Kim, Jae-Seung;Lee, Joo-Young;Song, Chong-Rye;Lee, Mi-Gyeong;Hwang, Moon-Sook
Journal of Home Health Care Nursing
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v.16
no.1
/
pp.49-58
/
2009
Purpose: This study aimed to clarify the needs for hospital-based home care nursing medical services in elder care institutions by analyzing the details and frequency of medical services provided by, and the needs for, hospital based home care nursing in select institutions in Korea. Methods: Seventy-seven staffs at elderly care institutions located throughout the country completed self-report questionnaires between February 1 and May 31, 2009. SPSS ver. 14.0 was used for data analysis regarding frequency and percentage, mean and standard deviation. Results: Forty-eight hospital-based home care nursing medical services in eight domains were identified as being needed in elderly care institutions. The most commonly used medical services were providing instruction in oral drug administration, checking drug beneficial/adverse effects, and administering blood glucose test, while the most needed medical services requiring hospital based home care nursing were complex pressure ulcer care, followed by diabetic foot ulcer management and nutrient injection. Conclusion: The present results should provide fundamental data for better healthcare services with hospital based home care nursing at elderly care institutions as part of a 'win-win' strategy through which medical expenses are reduced, insurance costs are kept stable, and safe and high-quality medical services are provided for residents of elder care institutions. Political decisions intended to promote visits by hospital based home care nurses to elder care institutions would be a prudent course.
Financial barrier is well known as a determinant of the perceived need for and utilization of medical care in urban areas. This study aims to; a) estimate the levels of the perceived need for and utilization of medical care, b) analyze the reasons for not receiving medical care, and c) determine factors affecting the levels of need and utilization, and major reasons for not receiving medical care. The data of household interview survey in urban areas collected for a National Survey on Reorganization of Nationwide Health Care Delivery Network is used. An interview was conducted with a total of 2, 538 households in urban areas during a 28 day period of October through November, 1981, giving an overall response rate of 99 percent. The results show a factor of third-party payer is most influential to utilization (physician visits by patient), and living standard is a determinant to explain the variance of major reasons for not receiving medical care. Therefore, financial burden is still a major determent in utilization of medical care in urban areas. Improved level of living standard and expanded coverage of the third-party payer such as health insurance and public medical assistance will increase both an overall levels of utilization of and the need for medical care in urban areas in the future. The major statistics are as follows; a) rate of the need for medical care during a 15 day period per 100 persons was 33 percent: the differential rates appeared in sex, age, living standard, and third- party payer variables, b) percent of treatment employed per 100 persons who are wanting medical care was 82: the percents were high in young ages, high levels of living standard and education, and persons covered by third-party payer, and c) economic reasons for not receiving medical care per 100 persons who are wanting medical care were occupied with 60 percent: the rates are high in old ages, low levels of living standard and persons not covered by third-party payer.
The Korean system of health and medical care has been organized with both Oriental and Western medical sciences. To get complete clinical treatment results is not possible with only one-sided medical care, therefore we need to formulate an interdisciplinary plan for better health care, that is to say our ultimate purpose is the cooperative medical care for the promotion of social welfare and health. Hereupon, I made a searching inquiry into the present condition of cooperative medical care and its problems and also took a consideration into the medical state of other countries like China. Japan and North Korea where the Oriental medical care is used. The results of this investigation are as follows. There are some problems in both Oriental and Western(general) medical care, such as a lack of mutual confidence, a severance of interdisciplinary study, a shortage of professional human resources and so on. There also used to be problems of the system such as, the responsibility of medical care, the double charge for medical treatment, the governmental passive participation and policy, the private-oriented study system and so on. The solutions of these problems are that the mutual understanding and coexistence between both Oriental and Western medical sciences should be preceded and the interdisciplinary study, identified terminology and cooperative medical specialists would be necessary. Furthermore, the government has to seek some policies and legislation for the cooperative medical system and needs to support the public research institutes and centers of the cooperative medical care. After all, we have to train the cooperative medical specialists for the mutual aid of both Oriental and Western medical sciences and the government also has to support it with some policies and legislation for the better medical care system.
Background : In order to improve the quality of life of dying patients, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care to die with dignity. However, no adequate medical services are available for these terminal cancer patients. We studied their behavior patterns of health care utilization to understand more of their medical and social needs. Methods : We investigated 108 bereaved families through the telephone interview with structured questionnaires. They were randomly selected through the retrospective chart review of the terminal patients who passed away due to cancer. Results : Most of the terminal cancer patients received their care from proper medical services including admission to hospital (45.4%), outpatient clinic (22.2%), emergency room (16.7%), and oriental medicine (12.0%). But during the terminal phase of their illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alterative natural care. 26 bereaved families (24.1%) pointed out the indifference of medical staff as a problem receiving proper hospital care, and 22 (20.4%) emphasized emotional strain of their helplessness with the patients' suffering as a problem of caring at home. Over 90% suggested availability of continuous care, hospice care, home care, and 24 hour telephone service to be improved. Conclusions : Due to various reasons, adequate medical care is not delivered to the terminal cancer patients in our present medical system. These problems can be approached with the establishment of proper education and medical delivery system. The role of comprehensive medical specialty cannot be overly emphasized to accomplish this most effectively.
Journal of agricultural medicine and community health
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v.17
no.1
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pp.17-24
/
1992
The medical care insurance system has been adopted in rural areas in 1988, since then, the utilization of medical care services has increased rapidly in rural areas. The government has restructured the 15 health centers, which are located in remoted rural areas and these 15 health centers were strengthend to provide the curative care to the residents in order to meet the curative can demand of the residents. Besides the reorganization of the health centers, the government has implemented the oriental medical care demonstration project at the health center in a designated rural areas. This study was aimed to analyze the utilization and expenses of medical and oriental medical care services in a designated rural areas. Number of annual visits of residents to health centers in 1991 showed slightly decreased compared with that in 1989. However number of annual visits to the hospitalized health centers was an increase of 49.3%~64.5%. Regarding the coverage of curative care for the residents in rural areas, the hospitalized health centers are functioning more effective than that of health center. Expenses per case of medical care rendered by health center was lower than that of oriental medical care, while the expenses of the medical care was quit higher than that of oriental medical care in the hospitalized health centers. According to the above mentioned study results, the hospitalized health centers were more effective and suitable to provide a curative care to the residents than the health centers, and also the oriental medical care could be needed to be provided by public health network in the near future.
Academic medicine is built from a foundation of education, research, and patient care. Since good patient care results from the application of medical research and continuous education, these three components cannot be separated for medical development to occur. In Korea, many obstacles hinder the achievement of academic medicine, such as an inefficient medical delivery system, limitations of primary care, low insurance prices, and no long-term health care plan. Medical education has changed to outcome-based education, but presented temporal integration status. Governance of healthcare research is not centralized, and Korea is awarded relatively fewer grants than other countries. Medical professors have reached a burnout state due to patient care responsibilities in addition to research and education duties. Many medical systems, including the medical delivery system and insurance problems, may contribute to distrust between doctors and patients. The government is not involved in a long-term health care policy. The multitude of factors mentioned here are hindering the achievement of academic medicine in Korea.
The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.
With the introduction of national health insurance, the burden of health care costs decreased and choices of medical services widened. However, because of the rapid expansion of non-covered medical services by health insurance, financial security for health care expenditure is still low. This gives patients barriers to choose medical services especially for non-covered medical services, and it becomes narrower. Compared to Korea, Japan has high financial protection in health care utilization, but there exists a limitation using covered and non-covered medical services both together. This is called a prohibition of mixed treatment in health care. This study reviews the Japanese health care system that limits choosing medical services and the burden of health care costs. The prohibition of mixed treatment can alleviate the out-of-pocket burden in the non-benefit sector, but it can be found that it has a huge limitation in that it places restrictions on choices for both healthcare professionals and patients.
Purpose : This study aims to investigate the status of delirium intervention in adult intensive care unit (ICU) patients and the perception of this delirium by medical staff. Methods : This retrospective study involves 185 patients, whereas, a descriptive survey is conducted with 197 medical staff members. Results : The delirium group includes 100 patients (54.1%). The incidence of delirium is 64.9% in the medical ICU, 65.9% in the surgical ICU, 42.4% in the neuro ICU, and 46.5% in the cardiac ICU. The percentages of delirium prevention intervention differs between the two groups: 65.0% in the delirium group and 95.3% in the non-delirium group. The medical staff recognize that delirium is a common problem in the ICU (100.0%) and requires active medical intervention (98.5%). Conclusion : The length of stay at the ICU is longer in the delirium group than in the non-delirium group. It is necessary to standardize delirium prevention and treatment protocols to be equally applicable to all ICU patients.
Purpose: This study aimed to investigate advance care planning needs expressed online. Methods: This study collected data from online community posts and healthcare news sites. The search keywords included "death," "euthanasia," "life-sustaining medical care," "life-sustaining treatment," "advance directives," "advance medical directives," and "advance care planning." Data collection spanned from February 2018 to February 14, 2020. Out of 2,288 posts, 1,190 were included in the final analysis. Data analysis was conducted using NVivo 12, a qualitative data analysis software program. Results: Content analysis categorized patients' advance care planning needs into eight themes, 11 theme clusters, and 33 meaningful statements. Similarly, care providers' advance care planning needs were categorized into eight themes, 14 theme clusters, and 42 meaningful statements. The identified themes of care needs included life-sustaining medical care, decision-making related to life-sustaining medical care, physical care, environmental care, supportive and spiritual care, respect, preparing for death, and family. Conclusion: This study identified care needs from the perspectives of patients and their families. The findings may serve as preliminary data for future research and clinical applications.
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