• Journal of Preventive Medicine and Public Health
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• 제31권4호
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• pp.814-827
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• 1998

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

• 한국치위생학회지
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• 제12권5호
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• pp.1017-1027
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• 2012

Objectives : The purpose of this study was to help form treatment relationship with patient through more effective communication by defining the relationship between dental hygienist's medical communication and outpatient's reliance satisfaction. Methods : The study researched 273 male and female patients who visited dental clinics and hospitals of Busan from March 12 to March 26, 2012 and its results are as follows. Results : 1. The linguistic communication of dental hygienist was $3.72{\pm}0.63$ and non-linguistic communication was $3.48{\pm}0.58$. 2. For the dental hygienist's reliance satisfaction, the reliance was $3.62{\pm}0.65$ and the satisfaction was $3.74{\pm}0.65$. 3. The dental hygienist's communication degree depending on general characteristic was statistically significant when the job of patient was housewife(p<0.001) and the number of dental clinic visits was more than 10 times (p<0.000). The dental hygienist's non-linguistic communication was statistically significant depending on patient's gender(p<0.000), age(p<0.002), job(p<0.001) and number of dental clinic visits (p<0.000). 4. The dental hygienist's reliance and satisfaction showed statistically significant difference depending on patient's gender(p<0.000), age(p<0.002), job(p<0.001) and number of dental clinic visits (p<0.000). 5. The dental hygienist's non-linguistic communication showed a positive correlation with reliance and satisfaction(p=0.000). Conclusions : When considering the result above, it is necessary to develop the teaching method and material to educate the communication ability of dental manpower. It is necessary to reinforce the curriculum of dental hygienics and the education of dental hygienist to perform effective, smooth communication between dental hygienists.

• 한국실내디자인학회논문집
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• 제17권1호
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• pp.120-129
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• 2008

It requires great efforts to satisfy all functional characteristics of the rehabilitating treatments space for the specialized clinic for the elderly as the rehabilitating scope for treatment of the clinic has become more specialized and sectionalized. The specialization of the clinic for the elderly is saliently different in terms of rehabilitation treatment. The changed concept of rehabilitation for the elderly means that it places great importance in helping the elderly in their day-to-day life through a short-term or outpatient treatment, not a long term stay at hospital for retreat. The rehabilitation space in the clinic is essential in that it provided environment for efficient space placement in varied location. Thus, this study has been researched on 6 clinics for the elderly. It is because the space will have a variety of functions, which will be for the sake of the effective rehabilitation treatment of those aged patients who use that medical facilities, and not only for the physical therapy. It could have been designed to accommodate and realize not only the physical well-being, but also psychological, social and spiritual integrity for a variety of treatments, with which as the basis, this study theorizes the characteristics of the essential elements and the specialization factors by extracting spatial element through theoretical investigation. In conclusion the study here proposes the planned guideline for the rehabilitation treatment space to be designed inside the specialized clinic for the elderly, with renewed awareness of the importance on the spatial element in a recently established clinic.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2717-2720
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• 2012

Background: The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. Methods: A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio-demographic predictors of mammography utilization among participants. Results: The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (all P<0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P<0.05) with mammography participation. Conclusions: The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women, after adjusting for all other demographic variables in the model.

• 대한한의학회지
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• 제37권3호
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• pp.112-122
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• 2016

Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.

• 한국산학기술학회논문지
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• 제14권8호
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• pp.3897-3906
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• 2013

본 연구의 목적은 임신 여성을 대상으로 산전우울의 발생 정도와 이와 관련된 영향요인을 파악하기 위함이다. D광역시 소재 종합병원 및 산부인과 병원 외래를 방문하거나 원내 특강을 받는 160명의 임부를 연구대상으로 하였으며, 우울을 측정하기 위한 도구로 한국형 EPDS(Edinburgh Postnatal Depression Scale)를 사용하였다. 자료분석은 서술적 통계, t-test, ANOVA, Pearson's correlation coefficients와 stepwise multiple regression을 사용하였다. 연구결과, 임신 여성의 우울점수는 평균 $7.80{\pm}4.86$점(0-30점)이었으며, 대상자의 56.3%가 정상(0-8점), 23.1%가 경계선(9-12점), 20.6%는 심각한 수준(13점 이상)인 것으로 나타났다. 임신 여성의 산전우울 영향요인으로는 주관적 건강상태, 임부스트레스, 자아존중감 순이었으며, 이 변수들은 산전우울을 36.7% 설명하는 것으로 나타났다. 따라서 산전우울을 예방하기 위해 이러한 변수들이 충분히 고려되어야 할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8371-8375
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• 2016

Background: Colorectal cancer is one of the most common neoplasms in Iran. Secondary prevention (colorectal cancer screening) is important and a most valuable method of early diagnosis of this cancer. The objectives of this study were to determine the factors associated with colorectal cancer screening adherence among Iranians 50 years and older using the Health Belief Model. Materials and Methods: This cross-sectional study was conducted from June 2012 to May 2013. A convenience sample of 200 individuals aged 50 and older was recruited from the population at outpatient clinics in teaching hospitals. Data gathering tools were the Champions health belief model scale (CHBMS) with coverage of socio-demographic background and CRC screening information. Multiple logistic regression was performed to identify factors associated with colorectal cancer screening adherence. Results: The mean age of participants was $62.5{\pm}10.8$ and 75.5% were women. A high percentage of the participants had not heard or read about colorectal cancer (86.5%) and CRC screening (93.5%). Perceived susceptibility to colorectal cancer had the lowest percentage of all of the subscales. Participants who perceived more susceptibility (OR =2.99; CI 95%: 1.23-5.45) and reported higher knowledge (OR =1.29; CI 95%: 1.86-3.40) and those who reported fewer barriers (OR =.37; CI 95%:.21-.89), were more likely to have carried out colorectal cancer screening. Conclusions: Our findings indicated that CRC knowledge, perceived susceptibility and barriers were significant predictors of colorectal cancer screening adherence. Strategies to increase knowledge and overcome barriers in risk individuals appear necessary. Education programs should be promoted to overcome knowledge deficiency and negative perceptions in elderly Iranians.

• Tuberculosis and Respiratory Diseases
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• 제69권5호
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• pp.361-367
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• 2010

Background: Difficult-to-treat asthma afflicts a small percentage of the asthma population. However, these patients remain refractory to treat, and account for 40% to 50% of the health costs of asthma treatment, incurring significant morbidity. We conducted a multi-center cross-sectional study to characterize difficult-to-treat asthma in Korea. Methods: Subjects with difficult-to-treat asthma and subjects with controlled asthma were recruited from 5 outpatient clinics of referral hospitals. We reviewed medical records of previous 6 months and obtained patient-reported questionnaires composed of treatment compliance, asthma control, and instruments for stress, anxiety, and depression. Results: We recruited 21 subjects with difficult-to-treat asthma and 110 subjects with controlled asthma into the study. The subjects with difficult-to-treat asthma were associated with longer treatment periods, more increased health care utilization, more medication (oral corticosteroids, number of medication), and more anxiety disorder compared to those of well-controlled asthmatics. There was no difference in age, gender, history of allergy, serum IgE, blood eosinophil count, or body mass index between the 2 groups. Conclusion: Difficult-to-treat asthma is characterized by increased health care utilization and more co-morbidity of anxiety.

• 근관절건강학회지
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• 제5권1호
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• pp.7-25
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• 1998

Rheumatoid arthritis, unlike other chronic diseases, causes the patients to experience uncertainty in their daily lives and thus to feel threat on their emotional comfort because of inconsistent and unpredictable symptoms such as pain. Therefore, a theoretical framework is needed for explanation of uncertainty in patients having rheumatoid arthritis. A hypothetical model was constructed on the basis of Mishel's Uncertainty Theory and other literature review. The model included 9 theoretical concepts and 19 paths. Subjects of the study constituted 330 partients who visited outpatient clinics of two university hospitals and one general hospital in Seoul. Self report questionnaires were used to measure the variables affecting uncertainty. Reliability coefficients of these instruments were found Cronbach's Alpha=$.70{\sim}.94$. In data analysis, SAS program and PC-LISREL 8.03 computer program were utilized for descriptive statistics and covariance structure analysis. The results of covariance structure analysis for model fitness were as follows : 1) Hypothetical model showed a good fit to the empirical data : Chi-square($X^2$)=41.81 (df=11, P=.000), Goodness of Fit Index=.974, Root Mean Square Residual=.049, Normed Fit Index=.928, Non Normed Fit Index=.814. 2) For the validity and the parcimony of model, a modified model was constructed by appending 2 paths and deleting 5 paths according to the criteria of statistical significance and meaningfulness. 3) The results of hypothesis testing were as follows : (1) Educational level, event familiarity and severity of illness had a direct effect on uncertainty : Event congruency had both direct and indirect effect on uncertainty : Credible authority and symptom consistency had a nonsignificant direct effect on uncertainty, (2) Illness duration, symptom consistency, and event congruency had a direct effect on severity of illness ; Credible authority had a both direct and indirect effect on severity of illness ; Event congruency had the greatest effect on severity of illness, and event familiarity had a nonsignificant direct effect on severity of illness.

• 여성건강간호학회지
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• 제4권2호
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• pp.231-244
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• 1998

The purpose of this study was to provide a basis for nursing intervention to enhance quality if life in women having hysterectomies. Data was collected using a self-report questionnaire from 205 women having hysterectomies at the outpatient clinics of four general hospitals and a mail survey in Pusan City. Reliability of eight instrument's was tested with Cronbach's alpha which ranged from .601-.901. The data were analyzed by percentage, mean, SD, Pearson's Correlation and Stepwise Multiple Regression by using the SPSS 7.5 WIN Program. The results are as follows: 1) The average score for the quality of life was 74.33(score range 23-92). 2) There was a significant correlation between the predictive variables on quality of life. The most significant correlation was sexual identity(r=.516, p=.000). 3) When quality if life score was entered into the equation as the dependent variable, 7variables explaining 54.5% of the variation in quality if life score. Sexual identity was the main predictor of quality of life and accounted for 24.6% of the variance in quality of life. 4) When physical domain score was entered into equation as the dependent variable, 5variables explaining 29.2% of the variation in physical domain score. 5) When psychological domain score was entered into the equation as the dependent variable, 5variables explaining 46.0% of the variation in psychological domain score. 6) When sexual life domain score was entered into the equation as the dependent variable, 6variables explaining 39.4% of the variation in sexual life domain score. In conclusion, sexual identity, pre-operational symptom, sense of loss, spouse's support, age, professional support, coping behavior were identified as important variables in the quality of life in women having hysterectomies.