• 한국산학기술학회논문지
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• 제20권10호
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• pp.351-357
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• 2019

본 연구는 일개 종합병원을 이용한 외래환자들을 대상으로 환자경험평가를 시행하여 외래진료의 전반적인 과정에 있어 환자가 경험한 의료서비스를 확인하고, 환자경험 및 인식에 영향을 미치는 주요 요인을 분석하고자 하였다. 조사대상은 2018년 5월 14일부터 5월 28일까지 일개 대학병원에서 외래진료 경험이 2회 이상 있는 환자 100명을 조사대상으로 선정하였다. 조사결과 성별로는 여자가 60.0%, 남자가 40.0%로 여자가 더 많은 분포를 보였고 연령별로는 60세 이상이 53.0%, 59세 이하가 47.0%로 60세 이상 그룹이 59세 이하 그룹보다 더 많은 분포를 보였으며, 병원을 이용하게 된 동기는 "병원이 가까이 있어서"가 42.0%로 가장 많은 분포를 보였으며, "의료진의 실력이 좋아서" 36.0%, "타 병원에서 권유받아서" 7.0% 순이었고 "주위사람 소개로"가 1.0%로 가장 적은 분포를 보였다. 이상의 연구결과, 환자 중심의 의료서비스를 제공하기 위한 문제점 파악과 환자의 요구에 부응하는 의료서비스 및 차별화된 의료서비스 방안을 모색하기 위한 기초 자료로 활용될 수 있을 것이다.

• 한국보건간호학회지
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• 제12권2호
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• pp.221-235
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• 1998

This study is a descriptive survey to explore the health lifestyle of adults. The study subjects are teachers of elementary. middle and high school. and staffs of research institutes located in Chungchung Province and Daejon city. The data was collected from Jan. to march 1997 through self reporte for structured questionnaire. Fantastic check list of Wilson and Ciliska for Health Lifestyle Assessment and DSM-III-R for somatic symptom were used as tools. Data was analysed by frequency, $X^2_test$, t-test and Anova using SAS program. The results are as follows: 1. There were statistically significant differences In drinking(t=7.75, P=.000), exercise(t=-2.99, P=.003)and interpersonal relationship(t=2.22, P=.027) among 10 health lifestyle between smoking group and non-smoking group, in drinking(t=17.98, P=.000), exercise(-4.71. P=.000), and job satisfaction(t=2.22, P=.027) between drinking group and non-drinking group, and in eating habit(t=-2.00, P=.045), drinking (t=4.47, P=000), exercise (t= -16.49, P=000), keeping traffic law(t= -2.68, P=.007), personality (t= -2.05, P=.040) and anxiety/depression(t=-3.47, P=.000) between exercise group and non-exercise group. 2. There was statistically significant difference in cardiovascular symptom(F=4.22, P=.0l) among somatic symptoms of subjects according to exercise level. 3. There was statistically significance difference in lifestyle according to smoking level(F=, 3.33, P=.011), drinking level(F=9.17, P=.0001) and exercise level(F=11.93, P=.000l), and in somatic symptom according to sex(t=-3.93, P=.0001), weight(F=3.83, P=.022), exercise level (F=3.29, P=.03) among general characteristics. 4. There was statistically significant difference between sex in general (t= -3.64, P=.0001), gastrointestinal(t=-2.21, P=.02), musculoskeletal(t=-3.92, P=.001), and total symptom (t= -3.92, P=.0001). 5. There was statistically very highly signigicant difference In weight according to smoking($x^2=25.18,\; P=.001)$ and exercise$(x^2=16.46,\; P=001)$. 6. There was statistically significant difference in frequency between smoking group, drinking group and exercise group$(x^2=24.52,\;P=.001)$. Among a number of habit, smoking, drinking and exercise are important factors of human health to prevent related disease morbidity and death. It is essential for industrial health nurse to committ in this subject considering the influence of those factors and lifestyle on health. There is also a relationship of weight with smoking and exercise, the frequency of overweight/obesiy in smoking/ no-exercise group were high. It is quite necessary for the people having cardiovascular symptom to exercise to lower morbidity and mortality. The industrial health nurse has to keep In mind on this point and consider of time and facilities of fitness of employee. It needs to explore the cause by further research on somatic symptom of women. This research shows that concerning the relationship between smoking, drinking, and exercise, health care provider must take not only management of disease, but health behaviors and lifestyle into consideration.

• 보건행정학회지
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• 제26권2호
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Environmental Engineering Research
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• 제20권2호
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• pp.127-132
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• 2015

Perfluorooctane sulfonate (PFOS) and Perfluorooctanoic acid (PFOA) are persistent environmental pollutants, extremely stable, and possibly adversely affect human health. They are widely used in many industries and consumer goods, including sunscreen products. These substances are stable chemicals made of long carbon chains, having both lipid- and water-repellent qualities. The research objectives are (1) to find the most effective method for the preparation of semi-liquid samples by comparing solid phase extraction (SPE) and centrifugation after Pressurized liquid extraction (PLE), and (2) to determine the contamination levels of PFOS and PFOA in waterproof sunscreen samples. All sunscreen samples were analyzed by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). Sunscreen samples were purchased from domestic and international brands sold in Thailand. Special chemical properties were considered for the selection of samples, e.g., those found in waterproof, sweat resistant, water resistant, and non-stick products. Considering the factors of physical properties, e.g., operation time, chemical consumption, and recovery percentage for selecting methods to develop, the centrifugation method using 2 mL of extracted sample with the conditions of 12,000 rpm and $5^{\circ}C$ for 1 hour after PLE was chosen. The highest concentrations of PFOS and PFOA were detected at 0.0671 ng/g and 21.0644 ng/g, respectively. Even though present concentrations are found at ng/g levels, the daily use of sunscreen products is normally several grams. Therefore, a risk assessment of PFOS and PFOA contamination in sunscreen products is an important concern, and more attention needs to be paid to the long-term effects on human health.

• Journal of Hospice and Palliative Care
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• 제16권1호
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• pp.10-19
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• 2013

목적: 경남지역 암센터와 경남지역 각 보건소와의 말기암환자를 대상으로 시행한 연계 사업을 담당자를 대상으로 한 설문조사를 통해서 평가하고자 하였다. 방법: 2008년 1월 1일부터 2011년 12월 31일까지 경남지역 암센터와 연계 사업 협약을 체결하고, 환자를 등록해서 진행한 보건소 실무자를 대상으로 진행하였다. 총 9개 지역 보건소의 실제 사업에 참여한 경험이 있는 재가암 담당자 20명을 대상으로 설문지를 개발하여 조사를 하였다. 각 문항의 평가는 Likert 5단계 척도를 변형하여 단계마다 -2에서 +2까지 점수를 부여하였고, 각 문항의 총점은 40점이었다. 결과: 2008년 1월부터 2011년 12월까지 73예(72예는 경남지역 암센터, 1예는 보건소에서 등록)가 연계되었다. 서비스에 대한 평가로 환자나 가족들의 심리적 안정에 도움이 된다라는 항목이 23점으로 가장 높았고, 전반적으로 재가암 사업에 도움이 된다는 점이 11점으로 가장 낮게 나왔다. 연계 서비스에 대한 개선 문항으로는 입원 절차의 간소화가 35점, 환자 병원 방문 시 실질적 혜택 제공이 34점으로 높게 나온 반면, 보건소의 인력 강화가 4점으로 가장 낮게 나타났다. 결론: 말기암환자를 대상으로 한 경남 지역 암센터-보건소 재가암 쌍방향 서비스는 몇 가지 한계점을 드러내었다. 보다 나은 연계 서비스를 위해서는 이번 연구를 통해 나타난 여러 점들을 개선하고, 또 지역 실정에 맞는 모델을 개발하는 등의 노력이 필요한 것으로 생각된다.

• 의료법학
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• 제18권2호
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• pp.195-218
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• 2017

요양병원에 대한 진료비의 증가폭이 비정상적으로 늘어나고 있어 건강보험재정에 막대한 부담을 주고 있다. 이는 요양병원 특수성이 급속한 노령화라는 사회적인 현상과 맞물리면서 나타나게 된 현상인데, 이 중 요양병원에 대하여 입원일당 정액수가제에 의하여 비용이 지급되는 점은 일부 요양병원이 환자를 돈벌이 수단으로 이용하는 유인이 되었다. 이러한 요양병원들은 일당정액수가를 지급받고도 그에 합당한 진료비용의 지출을 줄이기 위해 의도적으로 입원 환자를 타병원에서 정기적으로 진찰을 받게 하거나 주요 약제를 처방받게 하는 등 건강보험재정이 이중으로 지출되게 하였다. 이러한 재정누수를 방지하기 위하여 심사평가원은 위와 같은 환자들에 대하여 기존의 환자군을 부정하고 '신체기능저하군'으로 환자군을 조정한 다음 요양급여비용을 삭감하였다. 그렇지만 위결정은 규정상근거가 없음을 이유로 법원으로부터 취소판결을 받았다. 그러나 위 사건을 계기로 요양병원 수가제도의 문제점을 도출하고 제도를 정비하는 기회가 될 수 있다고 생각한다. 현재의 정액수가제를 수정하여 약제비 및 진료자체에 대한 행위별 청구를 일부 도입하면 요양병원의 의료적 기능을 강화할 수 있다고 생각한다. 또, 현재의 환자군 중 비슷한 군들은 통합하고 신체기능저하군은 입원이 부적절하므로 환자군에서 제외하는 것이 타당하다고 보인다. 다만, 사회적 필요에 의해 신체기능저하군을 입원대상으로 인정하게 된다 하더라도 장기요양대상과의 형평성, 건강보험재정의 건전성 등을 고려하여 건강보험대상에서는 제외되어야 한다고 생각한다.

• 의료법학
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• 제13권2호
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• pp.11-38
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• 2012

The Supreme Court stand in the position in specific lawsuit that it doesn't allow the discretionary not covered service, but recently in revocation suit of fine disposal that is imposed on medical fee of leukemia patient, it altered the existing adjudgement and admitted the discretionary not covered service exceptionally. It put forward the allowable condition roughly in that case. According as this alteration, it has become more important to embody the allowance conditions of exceptions. The Supreme Court presented three things, which are procedural condition, medical condition and subscriber's agreement. Concerning procedural condition, several present conciliation procedures are as follows: medical care benefit arret request, relative value conciliation etc, prior request on anti-cancer drug among chemicals which exceed acceptance criteria, request of non benefit object on common drugs. To be granted the existence of those system, there should be no obstacle to use that. Even if it were so, we should take circumstances into consideration; individual situation is unescapable concerning substance and urgency of the discretionary not covered service, process of the procedure, time required etc. Regarding medical condition, safety and effectiveness will be verified through evaluation procedures of new medical skill. About the necessity, the Supreme Court made clear through a sentence that it allow the discretionary not covered service, in case that needs to treat a patient out of the standard of medical benefit. Strict interpretation is right and it answer the purpose of the sentence that the supreme court permit the discretionary not covered service, exceptionally. We need to differentiate medical necessity and medical validity. Subscriber's agreement should holds true if it entails full explanation, and if it is preliminary, explicit and individual. On this account, it should be difficult to admit that someone agree effectively when he call for the affirmation that he is recipient of medical care. Reasonable expense needs to be a part of review whether the agreement is valid. Meanwhile If we adjust system of medical expense and eventually reorganize a fee for consultation payment system (Fee-for-service controlled by item to DRG (Diagnosis Related Groups)), controversial area of the discretionary not covered service will be decreased and that will guarantee the discretion of the doctor.

• 대한간호학회지
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• 제30권5호
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• pp.1156-1169
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• 2000

The study was aimed at developing an independent hospice center model that would be best suited for Korea based on a literature review and the current status of local and international hospices. For the study, five local and six international hospice organizations were surveyed. Components of the hospice center model include philosophy, purpose, resources (workers, facilities, and equipment), allocation of resources, management, financial support and hospice team service. The following is a summary of the developed model: Philosophies for the hospice center were set as follows: based on the dignity of human life and humanism, help patients spend the rest of their days in a meaningful way and accept life positively. On the staff side, to pursue a team-oriented holistic approach to improve comfort and quality of life for terminally ill persons and their families. The hospice center should have 20 beds with single, two, and four bed rooms. The center should employ, either on a part-time or full-time basis, a center director, nurses, doctors, chaplains, social workers, pharmacists, dieticians, therapists, and volunteers. In addition, it will need an administrative staff, facility managers and nurses aides. The hospice should also be equipped with facilities for patients, their families, and team members, furnished with equipment and goods at the same level of a hospital. represented by a center director who reports to a board and an advisory committee. Also, the center director administers a steering committee and five departments, namely, Administration, Nursing Service, Social Welfare, Religious Services, and Medical Service. Furthermore, the center should be able to utilize a direct and support delivery systems. The direct delivery system allows the hospice center to receive requests from, or transfer patients to, hospitals, clinics, other hospice organizations (by type), public health centers, religious organizations, social welfare organizations, patients, and their guardians. On the other hand, the support delivery system provides a link to outside facilities of various medical suppliers. In terms of management, details were made with regards to personnel management, records, infection control, safety, supplies and quality management. For financial support, some form of medical insurance coverage for hospice services, ways to promote a donation system and fund raising were examined. Hospice team service to be provided by the hospice center was categorized into assessment, physical care, emotional care, spiritual care, bereavement service, medication, education and demonstrations, medical supplies rental, request service, volunteer service, and respite service. Based on the results, the study has drawn up the following suggestions: 1. The proposed model for a hospice center as presented in the study needs to be tested with a pilot project. 2. Studies on criteria for legal approval and license for a hospice center need to be conducted to develop policies. 3. Studies on developing a hospice charge system and hospice standards that meet local conditions in Korea need to be conducted.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2781-2789
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• 2012

Assessment of perceptions of the community, the determinants and development of their behavior regarding common malignancies, helps in establishing evidence-based activities for prevention and early diagnosis of cancer. However information on this important aspect is lacking in our country. Qualitative methods were here used to obtain information through in depth interviews and Focus Group Discussions (FGDs) with all categories of identified stakeholders. Most were unaware of the activities of the cancer control program. Even the providers were not fully conversant. All respondents mentioned lack of diagnostic and treatment facilities in government, primary and secondary level facilities. Perceptions of different categories of stakeholders regarding why many community members did not attend screening camps and other services reflect the determinants of community behavior, acting independently as well as in combination. The cancer control program was thought to be restricted only to some private facilities and overcrowded government tertiary care facilities where the visits were time consuming. Almost all the facilities were considered curative oriented. Issues of supervision, monitoring and feedback were inadequately addressed by providers who were inadequately trained in many program activities. The program lacked effective planning, coordination and appropriate implementation at the grass roots level in Delhi. Social mobilization was grossly inadequate, as most of the community members were unaware of the existence of the program. Misconceptions about the risk factors, signs and symptoms, diagnosis, and treatment were common amongst community members as well as many of the providers. Thus the national cancer control program in our country needs further community participation and social mobilization. Accessibility, availability, acceptability and affordability of various preventive, curative and rehabilitative activities, as well as intersectoral coordination, training, supervision and monitoring of program activities, all need to be addressed to ensure the success of this important public health program.

• 노인간호학회지
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• 제20권sup1호
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• pp.119-126
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• 2018

Purpose: The aim of this study was to describe problems and solutions for older adults living alone and using wearable devices to report depressive moods in daily life. In addition, gerontology nurses' competencies and strategies were discussed based on lessons learned from the observational study. Methods: A hybrid method was used, combining literature review and content analyses based on interviews with 53 participants and observations done by the research team. Results: Main issues and relevant strategies were identified in terms of (1) applicability of information and communications technology (ICT) devices for older adults, (2) feasibility of older adults' use of ICT devices, (3) integration of ICT devices into daily life, and (4) relevant issues when older adults use ICT. Important roles and competencies were discussed regarding general and gerontology aspects of ICT. Conclusion: Findings indicate that a wearable device is feasible to measure daily depressive moods in older adults living alone in community settings. To extend our research protocol to practice, gerontology nurses must adequately prepare to meet emerging health care trends and end users' needs for ICT-based nursing. It is necessary to develop diverse educational programs and active involvement in research and design of relevant devices and programs.