보건행정학회지 (Health Policy and Management)

  • 제19권2호
  • /
  • Pages.51-70
  • /
  • 2009
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  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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우리나라 성인 2형 당뇨환자의 외래진료 지속성과 관련요인 분석

Continuity of Ambulatory Care among Adult Patients with Type 2 Diabetes and Its Associated Factors in Korea

  • 홍재석 (건강보험심사평가원 심사평가정책연구소) ;
  • 김재용 (한림대학교 의과대학 사회의학교실) ;
  • 강희정 (건강보험심사평가원 심사평가정책연구소)
  • Hong, Jae-Seok (Health Insurance Review & Assessment Policy Institute, Health Insurance Review & Assessment Service, Republic of Korea) ;
  • Kim, Jai-Yong (Department of Social and Preventive Medicine, Hallym University College of Medicine, Republic of Korea) ;
  • Kang, Hee-Chung (Health Insurance Review & Assessment Policy Institute, Health Insurance Review & Assessment Service, Republic of Korea)
  • 발행 : 2009.06.30
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초록

Background : Previous studies have reported that enhanced continuity of care prevented a sudden worsening in progress among chronic disease patients, and as a result was favorable for efficient spending of health care funds. This study aims to estimate the continuity of care of Korean with diabetes and to identify factors affecting the continuity of care. Methods : This study used the Korean National Health Insurance Claims Database which includes E11 (ICD-10) as a primary or secondary disease as of 2006. Study population is 1,160,725 type 2 diabetics (20-84 years). Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC) were used as indexes of continuity of care. Results : The continuity of care in the study population was $0.94{\pm}0.10$ as calculated by MMCI, $0.91{\pm}0.16$ as calculated by MFPC and $0.86{\pm}0.23$ as calculated by COC. The lower continuity of care was shown in the patients who were female, 65 and over years old, Medical Aid recipients, 13 times or more visitors, hospital users as main attending medical institution, patients experienced hospitalizations or comorbidities. Conclusion : The continuity of care for adult patients with type 2 diabetes was high in Korea, and showed variation according to patients' characteristics. This result provides empirical evidence for policymakers to develop or strengthen programs for managing patients showing low continuity of care.

키워드

참고문헌

  1. 김영열, 최보율, 박항배. 일차의료기관 방문환자의 지속성 지수에 관한 조사연구. 서울지역 의료보험환자를 대상으로. 한양의대학술지 1988;8(2):697-708
  2. 김재용, 김혜영, 김화영, 민경완, 박석원, 박이병 등. 우리나라 당뇨병환자의 외래이용 지속성 이 건강결과 (health outcome)와 의료비에 미치는 영향: 건강보험자료 분석결과. 당뇨병 2006;30(5):377-387 https://doi.org/10.4093/jkda.2006.30.5.377
  3. 김재용. Diabetes in Korea 2007. 서울: 건강보험심사평가원; 2007
  4. 민헌기. 한국인 당뇨병의 임상적 특성. 대한당뇨병학회지 1992;16(3);163-174
  5. 윤채현, 이신재, 주수영, 문옥륜, 박재현. 우리나라 당뇨병환자의 진료 지속성 및 이에 영향을 미치는 요인. 예방의학회지 2007;40(1):51-58
  6. 이영옥. 대도시 빈곤 계층 아동의 예방 의료 서비스 이용에 대한 연구: 정기적인 의료 이용도와 의료의 계속성. 보건사회연구 2005;25(2):147-172
  7. 정현주, 백진주, 배광석, 한은정, 이가영, 박태진, 김병성. 외래환자들의 주치의 지속성에 영향을 미치는 요인들-일개 대학 가정의학과 외래환자를 대상으로. 가정의학회지 1997;18(7):731-738
  8. 최용준. 우리나라 어린이 청소년 환자에서 일차의료의 지속성에 관한 연구[박사논문]. 서울: 서울대학교 대학원; 2006
  9. 홍재석, 김재용. 우리나라 노인환자에서 일차의료서비스 이용의 지속성에 관한 연구. 서울: 건강보험심사평가원; 2007
  10. American Diabetes Association: Standard of Medical Care in Diabetes. Diabetes Care 2004;27(1): S15-35 https://doi.org/10.2337/diacare.27.2007.S15
  11. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care 1977 ;15(4):347-349 https://doi.org/10.1097/00005650-197704000-00010
  12. Breslau N, Reeb KG. Continuity of care in a university-based practice. J Med Educ 1975;50(10):965-969
  13. Center for Chronic Disease Preventive and Control: Diabetes in Canada. Health Canada. CDC; 2002
  14. Christakis DA, Mell L, Koepsell TD, Zimmerman FJ, Connell FA. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics 2001;107(3):524-529 https://doi.org/10.1542/peds.107.3.524
  15. Christakis DA, Wright JA, Koepsell TD, Emerson S, Connell FA. Is greater continuity of care associated with less emergency department utilization? Pediatrics 1999;103(4 Pt 1):738-742 https://doi.org/10.1542/peds.103.4.738
  16. Cyr MC, Martens AC, Berbiche D, Perreault S, Blais L. Continuity of care in the ambulatory treatment of adolescents with asthma. J Adolesc Health 2006;39(6):926.e11-17 https://doi.org/10.1016/j.jadohealth.2006.06.013
  17. Darden PM, Ector W, Moran C, Quattlebaum TG. Comparison of continuity in resident versus private practice. Pediatrics 2001;108(6):1263-1268 https://doi.org/10.1542/peds.108.6.1263
  18. Department of Health. Improving Chronic Disease Management. London: Department of Health, http://www.dh.gov.uk/assetRoot/04/07/52/13/04075213.pdf;2006 (accessed on 30 May, 2009)
  19. Engelgau MM, Geiss LS, Saaddine JB, Boyle JP, Benjamin SM, Gregg EW., et al. Evolving Diabetes in the United States. Ann Intern Med 2004:140(11):945-951 https://doi.org/10.7326/0003-4819-140-11-200406010-00035
  20. Gill JM, Mainous AG 3rd, Diamond JJ, Lenhard MJ. Impact of provider continuity on quality of care for persons with diabetes mellitus. Ann Fam Med 2003;1(3):162-170 https://doi.org/10.1370/afm.22
  21. Gill JM, Mainous AG 3rd. The role of provider continuity in preventing hospitalizations. Arch Fam Med 1998;7(4):352-357 https://doi.org/10.1001/archfami.7.4.352
  22. Goldberg HI, Dietrich AJ. The continuity of care provided to primary care patients: A comparison of family physicians, general internists and medical subspecialists. Med Care 1985;23:63 https://doi.org/10.1097/00005650-198501000-00007
  23. Goldkin MA, Rice CA. Relationship of physician continuity to type of health problems in primary care. J Fam Pract 1981;12:99
  24. Gulliford MC, Naithani S, Morgan M. Continuity of care and intermediate outcomes of type 2 diabetes mellitus. Fam Pract. 2007;24(3):245-251 https://doi.org/10.1093/fampra/cmm014
  25. Gulliford MC, Naithani S, Morgan M. Measuring continuity of care in diabetes mellitus: an experience-based measure. Ann Fam Med. 2006;4(6):548-555 https://doi.org/10.1370/afm.578
  26. Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. Br Med J 2003;327:1219-1221 https://doi.org/10.1136/bmj.327.7425.1219
  27. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care 2003;26(3):917-932 https://doi.org/10.2337/diacare.26.3.917
  28. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington DC: National Academies Press;2005
  29. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academies Press;2003
  30. International Diabetes Federation. Diabetes Atlas, 2nd edition, 2003
  31. Magill MK, Senf J. A new method for measuring continuity of care in family practice residencies. J Fam Pract 1987;24:165-168
  32. Naithani S, Gulliford M, Morgan M. Patients' perceptions and experiences of 'continuity of care' in diabetes. Health Expect. 2006;9(2):118-129 https://doi.org/10.1111/j.1369-7625.2006.00379.x
  33. Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med 2003;1(3):149-155 https://doi.org/10.1370/afm.63
  34. Parchman ML, Pugh JA, Noël PH, Larme AC. Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes. Med Care 2002;40(2):137-144 https://doi.org/10.1097/00005650-200202000-00008
  35. Patten RC, Friberg R. Measuring continuity of care in a family practice residency program. J Fam Pract 1980;11(1):67-71
  36. Raddish M, Horn SD, Sharkey PD. Continuity of care: is it cost effective? Am J Manag Care 1999;5(6):727-734
  37. Ride R, Haggety J, MaKendry R. Defusing the confusion: Concepts and Measures of Continuity of Healthcare. Ottawa: Canadian Health Service Research Foundation; 2002
  38. Roos LL , Roos NP, Gilbert P., et al. Continuity of care: Does it contribute to quality of care? Med Care 1980;18:174 https://doi.org/10.1097/00005650-198002000-00004
  39. Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med 2005; 3:159-166 https://doi.org/10.1370/afm.285
  40. Saultz JW. Defining and measuring interpersonal continuity of care. Ann Fam Med 2003 ;1(3):134-143 https://doi.org/10.1370/afm.23
  41. Sloane P, Egelhoff C. The relationship of continuity of care to age, sex, and race. J Fam Pract 1983;16(2):404-405
  42. Smith CS. The impact of an ambulatory firm system on quality and continuity of care. Med Care.1995;33(3):221-226 https://doi.org/10.1097/00005650-199503000-00001
  43. Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am J Public Health 1996;86(12):1742-1747 https://doi.org/10.2105/AJPH.86.12.1742
  44. World Health Organization, World Health Report. WHO;2004

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