• Journal of Preventive Medicine and Public Health
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• 제57권3호
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• pp.298-303
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• 2024

Objectives: The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities. Methods: Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis. Results: In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions. Conclusions: In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.4895-4900
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• 2015

Physician recommendation is an important predictor of HPV vaccine acceptance; however, physician willingness and preferences regarding HPV vaccination may be influenced by factors including patient age, vaccine type, and cost. A cross-sectional survey was administered to a convenience sample of health care providers in Da Nang, Vietnam, to evaluate awareness, perceptions about HPV and HPV vaccines, and willingness to vaccinate a female patient. Willingness to vaccinate was evaluated using a full-factorial presentation of scenarios featuring the following factors: vaccine cost (free vs 1,000,000 VND), patient age (12, 16, or 22 years), and HPV vaccine type (bivalent vs quadrivalent). Responses from 244 providers were analyzed; providers had a mean age of $34{\pm}11.9$ years; a majority were female, married, and had children of their own. Thirty-six percent specialized in obstetrics/gynecology and 24% were providers in family medicine. Of the three factors considered in conjoint analysis, vaccine cost was the most important factor in willingness to vaccinate, followed by patient age, and vaccine type. The most favorable scenario for vaccinating a female patient was when the vaccine was free, the patient was 22 years of age, and the HPV4 vaccine was described. In multivariable analysis, older age, being a physician, being married, and having children were all associated with increased willingness to recommend HPV vaccination (p<0.05). Provider willingness is an important aspect of successful HPV vaccination programs; identifying preferences and biases in recommendation patterns will highlight potential areas for education and intervention.

• 한국병원경영학회지
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• 제23권1호
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• pp.78-86
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• 2018

Purposes: This study identifies local Chinese consumers' standard for selecting medical care provider and their standard for choosing medical staff, as well as their expectations and concerns regarding Korean medical care providers. Methodology: A survey was conducted in China, to identify Chinese medical care consumers' standards for selecting a medical provider and the factors that influence their use of general hospitals. A total of 1,500 people across three cities, between the ages 18 and 60 participated in the survey. Moreover, a multiple logistic regression analysis was used to analyze the factors that affect Chinese medical care consumers' use of general hospitals. Findings: A total of 75.5 percent respondents chose general hospitals as their most frequently-used medical provider. Those who have health insurance, visit general hospitals as outpatients or are hospitalized more frequently than those who do not have a health insurance. Furthermore, those who have private insurance visit general hospitals as outpatients or are hospitalized more frequently than those who are not signed up for private insurance. Major standards for selecting a hospital included: the doctor's skills, word-of-mouth regarding the hospital, and distance to the hospital from the respondents' home. Standards for choosing medical personnel included word-of-mouth regarding the medical team, recommendations from family members or acquaintances, and medical team's notoriety. Friends and neighbors, family members, television and other media outlets were the channels for acquiring information on a hospital. It was found that Chinese people mostly visit the cardiovascular department of Korean hospitals for treatment. For using Korean hospitals in China, the majority of respondents answered that they were concerned about the cost. Practical Implications: Backed by highly skilled medical experts and cutting-edge technology, Korean medical care providers are attempting to enter China's medical care market. To succeed in China's medical care market, it is vital to conduct a clear and precise analysis.

• Journal of Preventive Medicine and Public Health
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• 제40권1호
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• pp.51-58
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• 2007

Objectives : The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. Methods : We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. Results : The average continuity of care in the entire population of 1,498,327 patients was $0.89{\pm}0.17$ as calculated by MFPC and $0.92{\pm}0.16$ by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. Conclusions : The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.42-50
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• 2023

Purpose: The purpose of this study was to identify barriers to effective conversations about advance care planning (ACP) and palliative care reported by health care and community-based service providers in Massachusetts, USA. Methods: This qualitative research analyzed open-ended responses to two survey questions, inquiring about perceived barriers to having conversations about ACP and palliative care with patients and consumers. Data were collected between November 2017 and June 2019 from nine organizations in Massachusetts, including health care provider organizations, health insurers, community-based organizations, and a nursing education institution. Two researchers reviewed and coded the responses and identified common themes inductively. Results: Across 142 responses, primary barriers to ACP included hesitation and lack of understanding and knowledge, discomfort and resistance among service providers, lack of staff knowledge, difficulties with followup, and differences in ACP policies across regions. Common barriers to palliative care were misconceptions about palliative care and lack of knowledge, service providers' lack of preparedness, and limited policy support and availability. Challenges relevant to both ACP and palliative care were fear and discomfort around serious illness discussions, lack of knowledge and awareness, discussions that occur too late, and cultural and language barriers. Conclusion: Health care practitioners and community-based professionals reported consumer-, service provider-, and system-level barriers to facilitating conversations about ACP and palliative care with patients experiencing serious illness. There is a need for more tools and support to strengthen service providers' ACP and palliative care competencies and to promote a structured approach to health care planning conversations.

• 보건행정학회지
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• 제20권2호
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• pp.40-52
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• 2010

Health insurance fees are set by relative value scales and conversion factors. Since 2008 the conversion factor has been classified into 7 according to the provider type, and a separate contract has been made respectively. As such classification of the conversion factor reflects only the different characteristics of providers, however, further classification to reflect the different cost structures of providers is proposed. Cost varies according to the type of not only providers but also services each provider supply. In fact different cost structures of providers are the result of their different services. This study analyzed the cost structure of medical services to propose a new approach to the classification of the conversion factor. This study analyzed the cost structure of medical services using cost data constructed in the revision study of relative value scales. The cost data consist of doctor's fee, support staff's fee, cost of medical equipments, cost of medical supplies and indirect cost. The proportion of each cost component to the total cost was analyzed in terms of service department and service type. 72 service groups are defined in terms of the combination of service department and service type. Through cluster analysis, 72 service groups were reduced into 7 clusters each of which has a similar cost structure. Conversion factor is contracted annually to reflect the change in the cost of providing medical services. So the classification of conversion factor has to be based on the cost structures of medical services, not the characteristics of providers. Service clusters derived in this study can be used as a new classification for health insurance fee contract.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1565-1570
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• 2015

Background: In Aotearoa/New Zealand cervical screening programmes have reduced cervical cancer; however, half of cervical cancer cases among Pacific women are found among clients who had not attended cervical screening. Hence, we set out to determine health provider perspectives on barriers that prevent their services reaching Pacific women within Aotearoa/New Zealand. Materials and Methods: Twenty semi-structured interviews were conducted with health care providers, Pap smear takers and community workers in the Wellington region. Participants were asked their views on factors that enabled and/or constrained the participation of Pacific women in their cervical screening services. Results: Six interrelated themes influencing participation in cervical screening among Pacific women in the Wellington region were apparent: the funding and practice of service delivery; family always coming first; the cost of screening services; type of employment; the appropriateness of information; and attitudes to self and screening. Conclusions: Determining specific ethnic group actual health needs and meeting them contributes to overall improvement in New Zealand's health status. The results identified the need for improvements to the delivery of screening services including adapting cervical screening services to the requirements of Pacific women through more outreach services at alternate clinic hours; culturally appropriate practitioners; the ability to take up opportunities for health checks and foster long-term relationships; as well as appropriate monitoring and evaluation of approaches. Funding and reporting relationships also need to be compatible with the goal of improving outcomes for Pacific women. Further research into client voices for their particular needs to compliment the service provider perspective as well as minority groups is called for.

• 보건행정학회지
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• 제19권1호
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• pp.1-30
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• 2009

Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.

• 한국컴퓨터정보학회논문지
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• 제16권3호
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• pp.9-15
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• 2011

u-healthcare 시스템은 센서 네트워크로부터 수집된 대량의 생체신호를 신속히 처리 분석하여 의료진에게 전달함으로써 시간과 장소에 관계없이 환자에게 적절한 의료 서비스를 제공할 수 있다. 현존하는 u-healthcare 시스템들은 단지 환자의 건강 상태만을 모니터링 한다. 본 논문에서는 무선 센서네트워크에 기반한 u-health 모니터링의 프로토타입을 구현하고 검증하였다. 이 시스템은 수집된 생체 신호를 신속히 분석하여 의학적으로 의미 있는 결과를 도출하는 것이 용이하다. 이 모니터링 시스템은 피검자의 이상 데이터 수집 시에만 서비스 제공자에게 데이터를 전송한다. 이러한 방법은 모니터링부와 서비스 제공자사이의 무선 데이터 패킷의 부하를 줄일 수 있다. 실시간 생체 신호 모니터링 시스템을 구현함으로 유-헬스 서비스가 가능하게 되고 의료서비스의 효율성을 향상시킨다.

• 한국치위생학회지
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• 제14권5호
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• pp.703-713
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• 2014

Objectives : The purpose of this study is to investigate the knowledge and attitude toward cardiopulmonary resuscitation(CPR) in some dental hygienists. Methods : A self-reported questionnaire was filled out by 207 dental hygienists in Gwangju from February to March, 2014. The questionnaire consisted of knowledge and attitude toward CPR dental hygienists. The data were analyzed using IBM SPSS 19.0 program for chi-square test, independent t-test, one-way ANOVA and multiple regression analysis. Results : Dental hygienists having basic life support(BLS) provider accounted for 16.9%. CPR knowledge was 8.40 and attitude was 3.59 points. There were positive correlations between CPR knowledge and attitude including education, performance, and confidence(r=.231, r=.207, r=.377). In the regression analysis, attitude toward CPR confidence were positively associated with BLS provider certificate within two years. Conclusions : Dental hygienists had low level of knowledge and confidence toward CPR. It is important to educate BLS provider course to the dental hygienists.