• 농촌의학ㆍ지역보건
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• 제12권1호
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• pp.36-53
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• 1987

It is utmostly important to establish the efficient fitable way of peoples' active participation in primary health care especially in the areas where the public or governmental service input for the basic health care is insufficient like as in rural areas of Korea. In light of above reason, this study focused mainly on the evaluation of roles and activities of village health workers (VHWs) who were selected from grass- root level of village people in order to derive further motivation for active participation. This is believed to be a sort of feedback mechanisms. Actually, the authors collected the activity reports of VHWs who had been devoting themselves in the primary health care services of Jeomdong Area, of Yeoju Gun one of Korea University Community Health Action Programmes and survey record on the VHWs activity from correspondent people. 1 hose data were analyzed through computer programmed package. The activities performed by VHWs were limited to the performance in 1985 for conveniance. The summarized results were as follows; 1) General characteristics of VHWs. Among a total of 28 VHWs in the area, about 39.3g of them have been replaced up to the date since the implementation in 1983, because of moving out, occupational employment and of others. The age of majority (75.0%) lied between the range of 30-50, and educational background of 67.9% belonged to category of primary school graduation, about 50% of them experienced to be or were also entiled "chief of women club" of corresponding villages. 2) Work-load of VHWs. Each VHW was assigned for tasks of health care for average 55 households of 248 persons. They shared approximately 6 days a month for the activity in average and it covered 17 cases of basic health care in a month. A half of the VHWs performed home visits irregularly without solidified schedule. 3) Work performance analysis. Informations collected through VHWs were compared with data from official vital registration at local administration center "Myon Office" in 1985. VHWs collected 100.8 of new born, 116.2 of death, 58.3 of move in and 74.8 of move out in comparison with 100.0 of official registration each. Pregnant women of 79.8% of mothers among the total pregnancy of 94 which were confirmed as normally delivered or aborted cases by all means afterwards had been detected by VHWs as being pregnant and all of them received some of antenatal cares by VHWs. All(100%) of delivered women were detected by VHWs through home visits and they were cared postnatally. Whereas, according to the records of birth registration, the places of delivery were clinic in 33.7%, and mother's home in 66.3%, VHWs reported them to be clinic in 48.9%, midwifery in 20.2%. It was cleared that most of misinformation was caused by uncautious filling of birth registration at notification. Among the total of 717 eligible women under age 44 years, family planning status of 92.6% was reported by VHWs confirming practice of control to be 70.8% of reported fertile women. 4) Attitude of VHW on the roles and functions. Although 92.0% of VHWs expressed VHWs to be worthwhile, only 52.0% of them had dignity and satisfaction in their activity and 44.0% of them had passive attitude of working saying they followed direction regardlessly. Concerning difficulties in performance as a VHW, 60.7% of them pointed out lacking of medical and health related knowledge by themselves. Still, 64.0% of them thought visiting unfamilier house to be awful and 40.0% complained forms of activity to be difficult and hard. It was also revealed that 56.6% confessed lack of interest on community health service itself. Most of VHWs needed more educational training especially on clinical fields such as cares of gynecological diseases, hypertension, diabetes, and other chronic diseaes of the aged. Regular on-the-job basic trainings were said to be needed twice a year.

• 한국사회복지학
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• 제55권
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• pp.309-339
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• 2003

본 연구는 2002년, 우리나라 14지역에서 시범사업으로 실시되었던 지역사회복지협의체 사업을 기관간 연계로 보고, 그 효과성에 대해 평가를 한 것이다. 연구에서 밝히고자 하는 문제는 두 가지이다. 하나는 기관간 연계로서 협의체 사업의 참여자들은 이 사업에 대해 긍정적으로 평가하는가, 부정적으로 평가하는가이고, 다른 하나는 서비스 제공자들간 연계에 의한 서비스에 대해 수혜자들은 어떠한 반응을 보이는가이다. 이 두 가지 질문에 대한 답을 찾고자, 한국보건사회연구원의 조사 자료를 재분석 하였다. 먼저 참여자들의 태도를 요약하면 다음과 같다. 즉, 의사소통에 대해 기관장들은 부정적인 평가를 하고, 실무자들은 긍정적인 평가를 하고 있다. 역할 수행에 대해 참여자들은 68.2%가 긍정적으로 평가하고 있으며, 77.8%가 협의체는 상시적으로 운영될 필요가 있다고 하고 있다. 수혜자들은 기관간 연계 서비스에 대해 전반적으로 긍정적으로 평가하고 있다. 그러나, 협의체 사업 전.후 비교에서, 가사서비스는 통계적으로 유의미한 차이가 있어 개선되었지만, 의료서비스 등 기타 서비스는 개선되지 않았다. 클라이언트만족문항(CSQ)척도 점수도 사전과 사후에 차이가 없었다.

• 한국병원경영학회지
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• 제25권4호
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• pp.94-102
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• 2020

Purposes: The purpose of this study was to analyze the trends of hospitalization and emergency room visits of asthma patients over the three years in 25 districts of Seoul. And analyzed the relationship between preventable hospital service uses and number of clinics for asthma patients. Methods: Data was collected from a customized database of the NHI(National Health Insurance) for 2016 to 2018. The number of clinics means Internal Medicine, Pediatrics, Ear-Nose-Throat, and Family Medicine clinics. The hospital service means the number of adults admission for asthma and the number of total asthma emergency visits. This study used kappa analysis to assess the agreements of indicators between years, and structural equation modeling analysis was applied to analyze the relationship. Findings: The kappa value of the number of adults admission for asthma was compared between 2016 and 2017(kappa score=0.68), and was lowered when compared between 2016 and 2018(kappa score=0.26). And the value of kappa in the number of total asthma emergency visits due to asthma between 2016 and 2017(kappa score=0.51) was lower than that of between 2016 and 2018(kappa score=0.60). And the results showed that the number of clinics significantly negatively related to the uses of hospital services in asthmatic patients(β=-0.5, p=0.005). Practical Implication: This research could provide policy implications for strengthening primary care services that can contribute to the reduction of preventable hospital services.

• 대한간호학회지
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• 제22권4호
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• pp.636-652
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• 1992

This study identified the impact of childhood cancer on the Korean family. The purpose was to contribute knowledge for family nursing and pediatric hospice care practice with sick children and their families. This descriptive study was conducted during a 6 month period with children who were being treated for cancer at six university hospitals in Seoul. The data were gathered from members of 68 families ; 24(Group A), with a child newly diagnosed with cancer : 27(Group B), with a child under treatment and without complications, and 17 (Group C), with a child in relapse. Medical records, structured questionnaires and interviews were used for data collection. The questionnaires and interview schedules had been used previously in Martinson's research in the USA and China. The findings, conclusions, and suggestions are as follows. 1. The impact of childhood cancer on the family. Members of the family experienced fear, helplessness, guilty feelings, and anger at the time of the initial diagnosis and at relapse. Mothers complained of headache, anorexia and poor appetite, weight loss, sleep disturbance, and bad dreams. Many of the fathers either lost or changed jobs, and all working mothers stopped working. Half the parents reported changes in their marital relationships such as frequent quarrels but also stronger unity. Family members perceived cancer as the most frightening disease. Change in their world view was expressed as living on faith understanding suffering, determining to live a better life, wanting to live an upright life and valuing health as the most important. Religious activities are found most helpful through this difficult experience. Financial debt due to the treatment and care of the sick child, burdened 22 families. The above mentioned impact was most evidant in Group B(those presently undergoing treatment) and Group C(those in relapse). Findings indicate that nursing care should embrace the family of a child who is being treated for cancer. 2. Characteristics of the child with cancer The majority of the children in this sample had a diagnosis of leukemia. Their mean age was 6.8 and the ratio of boys to girls was 1.12 ; 1. The mean hospitalization frequency was 13.5 times and the mean duration of illness was 16.8 months. Most of 1.he children perceived cancer as the most frightening disease ; 32.7% of the children described their sickness as serious. Children in Group C were hospitalized more frequently, stayed in hospital for longer periods, and expressed their sickness as quite serious more often than the other two groups. These findings indicate how much comprehensive pediatric hospice nursing care services are needed along with relevant research and nursing education. 3. Characteristics of the families. The mean age of the father was 39.5 and the mother, 36,6 ; they are in their most productive life period. Mothers especially expressed feelings of financial uneasiness and powerlessness about giving up their jobs, and guilty feelings for not providing enough care and concern to other children due to taking care of the sick one. The burden of caring for the sick child can bring negative changes in family dynamics which they think provoke potential health problems in members of the family These findings suggest a need for nursing support and counselling resources. Findings also suggest the need for ethical inquiry about such questions as who should give information to the child in regard to diagnosis and prognosis, when, and how. Other suggestions included : 1) Quality health care for childhood cancer such as home care and pediatric hospice programs should be established. 2) Special and practical consideration for long-term patients should be made in the present insurance coverage. The reimbursement period for long-term patients should be lengthened. 3) Further in-depth qualitative studies are needed. 4) Education programs including guided practice experience for pediatric hospice care practitioners are needed.

• 보건행정학회지
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• 제19권3호
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

• 한국콘텐츠학회논문지
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• 제18권11호
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• pp.462-474
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• 2018

생체 감지기술 발달은 그동안 거대한 전문 의료기기에서만 가능했던 다양한 생체 정보 수집을 간편하게 가능케 하였다. 센서 소형화는 진단기기의 휴대성을 높여 기존에 병원에 직접 가서 해야만 했던 다양한 건강 진단을 생활 속에서 간편히 수행할 수 있게 하였다. 스마트폰 같은 휴대기기에 센서를 결합하거나, 첨단 IOT(Internet of Things, 사물인터넷) 기술을 적용해 체내 삽입형, 혹은 부착 가능한 초소형 모듈 등 의료기기의 새로운 폼팩터를 만들어냈다. 또한, 측정결과를 스마트폰 등 휴대용 정보기기를 통해 즉시 확인할 수도 있다. 아직 국내에서는 상용화가 더디게 이루어지고 있지만, 미국 등 원격의료 서비스를 허용한 나라에서는 이 분야에서 다양한 양상으로 신기술 적용이 이루어지고 있다. 세계적으로 가장 빠르게 고령화가 진행 중인 대한민국에서 의료수요, 공급, 그리고 비용 문제는 점점 커지고 있다. 이런 상황에서 새로운 건강관리 개념인 스마트 헬스케어가 기존의 의료체계를 보완할 수 있을지 크게 주목받고 있다. 본 연구는 스마트 헬스케어와 관련된 기술 동향을 확인하고, 다양한 헬스케어 제품을 UX 디자인적 측면에서 유형화하였다. 또한, 스마트 헬스케어 기술을 대상 사용자인 노인에게 적용하기 위한 UX 디자인 접근방법과 지침을 제시하였다. 본 연구가 새로운 사회적 문제인 고령사회 헬스케어 문제 해결에 돌파구가 될 UX 디자인 분야의 기반자료가 되기를 기대한다.

• 한국병원경영학회지
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• 제7권2호
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• pp.99-123
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• 2002

This study was conducted to determine whether follow-up management is carried out continuously following CQI activity and to analyze the factors behind the success and failure of follow-up management. Past presentations from 1994-1999 of CQI coordinators and lecturers from various institutions who presented at The Korean Society of Quality Assurance in Health Care(KoSQA) on the conditions of follow-up management in each institution were analyzed. The results of this study were as follows; Since the number of subjects on CQI increased each year at symposiums, this has expanded to all medical institutions. Although medical institutions usually conduct 11-20 subjects on CQI per year, there were many such occasions where more than 31 subjects were conducted. Moreover, institutions with less than 800 beds have come up with more projects than those with more than 800 beds, thus 23.3% of these institutions had at least 1 person involved in 4 projects. This had created an overload of responsibilities for specific persons' involvement, prompting them to incline toward formalities in their work rather than substantial activities. Among the projects presented at the symposiums, 51.7% demonstrated that follow-up management could be carried out. In particular, 55.3% of the projects from provincial regions could carry out follow-up management compared to 48.8% in Seoul. Moreover, it was demonstrated that 80% of the projects from institutions with 600-799 beds carried out follow-up management most effectively. With regards to previous presentations, the older they were, it was found that follow-up management could not be effectively carried out. Some institutions that responded that follow-up management was carried out effectively in their institutions were found to have conducted follow-up management without any inspection strategies or the appropriate tools. CQI activities were executed and terminated with no consistency and team members had no real concern for it. The most important factors that contribute to an effective follow-up management are the need for concern and interest from the directors of the hospitals, from the relevant departments and team members in addition to the role of the supervising department, follow-up management through management of target goals, consistency in tasks along with communication between all team members. The biggest problems were perceived to be overload of work due to accumulation of proposed projects in addition to lack of awareness pertaining to follow-up management. CQI is beneficial for all staff for the improvement of the mind and business administration and thus it is believed to be desirable. To carry out follow-up management effectively, leadership, analysis and application of information, follow-up management and planning, as well as quality management are perceived to be essential, on the other hand, the results showed a significant difference. To prevent CQI activities from becoming just an activity, the basic system should be reconstructed and augmented based on the problems derived from the results of this study. Moreover, we hope this study will be used as reference material that would encourage the administration of follow-up management after CQI activities in most hospitals. Furthermore, various studies on follow-up management should be conducted for CQI activities in the future.

• 대한지리학회지
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• 제46권4호
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• pp.501-517
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• 2011

본 연구에서는 원격진료 기술로 병원간 통합을 꾀하고 있는 일본의 사례를 중심으로, 원격진료의 지역화 형성 및 특성에 대해 알아보았다. 연구를 통한 결과는 다음과 같다. 첫째, 일본에서는 원격진료의 효과적인 운용을 위해, 현청, 지역 내 대학, 의사회, 지역 산업을 기반으로 하는 기업 등을 주축으로 하는 "원격진료 의원회"를 구성하여, 이를 활발한 의사 교환의 장(場)으로 이용하고 있다. 따라서 지역의 다양한 의료 종사자와 환자의 직접적인 수요를 최대한 반영하고, 조속히 맞춤형 원격진료 서비스를 제공할 수 있는 환경을 형성하였다. 둘째, 이미 형성된 긴밀한 인간관계가 원격의료의 지역화에 크게 관여하고 있다. 지역의료의 발전을 위한 정책 결정자-의사 집단 간의 관계, 의사회의 정기적인 모임과 연장자 의사 집단의 지역의료에 대한 깊은 이해 및 지원 등을 기반으로 하는 의사-의사 간의 관계, 긴 시간 신뢰를 쌓은 의사-환자 간의 관계 등은 원격진료의 발안 단계에서부터 실제적인 이용과 응용의 단계까지 두루 걸쳐 일본에서만 보여지는 지역화의 특성을 결정짓는다. 결론적으로 오프라인에서 형성된 개인적 차원의 관계(게마인샤프트)가 온라인상의 공적 차원(게젤샤프트)의 서비스로 전환되는 현상이 일본 원격진료의 지역화에서 보여지는 고유한 양식이라고 할 수 있다. 이는 하나의 현을 중심으로 하는 사회, 경제, 문화적인 특성들이 원격진료에서도 고스란히 투영되어 나타나기 때문인 것으로 파악된다.

• Child Health Nursing Research
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• 제7권2호
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• pp.245-257
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• 2001

This study analyzed the services as operated by the Child Health Telephone Service Center. The Center is a toll free service operated as part of the community services of the Korean Academic Society of Child Health Nursing. The aim of the study was to describe the concerns of child caregivers regarding child health care as discussed during telephone counseling. Specific objectives were as follows: 1. To analyze the activities of the Center. 2. To describe the characteristics of caregivers who made phone calls for counseling services and also the characteristics of their children. 3. To analyze the content of the counseling sessions. 4. To analyze counseling content according to the characteristics of the caregivers and their children. Data used for the study were obtained from the counseling records for the period from Sept. to Dec. 1999, as kept by the three counselors at the Center. The total number of calls was 8,261 and that consisted of 15,150 questions. The total questions were merged into 13,236 by eliminating those questions which overlapped or were of similar content. The final 13,236 questions were used for the final analyses. Almost of the callers (98.4％) were mothers. Among them 89.6％ were between 25 and 35 years of age. Geographical distribution of the callers covered the whole nation. The largest numbers who made the calls were from the Seoul metropolitan area (36％), followed by 28％ from Kyung Gi Province, and 20％ were from the Kyung Sang area. Among 8,261 callers, 72.8％ were first users. Sex of the babies and children in question for counseling was about even for males and females and ages ranged from one month to six years. The largest group (62.5％) was the less than six month age group. The finalized 13,236 questions/problems were categorized into 11 problem areas. They were in order of frequency, physical problems, feedings and nutrient concerns, information on child rearing, growth and development, guidance on utilization of child care facilities, elimination problems, sleeping concerns, immunization related concerns, behavior problems, injury and accidents, and safety measures. The most frequent problems for counseling were physical signs and symptoms (27.3％), followed by feeding and nutrients, information on child rearing, and growth and development. Of physical problems, abnormal gastrointestinal signs and symptoms were the most frequent concern and skin problems were next at 25％ and 23.3％ respectively. Loose bowels, vomiting and constipation were the most frequent gastrointestinal problems. Atopic dermatitis had the highest frequency at 53.3％ with diaper rash being the second highest among the skin problems. About 80％ of the growth and developmental category were physical development concerns related to physiological, body growth, and motor and sensory development. This study constitutes the activity report for the first year of the Center. The findings correspond with literature reports on child health problems and parents educational needs. One recommendation from this study is that since the services of the Center are carried out only by telephone, the psychology of the counselees and the counselor relationship must be considered for better services.

• 대한영양사협회학술지
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• 제19권3호
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• pp.265-286
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• 2013

The present study was conducted to develop a standardized job description for clinical dietitians working in hospitals. A developing curriculum (DACUM) method was used for the job analysis of clinical dietitians. Based on DACUM analysis with 14 members, including clinical dietitians and professors majoring in clinical nutrition and job analysis, information on the duties, tasks, and task elements of clinical dietitians was determined. To verify the job descriptions derived from DACUM analysis, a total of 46 tertiary and general hospitals with over 500 beds were recruited for the survey. The final developed job description for clinical dietitians included 7 duties, 27 tasks, and 93 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring evaluation, consultation cooperation, nutrition research, and self-development. The mean scores of perceived importance, performance, and difficulty on the clinical dietitian's task elements (out of a maximum score of 5.0) were 4.5, 3.7, and 3.5, respectively, with significant differences between the items (P<0.001). The perceived importance and performance grid of clinical dietitian's tasks showed that "construction and maintenance of collaboration" (E2) and "activity of quality improvement" (F1) received relatively low scores for performance despite their high importance scores; thus the performance of these tasks requires significant improvement. In conclusion, the job descriptions of clinical dietitians developed from this study are useful for the qualitative improvement of clinical nutrition services in hospitals.