi

"wyali, yvelgan wyali da erTi wveTic ara wyurvilis mosaklavad" antikuri xanis mezRvauris leqsidan

Sexeduleba informaciaze poetis Tvalsazrisi

sad aris sibrZne codnaSi gacvlili?

da TviT codna informaciaSi Cakarguli?

• T S Eliot

gasul kviras ra dro dauTmeT literaturis kiTxvas Tqveni pacientebis daavadebebTan dakavSirebiT?

kar i er i s et api ki T xvaz e saSual o d d axar j ul i d r o (wuT ebSi )

90

st ud ent ebi

House officers* Registrars** 0 60

ko nsul t ant ebi , r o ml ebmac d aamT avr es i nst i t ut i 1975 wl i s Semd eg

45

ko nsul t ant ebi , r o ml ebmac d aamT avr es i nst i t ut i 1975 wl amd e

30 40

% vi nc ganac xad a, r o m ar af er i wauki T xavs gasul kvi r as

0 75 40 30

bristolSi zogadi praqtikis eqimebis mier samedicino literaturis kiTxvaze daxarjuli dro

mo qmed eba wuT ebi bi bl i o T ekaSi ki T xva

35

bi bl i o T ekaSi misvl a d a

70

wamo svl a

rogoria CamorCena literaturis kiTxvaSi?

• Jurnalebis raodenoba • axali statiebis raodenoba yovelkvireulad

40 000

• erTi statiis wasakiTxad

saWiro dro 10 000 30 wuTi

• Tu eqimi mTel dros

kiTxvaSi atarebs, maSin 6 kviris Semdeg ramdeniT CamorCeba igi?

mTeli erTi saukuniT

informaciis sargeblianoba

Sesaferisoba x marTebuloba x urTierTmoqmedeba sargeblianoba= _____________________________________________ informaciis posapoveblad gaweuli Sroma

informaciis sxvadasxva wyaros sargeblianoba

i nf o r mac i i s wyar o Sesaf er i so ba saJur nal o st at i ebi

d abal i

mar T e bul o ba

maRal i

ur T i er T z egavl ena (ur T i er T mo qmed eba)

ar avi T ar i

i nf o r mac i i s mo sapo vebl ad gaweul i Sr o ma

maRal i

sar gebl i ano ba

d abal i

saxel mZRvane l o ebi

saSu al o saSu al o ar avi T ar i saSu al o

ko l egebi

maRal i saSu al o maRal i d abal i saSu al o maRal i

samedicino JurnalebTan dakavSirebuli problemebi

• am JurnalebSi mocemuli informacia

ar akmayofilebs mkiTxvelTa moTxovnilebebs;

• Zalian bevria; • bevri sisulele iwereba; • maTi kiTxva Zalian mZime Sromaa; • araa Sesaferisi; • Zalian mosawyenia; • Zalian Zviria;

samedicino JurnalebTan dakavSirebuli problemebi

• arafer mniSvnelovans ar sZenen mkiTxvels; • nebismieri saqme gadahyavT nel ritmSi; • adgili aqvs mikerZoebas; • mravali maTgani mtruladaa ganwyobili axali

azris mimarT;

• Zalian cudi Sesaxedavia; • Zalian pompezuria; • orientirebulia istebliSmentze;

samedicino JurnalebTan dakavSirebuli problemebi

• ver swvdeba ganviTarebad samyaros; • ver umklavdeba siyalbes; • uamravi ganmeorebaa; • ZiriTadad orientirebulia avtorze da

ara mkiTxvelze;

• maT aravin ar kiTxulobs.

rogor gavaumjobesoT eqimebisaTvis informaciis miwodebis procesi?

sistemebi sinTezi sinopsi gamokvlevebi

"klinikuri mtkicebuleba"

• is Seicavs efeqturi

jandacvisaTvis saWiro saukeTeso informacias;

• cvlilebebis Setana xdeba

yovel 6 TveSi;

• me-3-14 gamocemebze

xeli miuwvdeba aSS-Si 500 000 eqims;

• britaneTis erovnuli

jandacvis sistemam

(

NHS

)

SeiZina 40 000 egzemplari.

"klinikuri mtkicebulebis" damaxasiaTebeli Tvisebebi

• "Cven gawvdiT faqtebs, Tqven da Tqvenma

avadmyofebma ki unda miiRoT gadawyvetileba";

• saWirboroto sakiTxebisa Tu kiTxvebis

wamoyeneba xdeba TviT eqimebisa da avadmyofebis mier;

• WeSmariti, faqtebze dafuZnebuli

meTodologia;

• avlens xarvezebs, faqtebis deficits; • gvawvdis faqtebs ama Tu im Carevis

sargeblisa da zianis Sesaxeb;

• arsebobs internetis versia.

panacea, romelic gadagvarCens

• Zalian rTul kiTxvebze pasuxis gacemis

unari;

• dakavSirebuli sarwmuno informaciis

monacemTa did bazasTan;

• eleqtruli, portatuli, swrafi da advilad

gamosayenebeli;

• eqimebisaTvis daxmarebis gawevis

SesaZlebloba maTi grZnobebis Seuracxyofis gareSe;

panacea, romelic gadagvarCens

• dakavSirebuli avadmyofis samedicino

monacemTa bazasTan;

• daxmareba rogorc avadmyofebisaTvis,

aseve eqimTaTvis;

• rogorc fsiqologiuri mxardaWeris, aseve

moqmedebebze dasturis micemis SesaZlebloba.

daskvnebi

• mravali kiTxva wamoiWreba eqimebis mier

konsultaciebis Catarebisas;

• kiTxvaTa umravlesoba rCeba upasuxod; • Cven eqimebs kargad ver vawvdiT saWiro

informacias;

• informaciam eqimebi waleka, magram amasTanave

isini ver pouloben sasurvel informacias saWiroebis SemTxvevaSi;

• axali teqnologiebi gvaZlevs SesaZleblobas, rom

informacia eqimebs gacilebiT ukeTesad mivawodoT;

• es procesi ar iqneba advili da dakavSirebuli iqneba

did TanxebTan da drois danaxarjebTan, aseve igi moiTxovs Cveni azrovnebis Secvlas;

leqciis Sefaseba

Tqveni Sefasebebi Zalian mniSvnelovania superkursis Semdgomi ganviTarebisaTvis. gTxovT SeavsoT leqciis bolo gverdze (review) moyvanili forma da daaWiroT submit button -s. Tu inglisuri ena giqmniT problemas, gamoagzavneT Tqveni komentarebi Semdeg misamarTze: [email protected].