• 지역사회간호학회지
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• 제19권2호
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• pp.157-166
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• 2008

This study was conducted with whole home care nurses nationwide to provide secondary analyzed data to understand on their usage of medical equipments and their need of them for a month. This study found that treatments given by home care nurses were nelaton catheterization, bladder washing/urethral washing, newborn care, exchange and care for nasogastric tube and suction in that order of frequency. Second, instruments and equipments used for home care were reported to be stethoscope, patient monitor, blood pressure measuring equipment, air flotation mattresses, beds for patients, mattresses, suctioning device sets, enteral feeding equipment and dressing set in that oder of frequency. Moreover, need assessment of medical instruments and equipments showed renal dialysis was most needed and patient monitor, blood pressure measuring equipment, enteral feeding equipment, solution and other supplies for renal dialysis and beds for patient were necessary in that order. In conclusion, the results of this study investigating special treatments and medical instruments and equipments used for home care patients and analyzing patients' need, were expected to be useful for expansion of application of long-term care insurance for the elderly and health insurance as well as for quality control of home care and development of medial instruments and equipments used at home.

• 한국엔터테인먼트산업학회논문지
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• 제15권8호
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• pp.423-432
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• 2021

본 연구에서는 노인의 라이프케어 및 삶의 질향상을 위해 도입되어 시행되고 있는 통합돌봄사업의 미래 가치성 확대와 방향성 제시를 위하여 현황과 문제점들을 알아보고 이를 통해 다음과 같은 연구적 결론을 제시하였다. 첫째, 서비스 수혜 노인의 욕구분석은 조사자 중심이 아닌 환자 중심으로 구성하며, 특히 의료진의 진료방문을 통한 의학적관리 부분이 강화되어야 하며, 성별과 연령, 장애유형과 개인적 욕구취향에 따른 특화된 서비스 항목 부분이 점진적으로 강화되어야 할 것이다. 둘째, 서비스 항목에 대한 만족도 및 중복성 그리고 효과성 등을 분석하여 예산을 절감하며 수요자 중심의 서비스 항목구성과 신규 서비스 필요 항목 적용 등을 고려해 나간다. 셋째, 통합 스케줄관리시스템 도입을 통하여 서비스 제공 직역단체와 수혜자 간의 사전예약 및 방문 스케줄 관리의 전문화가 필요하다. 넷째, 재원 문제해결을 위한 노력으로, 보건의료 재정과 장기요양보험제도 그리고 사회복지재정사업 등과 합리적 재원공유 제도마련이 필요하며, 서비스 관련 산업분야와의 재원의 연계나 순환, 지방 공공의대 출신 인력투입 방안을 고려할 수 있다. 이상의 제안을 통해 통합돌봄사업은 보편적 노인 케어시스템으로의 완성과 미래 가치를 지닐 수 있게 될 것이다.

• 한국지역사회생활과학회지
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• 제18권3호
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• pp.369-378
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• 2007

This study purposed to examine elderly welfare facilities by type, to analyze their local variations, and ultimately to contribute to the expansion of elderly welfare infrastructure. The results are expected to help inspect elderly welfare infrastructure for providing the aged with social services before the execution of 'the insurance for elderly long term care' and establish welfare facilities by area in the future. For these purposes, we used the national data "The Current State of Elderly Welfare Facilities in 2007" produced by the Ministry of Health and Welfare. We digitized elderly welfare facilities in 163 cities and counties by type and analyzed them by area. We also examined the differences in the local distribution of representative elderly welfare facilities such as elderly welfare centers, home based facilities (home helper centers), asylums for the aged and elderly care facilities in 16 cities and provinces. Furthermore, we analyzed differences and problems in their local distribution urban areas, mixed areas of urban and rural communities, and rural areas. In addition, we studied the current state of institutionalized care and home based care, which are two major directions of current elderly welfare policies, based on the local distribution of facilities and analyzed differences in the trends according to area. According to these results, the urban had more home based care facilities than the rural. However, the rural had more institutionalized care facilities than urban. Also, each local self-governing body showed unique characteristics. Therefore, these results suggest that we need to establish elderly welfare policies based on the distribution of facility types by area.

• 한국보건간호학회지
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• 제6권2호
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• pp.70-107
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• 1992

This study was intended to assess the need of home nursing care and analyze the effect of home nursing care, and find out the problems during the performance of home nursing care for the chronic patients among the low-income people in urban area. Data collection by interview was carried out from Nov. 1991 to Jul. 1992. The main results were as follows; 1) Total subjects for the need assessment of home nursing care were 123 households wi th 488 persons in a urban poor area. Over half of households $(57.7\%)$ was teenage family. The overall living conditions were poor and the average monthly income was 580 thousands won. $74.8\%$ of subjects was covered by medical care insurance and only $4.7\%$ was covered by public assistance. The morbidity rate was $8.2\%$ among 488 subjects and $27.5\%$ of them was not treated at all, $30\%$ was treated in utilizing pharmacies or local clinics. 2) The subjects of home nursing care were 46 with Hypertension or DM who agreeded the participation of study among registered patients at a public health center in Incheon. Home visiting was performed at intervals per one month for one year. Most of them were the elder(mean age=61 years) and long term patients(7.8 years continued). Home nursing care was effective. That is, blood pressure(including systolic and diastolic pressure) was significantly reduced (t(n=22)=2.31, P=.031, t(n=24)=4.16, P=.000 respectively) and knowledge of disease(t(N=46)=-7.63, P=.000), attitude of disease (t(N =46) = -4.92, P=.000), and self-care(t(N =46) = -4.89, P= .000) were significantly improved through home nursing care. But there was no difference in blood sugar for diabetics between the beginning and the end of visits. At the beginning of visit for home nursing care, sex$(\beta=-0414,\;t=-3.012)$ and nursing need({3=.310, t=2.164) were influencing self-care, and duration of disease$(\beta=.297,\;t=2.106)$ and nursing need $(\beta=.385, t=20417)$ were influencing blood pressure, blood sugar level. Namely, the subjects who were male and had higher nursing need showed better self-care and the longer duration of disease and the higher nursing need were relationship with the better blood pressure and blood sugar level. At the end of visit for home nursing care after one year, the blood pressure and blood sugar level was influenced by age $(\beta.320,\;t= 2.242)$, duration of disease ($(\beta.352,\;t= 2.395)$ and nursing need $(\beta=.350,\;t=2.623)$ and self-care had no influencing factor. The higher age and the longer duration of disease and the higher nursing need were relationship with the better blood pressure and blood sugar level. 3) The problems that were found out during the performance of home nursing care were the absent of useful protocols for services and the clear evaluation base, and the difficulty of teaching elders who were the major part of our subjects.

• 농촌의학ㆍ지역보건
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• 제16권2호
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• pp.97-119
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• 1991

본 연구는 농촌지역의 보건의료수준이 의료자원의 양적, 질적 격차와 의료이용과 의료접근도 및 건강수준의 면 등에서 도시지역보다 낙후되어 있다는 사실을 각종 통계지표를 이용하여 논증하였다. 다음으로 이러한 격차를 빚은 농촌보건사업의 문제점을 파악하여 이에 대한 대처방안을 농촌보건사업의 조직, 인력, 시설 및 장비, 재원 및 그리고 관리라는 5가지 부문으로 나누어서 모색해 보았는데 구체적으로는 첫째, 농촌보건 인력의 자질향상과 적정배치방안의 수립, 둘째, 농촌보건인력의 생산성 증대, 셋째, 보건소 및 지소의 운영개선, 넷째, 취약지 민간병원의 운영 개선, 다섯째, 사회, 경제여건의 변화에 따른 새로운 보건사업의 개발, 여섯째, 통합적인 보건의료인력관리 전담기관의 설립 등의 정책대안을 제시하고 있다.

• Asian Journal for Public Opinion Research
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• 제5권3호
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• pp.228-249
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• 2018

In 2015, the population of elderly people in Thailand was 16% of the total population and is predicted to be over 20% by 2021 and nearly 28% by 2031. The increase of the elderly population in Thailand has also increased the proportion of dependent elderly people, and caring for them poses many challenges for both families and the government. This descriptive method research aimed to survey the health status of dependent older people in the rural community of Lampang province in northern Thailand. The participants consisted of 62 older people and 62 primary family caregivers from Hong Ha Health Promoting Hospital, Lampang, Thailand (totaling 124 people). The researchers assessed the health status of older people and their activities of daily living (ADL). In addition, researchers assessed the health status and stress of caregivers. All the participants were interviewed about their experiences with caregiving. The results showed that most of the older respondents were female with an average age of 78.15 years. Based on the ADL assessment, 50 of the 62 older persons were homebound while the rest were bedridden. The majority of older people had chronic or long-term conditions that required hospitalization from time to time. Their frequent health problems included oral disorders such as tooth decay or caries/gum disease/no teeth, reduced sight, psychological disorders, knee pain and risk of falling, low BMI, risk of malnutrition, and urinary leakage and incontinence (58.06%, 66.13%, 62.90%, 70.97%, 38.71%, 66.13%, and 37.10%, respectively). Usual care provided by the family members included personal hygiene care, food preparation and feeding, medication management, housekeeping and organizing necessary equipment, supply of needed equipment, prevention of falls, helping with travel for medical checkups and treatment, and providing companionship. Families experienced shortages of medical supplies, daily use equipment, lack of employment, inadequate income, and difficulty accessing health care services due to lack of transportation. Some caregivers experienced caregiving stress related to a lack of social interactions as well as routine caregiving activities. Families need different types of support in order to promote the well-being of older people and caregivers. This highlights the need for a community participation model for the care of older people in order to reflect sustainable long-term outcomes.

• 한국노년학
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• 제31권4호
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• pp.985-998
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• 2011

본 연구는 노인장기요양보험제도 도입 이후 주야간보호사업소 운영현황을 파악하고 가동률 관련 요인을 탐색하고자 하였다. 전국 주야간보호사업소에 2010년 7월 14일에서 7월 28일까지 설문지를 우편 발송하여 설문에 성실히 응답한 277개소의 조사지를 분석하였다(응답률 24.5%). 사업소의 운영주체는 법인이 219개소(79.1%), 개인이 48개소(17.8%), 국공립 등이 10개소(3.6%)이었으며, 평균 가동률은 국공립 등은 79.08%, 법인은 72.49%인 반면, 개인운영 사업소는 57.58%로 낮았다. 사업소 운영주체별로 전체 인력 수에는 차이가 없었으나, 국공립 사업소는 간호사 수가 1.07명인데 비해 개인 사업소는 0.08명으로 유의한 차이가 있었다. 법인 및 국공립사업소가 개인사업소보다 프로그램 실시율이 높았고, 신체활동, 음악활동, 물리치료, 레크레이션, 작업치료 등에서는 통계적으로 유의한 차이가 있었다. 본 연구결과에 기초할 때, 개인운영 사업소와 2008년 이후에 설립된 사업소에 대해 대상자 평가 및 모니터링, 프로그램 실시에 대한 교육훈련 및 서비스 질 관리를 강화할 필요성이 제기된다. 또한, 주야간보호서비스 이용자의 가족에 대한 실효성 있는 지원을 강화하여 주야간보호서비스에 대한 수요를 확대해야 할 것이다.

• 보건행정학회지
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• 제22권1호
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• pp.85-108
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• 2012

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

• Safety and Health at Work
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• 제9권4호
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• pp.408-415
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• 2018

Background: Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. Methods: Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. Results: A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. Conclusion: Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.

• KDI Journal of Economic Policy
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• 제12권3호
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• pp.47-69
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• 1990

한국(韓國)의 의료보험제도(醫療保險制度)는 일본제도(日本制度)를 거울삼아 서둘러 적용대상자(適用對象者)를 확대하여 1989년 전국민의료보험(全國民醫療保險)을 달성하였으나 제도(制度)와 효율적(效率的) 운영(運營)을 위한 장치가 결여되어 있고 직장(職場), 공교(公敎), 지역의보간(地域醫保間)에 형평문제(衡平問題) 제기되는 등 구조적인 과제를 안고 있다. 앞으로 제도(制度)의 개혁추진(改革推進) 노력으로 이 분야의 정책수립(政策樹立)과 집행(執行) 에 있어서 경직성을 줄이고 비용효과적(費用效果的)인 의료이용(醫療利用)을 도모해 나가지 못할 경우 낭비요인(浪費要因)이 점점 더 크게 불어나 국민의료비(國民醫療費)가 계속적으로 급속히 증대될 전망이다. 이와 같은 제도(制度)의 질적개선(質的改善)의 필요성에 비추어 최근 네덜란드가 시도하고 있는 제도개혁(制度改革)은 우리에게 여러가지 귀중한 교훈을 던져주고 있다고 판단된다. 네덜란드의 개혁안은 시장경쟁원리(市場競爭原理)를 폭넓게 수용하여 제도(制度)의 능률(能率)을 높이고 의료비(醫療費)를 절감하려는 취지를 담고 있다. 특히 의보가입자(醫保加入者)가 보험자(保險者)를 선택할 수 있고 또한 보험자(保險者)가 의료기관(醫療機關)을 선택할 수 있도록 관계(關係) 집단간(集團間) 상호경쟁(相互競爭)을 유도함으로써 효율(效率)을 증진시켜 나가겠다는 정책방향이 뚜렷히 제시되고 있어 우리의 주목을 끌고 있다.