• 제목/요약/키워드: Korean medical doctor

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말기암환자의 완화의료에 대한 의사들의 인식과 완화의료 의뢰 시 장애요인 (Doctor's Perception and Referral Barriers toward Palliative Care for Advanced Cancer Patients)

  • 이재리;이정권;황선진;김지은;정지인;김시영
    • Journal of Hospice and Palliative Care
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    • 제15권1호
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    • pp.10-17
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    • 2012
  • 목적: 완화의료를 위해서는 완화의료 대상자에 대한 판단을 하고 완화의료를 직접 시행하거나 완화의료에 자문/의뢰하는 의료인의 역할이 중요하다. 이에 본 연구는 한국의 암환자를 주로 진료하는 의사들의 완화의료에 대한 인식과 완화의료 의뢰 시 장애요인에 대해 알아보았다. 방법: 2010년 5월부터 6월까지 암환자를 주로 진료하는 전문의 477명을 대상으로 무기명 자기 기입식 웹 설문 조사를 수행하였다. 결과: 총 128명(26.8%)이 응답하였고, 설문에 응답한 모든 의사들은 말기암환자에게 완화의료가 필요하다고 생각하는 것으로 조사되었다. 80% 이상의 응답자들이 '3차 의료기관 및 암센터는 완화의료 서비스를 제공해야 한다.', '진행 암환자는 항암 화학요법을 받는 중이더라도 완화의료를 받아야 한다.', '말기암환자의 치료에는 여러 과의 협력이 필요하다.'에 동의하였다. 완화의료 수행능력에 대해서는 58% 이상이 자신이 하고 있는 신체 증상 조절 및 정신증상 조절, 말기암환자 가족의 정서적 지지에 만족한다고 응답하였으나 전반적인 말기암환자 및 임종 환자 관리 서비스는 64%에서 '만족스럽지 않다'고 응답하였다. 응답자 중 34명(26.6%)은 '자신의 말기암환자를 완화의료팀으로 자문'하거나 '의뢰한 경험이 없는 것'으로 나타났고 완화의료 의뢰의 장애 요인으로 '환자나 보호자의 거부'가 61명(47.7%)으로 가장 많았으며 다음으로 '믿고 의뢰할 수 있는 완화의료팀이 없어서'라고 응답한 의사가 59명(46.1%)으로 많았다. 결론: 본 연구에서 대부분의 암환자를 주로 진료하는 의사들은 말기암환자의 완화의료 시행에 대해 긍정적 인식을 가지고 있지만 실제 말기암환자 진료에 있어 다학제 간 협력이나 임종관리까지 충분한 완화의료의 제공은 이뤄지지 않는 것으로 나타났다. 효율적이고 수준 높은 말기암환자의 관리를 위해서 보다 적극적인 완화 의료 자문이나 의뢰가 시행되어야 할 것으로 생각된다.

부분 히스토그램 문턱치 알고리즘을 사용한 조영증강 CT영상의 자동 간 분할 (Automatic Liver Segmentation of a Contrast Enhanced CT Image Using a Partial Histogram Threshold Algorithm)

  • Kyung-Sik Seo;Seung-Jin Park;Jong An Park
    • 대한의용생체공학회:의공학회지
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    • 제25권3호
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    • pp.189-194
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    • 2004
  • 조영 증강된 CT 영상의 화소값은 조영제에 의해 이산적으로 변한다. 또한 간의 중간부분에서는 간과 유사한 농도값을 갖는 췌장 때문에 간의 분할이 어렵다. 본 논문에서는 조영증강된 CT영상의 화소값의 이산적인 변화와 간과 겹치는 췌장을 제거하기 위하여 부분 히스토램 문턱치 알고리즘을 사용한 간 분할법을 제안한다. 히스토그램 변환 후 간 구조의 농도 값의 범위를 찾기 위한 적응 다봉성 분할과 췌장 제거를 위한 부분 히스토그램 문턱치 알고리즘을 수행한다. 다음으로, 간 이외의 불필요한 대상을 제거하고 경계를 매끈하게 하기 위해 모폴러지 필터링을 수행한다. 제안된 방법을 평가하기 위해 8명의 환자로부터 획득된 CT 영상중 중간부분에서 4개씩 총 32단면을 선택하였다. 부분 히스토그램 문턱치 알고리즘을 사용한 자동 분할법 II와 수동 분할법의 정규화된 평균 면적의 평균은 0.1671과 0.1711이었으며, 이 두 방법은 아주 적은 차이를 보인다. 또, 자동 분할법 II와 수동 분할법의 평균 면적 오차율은 6.8339 % 이다. 이 실험 결과로부터 제안된 자동 간분할 법은 의사에 의해 시행된 수동 분할법과 매우 유사한 수행능력을 갖는다.

체질에 따른 침치료가 특발성 파킨슨 환자의 심박변이도에 미치는 영향 (The Comparative Study on the Effect of Constitution-dependent Acupuncture Treatment for Idiopathic Parkinson's Disease on Heart Rate Variability)

  • 김행범;이민호;이소영;남동우;양동훈;최양식;박연철;고형균;이윤호
    • Journal of Acupuncture Research
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    • 제24권3호
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    • pp.163-174
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    • 2007
  • Objectives : This study was designed to evaluate the effect of acupuncture on Heart Rate Variability(HRV) of patients with Parkinson's disease. Methods: Subjects were voluntarily recruited through newspaper and internet advertisement. All the subjects were confirmed as idiopathic Parkinson's disease by a neurologist. Patients were divided into three groups. Experimental group was acupunctured based on Sasang Constitution. Standard group was acupunctured on $LR_3$, $GB_{34}$ and $ST_{36}$. Control group was sham-acupunctured. Acupuncture was applied 2 times a week for four weeks by an oriental medical doctor at Kyung-hee Oriental Medical Hospital. The patients were assessed by HRV before and 4 weeks after the treatment. Results : The results were as follows 1. In experimental group, increase in SDNN, TP, LF, HF Nonn were statistically significant after 4 weeks compared to the pre-treatment. 2. In standard group, increase in SDNN, TP, LF were statistically significant after 4 weeks compared to the pre-treatment. 3. After 4 weeks of treatment SDNN, LF showed statistically significant cufferences among three groups. Conclusions : This study suggests that acupuncture treatment based on Sasang Constitution and other specific acupuncture treatment can be beneficial for patients with idiopathic Parkinson's disease. Further study on various acupuncture treatment for Parkinson's disease is required.

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병원의 직종별 임금수준에 관한 연구 (An analysis of direct financial compensation of hospital personnel in Korea)

  • 홍상진;김한중
    • 보건행정학회지
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    • 제8권1호
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    • pp.15-51
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    • 1998
  • compensation is a major function of human resources management. The hospital industry is characterized by its remarkable labor intensity and human resource input by unit. That is why the hospital industry has a higher level of wage/cost ration. The issues of how much the hospital personnel's direct financial compensation amounts to and how the organizational and other factors generate compensation differentiation, are central problems for research in hospitals. But there have been few approaches to study staff compensation in hospitals, its magnitude and inter-hospital relative compensation amounts for the same personnel. A worker who moves from low-wage to a high-wage employer can usually increase his or her pay without change in job description. This means in the cases of same jobs, relative importance is different for each hospitals. The purpse of this study were to find the compensation levels of hospital personnel and to determine the factors affecting compensation levels of hospital personnel. The unit of analysis is the hospital and 145 hospitals were studied for nurse(RN), medical technoloist(MT), managerial personnel(MP) and 100 hospitals for medical doctor(MD). In this study the definitions of direct financial compensation are before tax, excluding employer's contriution and total annual remuneration received by the employee. Main findings of the research can be summarized as follows. 1. Direct financial compensation of hospital personnel are MD 45,056,000 won, RN 9,222,000 won, MT 9,513,000 won and MP 9,185,000 won in the starting year's employment in hospital. 2. According to determinants of hospital personnel compensations, there are no statistical significant variables to determine the level of MD's compensation. Wlith RN and MT's compensation level, the greater the patient revenue per 100 hospital beds, the higher the RN compensation and the tertiary hospital's compensation is much more than other types of hospitals. The location of hospital is another determinant factor for the MT's compensation level. Hospitals that are in the uban area have lower compensation level than rural area. There are the same results in MP with MT. Conclusions can be drawn from the results of the study. First, the wage differentiation of MD and other health personnel still remains and the differentiation existed in inter and intra job personnel of hospitals. Second, determinants of hospital personnel personnel compensation level are patient revenue, location, and type of hospital level.

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일개 독립형 호스피스 기관의 가정호스피스 이용자 특성 및 서비스 제공 실태 (Home-Based Hospice Care Provided by a Free-Standing Hospice Center: Patients' Characteristics and Service Conditions)

  • 김형숙;전경자;손영순
    • Journal of Hospice and Palliative Care
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    • 제19권2호
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    • pp.145-153
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    • 2016
  • 목적: 본 연구는 독립형 호스피스기관의 가정호스피스 서비스에 등록한 말기환자의 특성과 가정호스피스 서비스 제공 실태를 파악하여 가정호스피스 서비스 모델 개발을 위한 기초자료를 제공하기 위하여 수행되었다. 방법: 일개 독립형 호스피스기관의 가정호스피스에 등록하여 방문서비스를 받고, 2014년 1월 1일부터 2014년 12월 31일 사이에 서비스가 종료된 말기환자의 의무기록지 75개를 후향적으로 분석하였다. 결과: 등록 환자의 54.7%가 자가 의뢰를 통하여 가정 호스피스를 이용하였다. 종료 후 25.3%가 가정에서 임종하였고, 50.7%는 호스피스병동, 22.6%는 대학병원이나 요양병원으로 입원하였다. 등록 당시 97.3%가 암성질환이었으며, 비암성질환으로 가정호스피스를 이용한 경우는 2.7%였다. 등록 환자의 58.7%가 임종기에 있었으며, 34.7%는 거의 완전한 와상 상태에 있어 전반적으로 낮은 활동수준을 보였다. 등록 당시 환자들이 가진 신체 증상은 통증(89.4%), 수면장애(71.2%), 배변문제(47.8%), 배뇨문제(35.8%) 순으로 나타났다. 전체 환자의 77.4%가 1개월 이내에 서비스가 종결되었다. 환자들에 대한 가정방문 횟수는 평균 3.25회로 전체 환자의 82.7%가 5회 미만의 가정방문을 받고 서비스가 종결되었으며, 전화상담 횟수는 평균 3.4회였다. 의사 방문 횟수는 평균 1.21회였으며, 이는 불안정기에 유의하게 증가하였다. 결론: 독립형 호스피스기관을 이용하는 환자의 특성과 서비스 제공 형태를 반영한 가정호스피스 서비스 모델 개발이 필요하다.

방사선사(放射線士)의 동무(勤務) 실태(實態)에 관한 조사연구(調査硏究) (Survey on Working Condition of Radiological Technologists)

  • 최종학;전만진;박영선
    • 대한방사선기술학회지:방사선기술과학
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    • 제9권1호
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    • pp.51-63
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    • 1986
  • We got the following results from the 324 radiologic technologists as we surveyed their working condition by using the questionaire, who were working in the medical institutions (general hospitals and doctor's clinics) situated in the area of Seoul city, Kyung ki-do and Chung-chong-do since June to December 1985. 1. Their daily average working time was almost within 10 hours (in 93.9% of general hospitals, 66.1% of clinics). 2. About the numbers of holidays, 85.5% of general hospitals have one holiday per week,41.3% of clinics have one holiday per week or 38.5% of clinics have one holiday per two weeks. 3. Duty appointment of radiologic technologists in the department of radiology is taking charge of each part after serving for a certain part for some period (42.8%), taking charge of the special part continually or by turns in other working parts (35.3%). On the other hand in the clinics they took charge of all parts continually (53.2%) or by turns with their own situations. (30.3%). 4. Their daily working amount is too much in 51.6% of general hospitals or 45.8% of clinics. 5. They answered it was hard in 81.4% of general hospitals or 43.1% of clinics about the degree of difficulty of their work. 6. Their monthly salary is higher in the clinics than in the general hospitals and higher in Seoul area than in Kyung-ki or Chung-chong area. 7. Their yearly bonus .ate is 400%-600% (69.2%) in almost general hospitals, 100%-300% (57.8%) in th. clinics. 8. Danger allowance is paid with the monthly salary in 62.8% of the general hospitals or 19.2% of clinics and license allowance is paid in 44.7% of general hospitals or in 12.8% of clinics. 9. Their initial salary (except bonus) is about 200,000 won (in 76.8% of general hospitals, in 67.8% of clinics). 10. Their salary is raised regulary every year in 52.6% of general hospitals, but it is irregulary in 73.4% of clinics. 11. Promotion system is managed in 48.4% of the general hospitals or in 14.7% of clinics. 12. Retirement allowance is assured in 96.9% of the general hospitals or in 63.3% of clinics. 13. Main cause of their retirement is moving to more paid hospitals, better hospitals in working condition or facilities, moving to another cities, to the hospitals with more opportunities of promotion or choosing other jobs etc. 14. Human relationship with doctors, nurses or co-worker technologists as a member of medical team appeared almost intimate and good.

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동추금침(東樞金鍼)에 의한 비침습적 백회혈(百會穴) 자극이 뇌파에 미치는 영향 (The Effect of Non-ivasive Baihui($GV_{20}$) Point Stimulus by 'Dong Chu Gold Chim' on Electroencephalogram)

  • 마정훈;한창현;박수진;최우석;이상남;박지하
    • Journal of Acupuncture Research
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    • 제27권1호
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    • pp.87-100
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    • 2010
  • Background : Recently a discussion about Qi including a study about the effect or the theory of acupuncture is getting prevailing in various angles. In most of studies about acupuncture stimulus, 'Filiform acupuncture'(毫鍼) is used. A study about Nine kinds of acupuncture(九鍼), except 'Filiform acupuncture'(毫鍼) has not been reported yet, and there is no study about using a special acupuncture made for controling Qi either. Objectives : 'Dong Chu Gold Chim(DCG-chim, 東樞金鍼)' can be used for patients who are scared of a pain because it is a medical Qi-gong tool and non-invasive stimulus one. To assess a effect of Qi-gong operation using DCG-chim objectively Methods : The present study was performed to elucidate the effects of DCG-chim stimulation of an acupuncture point Baihui($GV_{20}$) on the Electroencephalogram(EEG). Twenty healthy subject were treated with DCG-chim one time accompanied by the light and vertical pressure and EEG were measured during five minutes for three times (before, during and after treatment). The EEG results of DCG-chim treatment were compared with those of 'Filiform acupuncture(毫鍼)'. Results : EEG power spectra changed significantly after both kind of acupuncture stimulation. Significant increase of $\alpha$ wave and decrease of $\beta$ wave were observed but interestingly, Mid-$\beta$ and SMR of $\beta$ wave which mean the state of concentration were increased with statistically significant. According to these results, DCG-chim stimulation of Baihui($GV_{20}$) seems to lead to relaxation with antianxietic effect and improvement of concentration at the same time. Conclusions : It would be expected that the doctor can apply DCG-chim for treating anxiety, tension, symptom caused by stress and also can use it clinically for patients who have needlphopia or children as a non-invasive procedure. It is suggested that additional studies about the effect of DCG-chim on other acupuncture points and comparison study about the effect of DCG-chim with those of the finger-pressure treatment using other tool should be done in the future.

실태조사를 통한 장기요양시설과 요양병원의 효율적 연계방안 (Study on the Efficient Integration of Long-term Care Facilities and Geriatric Hospitals by Using NHIC Survey Data)

  • 최인덕;이은미
    • 한국노년학
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    • 제30권3호
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    • pp.855-869
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    • 2010
  • 본 연구는 노인장기요양보험 도입이후 장기요양시설과 요양병원의 효율적 연계방안을 모색하기 위한 기초조사 연구이다. 본 연구는 문헌고찰을 기반으로 국민건강보험공단 노인장기요양운영센터를 이용 장기요양시설 192곳과 요양병원 168곳 시설관계자(시설장, 병원장 및 이용자 등)에게 운영현황과 효율적 연계방안에 대해 면접조사를 실시 분석하였다. 자료분석은 기술통계, χ2검증 등을 SPSS 13.0으로 분석하였다. 연구결과 운영현황에서는 요양시설과 요양병원 모두 본인부담의 차이가 미미하나 식대에 대한 편차가 크게 나타났다. 경영수지적자에 대해서는 양 기관 모두 수가보전에 문제점을 지적하고 있으며, 교통과 환경요인이 입지조건을 좌우하는 것으로 파악되었다. 둘째 이용행태면에서는 양 기관 모두 비용할인 경험이 높은 것으로 나타났고, 면회를 오지 않는 경우가 많은 것으로 파악되었다. 반면, 요양시설이 사망 시까지 있는 경우가 요양병원에 비해 더 높게 나타나고 있다. 셋째, 기관의 서비스제공문제점으로는 일률적인 서비스제공, 가족의 지지나 방문 부족 등을 들 수 있다. 끝으로 양 기관의 효율적 연계방안으로는 수가현실화, 간병비 지급, 복합시설 허용, 판정기준 강화, 주치의, 요양병원의 장기요양보험 관리 방안 등을 제시하였다.

암환자 인식에 관한 연구 - 간호사ㆍ의사를 중심으로

  • 조인향
    • 호스피스학술지
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    • 제2권1호
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    • pp.58-74
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    • 2002
  • This paper constitutes a descriptive investigation and used a structured questionnaire to investigate nurses' and doctors' recognition of cancer patients. The subjects were extracted from the medical personnel working at the internal medicine, the surgery ward, the obstetrics and gynecology department, the pediatrics department, the cancer ward, and the emergency room of five general hospitals located in Seoul and Gyeonggi Province. The research lasted from August, 2001 to September 2001. Total 137 nurses and 65 doctors were included and made out the questionnaires directly distributed by the investigator. The study tool was also developed by the investigator and consisted of such items as the demographic and social characteristics, the medical personnel's recognition degree of cancer and cancer patients, their recognition of the management of cancer patients, and their participation in a hospice. The results were analyzed using the SPSS Window program in terms of technological statistics, ranks, t-test, and ANOVA. The reliability was represented in Cronbach' α=.75. The nurses' and doctors' recognition degree of cancer and cancer patients had an overall average of 3.86 at the 5 point-scale. The items that received an average of 4.0 or more included 'Medical personnel should explain about the cancer cure plans to the cancer patient and his or her family', 'A patient whose case has been diagnosed as a terminal cancer should be notified of it, 'If I were a cancer patient, I would want to get informed of it,' and 'Cancer shall be conquered whenever it is'. In the meantime, the items that received an average of 3.0 or less was 'My relationship with the cancer patient's family has gotten worse since I announced his or her impending death.' And according to the general characteristics and the difference test, the recognition degree of cancer and cancer patient was high among the subgroups of nurses, females, married persons, who were in their 30s, who had a family member that was a cancer patient, and who received a hospice education. The biggest number of the nurses and doctors saw 'a gradual approach over several days'(68.8%) as a method to tell a cancer patient about his or her cancer diagnosis or impending death. Those who usually tell tragic news were the physician in charge(62.8%), the family members or relatives(32.1%) and the clergymen(3.8%) in the order. The greatest number of them recommended a cancer patient's home as the place where he or she should face death because they thought 'it would stabilize his or her mentality'(91.9%) while a number of them recommended the hospital because they 'should give the psychological satisfaction to the patient'(40%) or 'should try their best until the last moment of the patient's death'(30%). A majority of the medical personnel regarded 'smoking or drinking' and 'diet' as the causes of cancer. The biggest symptom of a cancer patient was 'pain' and the pain management of a cancer patient was mostly impeded by the 'excessive fear of drug addiction, tolerance to drugs and side effects of drugs' by medical personnel, the patient, and his or her family. The most frequently adopted treatment plan of a terminal cancer patient was 'to do whatever the patient or his or her family wants' to resort to a hospice' and 'to continue active treatment efforts' in the order. The biggest reasons why a terminal cancer patient went to see a doctor were 'pain alleviation' 'control of symptoms other than pain(intravenous supply)' and 'incapability of the patient's family' in the order. Terminal cancer patients placed their major concern in 'spiritual(religious) matter' 'emotional matters' their family' 'existence' and 'physical matters' in the order. 113(58.5%) of the whole medical personnel answered they 'would recommend' an alternative treatment to a terminal cancer patient mostly because they assumed it would 'stabilize the patient's mentality.' Meanwhile, 80(41.5%) of them chose 'not to recommend it mostly due to the unverified effects and high cost of it(78.7%). A majority of them, I. e. 190(94.1%) subjects said they 'would recommend' a hospice to a terminal cancer patient mostly because they thought it would help the patient to 'mentally prepare'(66.6%) Only 17.3% of them, however, had received a hospice education, most of which was done through the hospital duty education(41.4%) and volunteer training(34.5%). The follows are results of this study: 1. The nurses and the doctors turned out to be still passive and experience confusion in dealing with a cancer patient despite their great sense of responsibility for him or her. 2.Nurses and Doctors realize the need of a hospice, but an extremely small number of them participate in a hospice education or performance. Thus, a whole recognition of a hospice should be changed, for which purpose a hospice education for nurses and doctors should be provided. 3.Terminal cancer patients preferred their home to a hospital as the place to face their impending death because they felt it would bring 'mental stability.' And most of nurses and doctors think it would be unnecessary for them to be hospitalized just for control of their symptoms. Accordingly a terminal cancer patient can be cared at home, and a home hospice care needs to be activated.

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보건지소 공중보건의사의 지역보건사업 참여 실태 (A Study on Public Health Doctors' Participation in District Public Health Program of Health Sub-centers in Korea)

  • 이재천;박용문;안성복;이해영;황진원
    • 농촌의학ㆍ지역보건
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    • 제28권1호
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    • pp.53-66
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    • 2003
  • 본 연구는 2002년 2월 한 달 동안 전국 보건지소에 근무하는 공중보건의사 1,036명을 대상으로, 보건지소의 전반적인 의료서비스 제공여건과 지역사회를 기반으로 이루어지고 있는 보건사업의 수행 현황을 조사하고, 보건사업의 기획, 수행, 평가의 각 단계별 참여 현황과 지역보건사업에 대한 견해 및 관련특성 등을 파악하고자 하였다. 보건지소의 전반적인 의료여건으로는 근무하는 의사수가 1명 내지 2명인 경우가 98.7%였고, 의사 이외의 직원수는 3명 이내인 경우가 89.7%였다. 보건지소 관할 구역인 읍 면단위에서 보건지소 이외에 다른 의료기관이 있는 경우가 45.9%였고, 이 경우 해당 의료기관까지의 소요시간은 도보로 평균 5분정도였다. 보건지소의 33.5%가 의약분업제도 시행지역에 위치하고 있었고, 보건지소 이외에 타 의료기관이 있는 지역 중 의약분업을 시행하는 곳은 68.8%였다. 평균 1일 진료건수는 2000년 5월 18.0${\pm}$15.6건에서 2001년 11월 14.8${\pm}$14.8건으로 점차 감소하는 추세였으며, 특히 의약분업 실시 지역인 경우 감소정도가 크게 나타났다. 보건지소에서 이루어지고 있는 보건사업은 예방접종사업이 96.7%로 가장 높았고 보건교육이 76.5%로 가장 낮았으며, 각 사업의 기획 및 평가단계에 관여하는 경우는 예방접종사업과 방문보건사업이 각각 49.5%, 49.1%로 높게 나타난 반면 전혀 관여하고 있지 않은 경우가 29.6%였다. 보건사업의 세부 항목별 참여에서는 예방접종예진, 방문보건사업대상자 방문, 근무지역내 학교 수 인지도가 각각 94.2%, 81.5%, 75.5%로 높게 나타났으며, 보건사업의 기획, 수행, 평가의 각 단계별 참여는 평균적으로 수행 단계가 61.8%로 높게 나타났고, 기획 단계가 34.8%, 평가 단계가 22.6%로 나타났다. 보건지소에서 이루어지는 지역보건사업이 주민 보건향상에 긍정적인 효과를 나타낼 것이라고 보는 견해가 55.8%, 지역보건향상에 공중보건의사의 역할을 긍정적으로 보는 경우가 37.6%, 지역보건사업에 참여 의사가 있는 경우가 58.7%로 나타났다. 현재 농어촌 지역에서 보건지소의 단순진료실적이 감소하고 있는 상황인 반면 보건지소의 지역보건사업 중추기관으로서의 요구가 증가되고 있다. 주로 진료 위주의 역할에 국한되었던 공중보건의사를 보건사업 인력으로 활용하여 지역보건사업 인력 확충 및 전문화 등 지역보건사업의 양적 질적 향상을 도모할 수 있을 것이다. 아울러 공중보건의사에 대한 지속적인 보건사업 관련 교육 및 보건사업 참여에 대한 동기부여를 통해 지역보건사업의 수행단계에 수동적으로 참여하는 단계에서 기획 및 평가 단계에까지 능동적으로 참여하게끔 유도하는 정책적인 지원이 필요할 것으로 사료된다.

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