A National-wide Survey on Utilization of Pattern Identification for Chronic Diseases among Korean Medicine Doctors (전국 한방의료기관 한의사 대상 만성질환의 변증활용 현황 조사)
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- Journal of Society of Preventive Korean Medicine
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- 제21권2호
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- pp.23-34
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- 2017
Objectives : The aim of this study was to survey the present utilization of pattern identification(PI) by chronic disease and using PI system in the clinical field among Korean medicine doctors. Methods : This survey was conducted from Oct. 1 to Oct. 31, 2014 by face-to-face interview using structured questionnaire. The subjects were 400 Korean medicine doctors who worked in hospitals or clinics. The questionnaire consisted of whether use clinical experience by chronic disease and the utilization of PI, the utilization of PI systems, the PI utilization rate, and the correlation between utilization PI and so on. General elements consisted of sex, age, clinical experience, place of work, district and so on. Results and Conclusions : This study revealed that clinical experience by chronic disease used 24.0-90.8%. The most chronic diseases were chronic fatigue and chronic pain, and least disease was cancer. Experience of the utilization of PI among Korean medicine doctors who have clinical experience was 87.8-97.1%. Also, the most utilized disease was chronic gastritis & gastric ulcer, and least disease was dyslipidemia. In this case, the most common cases were using the one PI between the utilization of PI systems, and the utilization ratio of Visceral PI was the highest. Phi coefficient between the PI systems in chronic diseases divided into positive correlation and negative correlation. The correlation of dementia between Triple energizer PI and Six excesses PI was the highest at positive correlation, and the frequency of occurrence between Defense, Qi, Nutrient and Blood PI was the highest at positive correlation. The correlation of osteoarthropathy between Meridian and Collateral PI and Sasang Constitutional Medicine was the highest at negative correlation. Also the frequency of occurrence between Qi, Blood, Fluid and Humor PI and Sasang Constitutional Medicine was the highest at negative correlation. We hope that additional studies on systematic PI research of chronic disease which needed to be in korean oriental medicine and meet the needs of clinical consumer continue based on this study.
Objectives : The purpose of this study is to investigate the practice patterns of traditional Korean medicine (TKM) doctors and the acceptance of payment model in order to develop a new TKM health insurance payment model linked with TKM clinical practice guidelines (CPGs). Methods : Lumbar herniated intervertebral disc (HIVD) and idiopathic facial palsy (IFP) were selected as a test diseases to develop a new TKM payment model. The level of benefit coverage in the National Health Insurance (NHI) was designed. The survey asked 228 TKM doctors about their practice patterns in HIVD and IFP patients and acceptance of new payment model. Results : Mean of medical cost for treatment of HIVD was 441,000 KW, mean of treatment period ranged from 4.9 to 17.5 weeks, and mean of number of treatment ranged from 14.6 to 50.4 HIVD patients. In the case of IFP, mean of medical cost for treatment of IFP was 468,000 KW, mean of treatment period was at least 4.2 and up to 15.9 weeks and mean of number of treatment ranged from 14.2 to 52 IFP patients. Conclusions : Current study suggests that mixed payment model of per-visit and episode-based model seem to be proper. The model 1 bundles both items which were covered and not covered by NHI in a rational way. The model 2 is based on the development and application of critical pathway. Lastly, model 3 suggests bundling of items covered by current NHI. Acceptance of TKM doctors is expected to be highest in the model 3.
Objectives : In an effort to suggest a developmental plan of Traditional Korean Medicine health promotion project(TKM-HPP), this study was conducted to identify the problems experienced by public health Traditional Korean Medicine(PH-TKM) doctors in duty and to analyze successful cases of the health promotion project. Methods : Two PH-TKM doctors in duty at the Public Health Centre branch and Public Health Centre respectively, and one TKM doctor in charge of Public Health Centre participated in the in-depth interview. The research procedure was as follows; 1) inform study objectives and interview questions to participants, 2) in-depth interview with semi-structured questions, and 3) post-confirmation and verification. The interview was recorded and transcripted. In-depth interview was composed of 6 subsections: 1) Introducing participants and share purpose of interview, 2) Confirmation of the job status and difficulty of public health centre, 3) Reflecting and sharing experiences of public health clinic job performance cases, 4) Current status and improvement needs of TKM-HPP, 5) Discussions on improvement of TKM-HPP in public health center, 6) Sharing and reconfirmation of interview results. Thematic analysis was conducted from the narratives. Results : The study showed that; 1) the support from the local government was critical for the successful TKM-HPP and participation of the PH-TKMs; 2) the major problems experienced by PH-TKMs were lack of training for TKM-HPP in the field and lack of knowledge at local government level; 3) the suggestions to provide PH-TKMs with manual to educate residents effectively and redefine roles of PH-TKMs in the project. It also suggests that TKM-HPP model should be developed by the district in a way of reflecting regional characteristics. Conclusions : Firstly, more efforts should be made on the projects rather than medical treatment in public health centers, except for areas where medical institutions are scarce. Secondly, in order to facilitate participation of PH-TKM doctors, each local office should reduce medical care and increase efforts related with projects. Thirdly, the institution has to develop feasible TKM-HPP plans that can be carried out by PH-TKMs by the manual. Lastly, pre-training should be provided to PH-TKMs to understand contents of TKM-HPP related to public health centre work before the placement.
This study is conducted to compare how the Western.Oriental medical practitioners and health professionals perceive reciprocal development strategies respectively of Western.Oriental Medicine in Korea. A total of 3,273 persons were questioned by direct distribution, e-mail, and mail with a self-developed questionnaire. Of those questioned, 362 responded (the response rate of 11.1%), and of them n persons (Western medical practitioners 206, Oriental medical practitioners 90, and health professionals 64) were analyzed with SPSS for Windows. The results were as follows： The need for legislation on the mutual development system for Western.Oriental Medicine was recognized by 66.9% (218 persons) of respondents. Among them, largest group who agreed with this need was the health professionals. Western medical practitioners chose the "the difference of approach methods on the diseases between Western.Oriental Medicine" as their response, and Oriental medical practitioners ＆ health professionals selected "the indifference or bias of Western medical practitioners"as the reasons for the inactivity in developing a mutual system of Western.Oriental Medicine. Therefore, Western medical practitioners and health professionals selected the category of "the reformation of educational system", while Oriental medical practitioners selected the category of "the activation of joint research on Western.Oriental medical care" as the most important condition for setting a precedent. Also, Western medical practitioners preferred "cooperative health care system for Western medical care supported by Oriental medical care", but Oriental medical practitioners and health professionals preferred “cooperative health care system of Western.Oriental medicine on equal terms" In conclusion, Western '||'&'||' Oriental medical practitioners have to make every effort to close the gap between differing views through mutual understanding and respect if joint research of Western.Oriental medical care is to become a reality. The government should continuously enforce the health policy on development of a legal and systematic infrastructure for mutual development strategy of Western.Oriental Medicine in Korea.strategy of Western.Oriental Medicine in Korea.
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