• Korean Journal of Health Education and Promotion
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• v.30 no.5
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• pp.79-90
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• 2013

Objectives: This study is based on Public Care Service for Chronic Diseases in Incheon Metropolitan City featuring Health-Point Service. It is objective to evaluate whether the service could improve self-management ability of hypertension and diabetes patients. Methods: The knowledge about diabetes and hypertension, which can be improved by educational intervention, is considered as one of the most important factor for self-management ability. While the education service have been conducted, 194 patients who have been diagnosed as hypertension and diabetes within 3 months were included. They completed questionnaires two times within 4 months period, which give information about the knowledge, service registration and education experiences. For further inspection, 396 patients who had been diagnosed formerly were studied by cross-sectional analysis. Results: Regardless of service registration or educational intervention, there wasn't statistically meaningful difference between the initial and the follow-up assessments on the knowledge. However, when investigating formerly diagnosed patients, educated patients had better knowledge on hypertension compared with non-educated patients and registered patients, educated patients had the better knowledge on diabetes compared with non-registered patients, non-educated patients. Additionally, analyzing each questions, educated patients got higher grades in questions about definition of hypertension, diabetes managements which they can practice in daily lives. Conclusions: It is probable that long-term service registration and education experiences could improve the knowledge and self-management ability.

• Health Policy and Management
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• v.22 no.2
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• pp.263-274
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• 2012

This study describes the hypertensive patients characteristics associated with the health incentive point program, and develops and analyzes a simple predictive model of participation in the program. Based on the Incheon Chronic Disease Management System(iCDMS), a model program of community partnership for hypertensive or diabetic patients detection and follow-up since 2005 in Incheon metropolitan city, a cross-sectional design was used in this study. An effective 10.844 adults sample was divided into groups according to participation in the health incentive point program and continuing treatment, and individual and health characteristics among groups were compared. Furthermore, the predictors associated with participation in the program were identified by the logistic regression analysis. After the health incentive point program in iCDMS was introduced, the number of hypertensive patients participation in the program increased 23.9 times which is vastly high given the various programs were provided. There were statistically significant differences among the groups: age(p=0.000), treatment compliance(p=0.000), and blood pressure control at the last measurement(p=0.000), in particular, between participation group(GroupI, n=246) and non-participation group(GroupIII, n=10,408). Furthermore, age over 60 years(OR: 0.33), treatment compliance(OR: 3.49~3.78) and blood pressure controls(OR: 2.13~2.30) were statistically significant predictors associated with participation in the program, based on the logistic regression analysis with GroupI and GroupIII. To increase participation in the health incentive point program, variables such as age, treatment compliance and blood pressure controls are more concerned. And, high-risk patients and family members need targeted health incentive programs.

• Health Policy and Management
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• v.23 no.4
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• pp.427-433
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• 2013

Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.9
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• pp.4388-4393
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• 2013

This study described hypertensive patients characteristics associated with a health incentive program, and analyzed the effects of the health incentive program on blood pressure control. Based on the Incheon Chronic Disease Management System (iCDMS), a community partnership program for hypertensive patients, a cross-sectional design was used. There were statistically significant differences between the control group (n=17,278) and the experimental group (n=5,020) in gender, age, points earned, and number of hospital visits. Furthermore, being male, being over 60 years of age, and points earned were statistically significant factors associated with blood pressure control. To increase the effectiveness of chronic diseases management systems, various health incentive programs will be developed and introduced.

• Korean Circulation Journal
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• v.53 no.7
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.