faqtebze dafuZnebuli medicina

1
faqtebze dafuZnebuli medicina
imedebi da problemebi

• Victor R. Fuchs
• Henry J. Kaiser Jr. Professor Emeritus
• Stanford University
• Nuffield Trust, London, 12 May 2003

2

• "faqtebze dafuZnebuli medicina warmoadgens
  gamokvlevebis Sedegad miRebuli saukeTeso codnis
  (faqtebis), eqimebis klinikuri gamocdilebisa da
  avadmyofTa prioritetebis integracias." David
  Sackett et al. "faqtebze dafuZnebuli
  medicina" ("Evidence-Based Medicine") me-2
  gamocema, 2000, gv.1

3
faqtebze dafuZnebuli medicinis mniSvnelobis zrdis
mizezebi

• faqtebze dafuZnebuli medicinis saWiroeba
• Tanamedrove medicinis sirTule
• Tanamedrove medicinis siZvire
• faqtebze dafuZnebuli medicinis momxmareblisaTvis
  miwodebis SesaZlebloba
• informaciis SeZenis, Senaxvis, gadamuSavebisa da
  saWiroebis SemTxvevaSi misi amoRebis saqmeSi
  siaxleebis danergva, rasac mohyva am procesebis
  gaiafeba
• arsebiTi da meTodologiuri miRwevebi maTematikaSi,
  statistikasa da qcevis Semswavlel mecnierebebSi.
  am miRwevebis gamoyeneba SesaZlebeli gaxda
  jandacvis ukeTesi organizaciisaTvis.

4
faqtebze dafuZnebuli medicinaimedebi

• ufro efeqturi da usafrTxo samedicino Carevebi da
  manipulaciebi avadmyofTa janmrTelobis
  gaumjobesebis mizniT
• jandacvis xarisxSi uTanasworobis Semcireba
• samedicino xarjebis zrdis Seneleba.

5
gamokvlevaTa Sedegad miRebuli saukeTeso codna

• ras niSnavs "saukeTeso"?
• ratom mxolod "saukeTeso"?
• SeiZleba "saukeTeso" gaxdes "kargis" mteri?
• ra saxis codnas gamoricxavs sityva "gamokvleva"?

6
klinikuri gamocdileba eqimTa maRali kvalifikacia

• faqtebze dafuZnebuli medicina ver Secvlis
• daavadebebis klinikuri niSnebisa da simptomebis
  amocnobis unars,
• anamnezis ostaturad Segrovebis xelovnebas,
• laboratoruli testebis Sedegebis interpretaciis
  SesaZleblobasa da
• analitikur azrovnebas.

7
eqimis klinikuri azrovneba

• "arc savaldebuloa da arc sasurveli, rom yvela
  eqimi gaxdes statistikosi an analitikosi, magram
  arsebuli realobidan gamomdinare Cveni mizani unda
  iyos Semdegi eqims mivceT sakmarisi codna
  martivi sakiTxebis gadasaWrelad. amasTanave,
  eqimma unda icodes, Tu rodis da rogor mimarTos
  daxmarebisaTvis analitikoss da rogor moaxdinos
  misgan miRebuli rCevisa Tu informaciis
  interpretacia".
• David Eddy , NEJM, 1982

8
avadmyofTa prioritetebi

• riskis acileba
• drois deficiti
• cxovrebiseuli problemebi an valdebulebebi
  ("dagegmili" cxovreba)
• samsaxurebrivi valdebulebebi
• sxva saxis, arasamedicino momsaxureba
• Semosavali?

9

• "nebismieri efeqturi samedicino Careva
  yvelasaTvis ufaso unda iyos."
• A.L.Cochrane. "Effectiveness and Efficiency
  Random Reflections on Health Services". 1972
• aris es SesaZlebeli 2003 wels?
• bat. koxreinis am postulats mravali
  mowinaaRmdege hyavs. isini amboben, rom ufaso
  samedicino daxmareba iwvevs misi momxmareblebis
  raodenobis zrdas, rasac saboloo jamSi mohyveba
  saxelmwifos mier jandacvaze gamoyofili saxsrebis
  katastrofuli zrda (mTar. SeniSvna).

10

• "zogadad sazogadoebas aqvs garkveuli azri imaze,
  Tu romeli samedicino xarjebi unda daifaros
  sazogadoebrivi fondebidan, magaliTad,
  qimioTerapia Tu qirurgiuli operacia da mravali
  adamianisaTvis es azri misaRebia, magram roca
  saqme exeba individualur pacientebs, maSin
  mxedvelobaSi unda iqnes miRebuli maTi
  Rirebulebebi da prioritetebi".
• David Sackett et al. "faqtebze dafuZnebuli
  medicina" ("Evidence-Based Medicine") me-2
  gamocema, 2000, gv. 180

11
faqtebze dafuZnebuli medicina da samedicino
xarjebi

• SeuZlia Tu ara faqtebze dafuZnebul medicinas
  daamuxruWos samedicino xarjebis zrda?
• diax is SezRudavs araefeqturi Carevebis
  gamoyenebas
• diax is dagvanaxebs, rom zogierTi SedarebiT
  iafi Careva iseTive efeqturia, rogorc misi Zviri
  alternativa
• ara is dagvanaxebs, rom siZviris miuxedavad
  zogierTi Careva sjobs sxva ufro iaf Carevebs.
• faqtebze dafuZnebuli medicinis potencialis sruli
  realizaciisaTvis aucilebelia misi SeuRleba
  xarjebisa da Sedegebis analizTan (Cost benefit
  analysis).

12
daskvnebi

• medicinaSi gadawyvetilebebis miRebis TvalsazrisiT
  faqtebze dafuZnebuli medicinis warmoSoba da
  ganviTareba mniSvnelovani win gadadgmuli nabijia,
  radgan aSkaraa misi upiratesoba Tvisobriv,
  araraodenobriv SefasebebTan SedarebiT
• Tanamedrove medicinis sirTulem da siZvirem
  moitana gaxada faqtebze dafuZnebuli medicinis
  saWiroeba, xolo mecnierebis sxva dargebSi
  momxdarma cvlilebebma SesaZlebeli gaxada misi
  Seqmna da gamoyeneba.
• faqtebze dafuZnebuli medicinis principebis
  danergvas unda mohyves jandacvis xarisxis
  gaumjobeseba da gaTanabreba, aseve misi
  ekonomikuri efeqturobis (rentabelobis) gazrda

13
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 malkhaz_j_at_hotmail.c
  om