• Quality Improvement in Health Care
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• v.25 no.2
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• pp.16-25
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• 2019

Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

• Korean Journal of Health Education and Promotion
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• v.29 no.2
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• pp.1-12
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• 2012

Objectives: Several practice guidelines recommended both medication and behavior modification to control hypertension. The objective of this study was to analyze ambulatory care utilization pattern and related factors. Methods: A retrospective cohort study was conducted among 45,267 new users who initiated treatment with hypertensive drugs in 2003. Korean National Health Insurance Claims Data was used to study the medical care utilization behavior and related factors after treatment initiation for up to four years. Taking prescription was considered as medical care utilization. Results: More than 20% of patients discontinued visiting physicians for prescription after initiating antihypertensive drug therapy. The average number of institutions visited by patients was about 1.3 annually. Clinic was the most frequently visited institution by patients. In GEE analysis, probability of continuous visit one institution after initiating antihypertensive drug treatment increased in patients who were women, old, have comorbidity, visited clinic or hospital mainly in previous year. Conclusions: Young hypertensive male patients who have no major comorbidity showed high possibility to discontinue medical service utilization. It is necessary to educate these targeted patients about importance of hypertension management in early stage after treatment initiation.

• The Journal of Korean Physical Therapy
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• v.6 no.1
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• pp.49-60
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• 1994

Stress is experienced when a person tries to maintain stability in the face of life change but is not able to meet the adaptive demands of change. This can be especially true for the parents who has a cerebral palsy childs who needs long term rare, where parents, are the primary source of care and responsibility. Successful coping leads to maintenance of the parents role and this has an effect on the health status of the child. This descriptive study was attempted to identify stress factors, levels and helpful coping patterns for parents who must take care of cerebral palsy children. Data were collected from 43 subjects who were parents of children diagnosed with cerebral palsy The informations gathered from March 25, 1994 to April 14, 1994 by means of structured questionnaires were analyzed. Two instruments were used to collect the data 1) Lee's stress questionnaire consisted of 33 stress factors and measured by four point Likert scale. 2) Modified Chronic Health Inventory for parents: The modified CHIP included 43 items of coping methods with four point Likert scale. The results of this study were as follows: 1) Stress items could have a maximum score of three points, for a total possible score of 132 points. The mean score for the total was 92.02 points. The item mean score was 2.85 points showing that the parents were experiencing moderate to much stress. 2) The items with the highest stress items were 16 items. The stress items with the lowest mean scores were 10 items. 3) Of the stress categories: The highest stress category was related to changes in the illness status of the child and difficulty in taking rare of the child. The second stressful category was related to the prognosis of the child's condition. The least stress was noticed to social-personal relationships and the responsibility of the care givers. 4) Items measuring coping in the parents had a maximum score of three points each with a total possible roping score of 172 points. The mean score for the total was 103,9 paints. The item mean score was 2.42 points indicating that there were responses of little helpful to moderately helpful on each coping pattern. 5) The most helpful coping items were 7 items. The least helpful coping items were 2 items. 6) Effectiveness of the coping for each patterns was examined : Understanding the illness condition from communication with parents of children with the same condition and consultation with the medical team was the most helpful coping pattern. Family's coorperation and integration and optimism were a moderately helpful coping pattern. Social support psychological stability and self esteem were the least helpful toping pattern. In conclusion, the highest stress for parents of children with cerebropalsy was found to be very stressful changes in the illness of the child and to taking care of a child who is suffering. The parents were helped by the coping methods using understanding of the illness condition through consultation with the medical learn and communication with parents in the same situation. Based on the knowledge, care could develop intervention strategies appropriate for them, help them to develop their effective coping patterns, and give support them in the process of coping with their stress.

• The Journal of Pediatrics of Korean Medicine
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• v.25 no.1
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• pp.90-110
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• 2011

Objectives: The purpose of this study is to examine the parental recognition and utilizing patterns of oriental medical care in children who live in Seong-Dong district. Methods 802 day-care center children's parents participated in the survey on recognition and utilizing patterns of oriental medical care, and 702 of the surveys were analyzed. Results: 1. 38.33% has received previous oriental medical treatments and most were received at the children's age under 12-24 months. Majority of the treatments took place in the clinical settings. By recommendation, some also received their treatment at the medical centers. One of the reasons why they receive oriental medical treatments was that they prefer to balance their treatment with the orental medical treatments along with the western's. 2. 53.85% of those who received oriental medical treatments were satisfied with their treatments. The effective treatment results were the major reason for the satisfaction. 3. 49.56% of those who had oriental medical treatments chose specific oriental medical facilities for the children's ailment. Most specific oriental medical facilities were local oriental medical clinics. Reputation fame were the main reason in choosing the clinics. 4. In 2009, 55.26% had received care in the specific oriental medical clinics for the diseases, such as respiratory symptoms, systemic symptoms, gastrointestinal symptoms, skin problems, neurological and psychiatric disease for infants, and respiratory symptoms, gastrointestinal symptoms, systemic symptoms, skin problems, neurological and psychiatric symptoms, urinary symptoms and musculoskeletal symptoms for toddlers. 5. The average duration of herbal treatment were 7-14 days, preferably 4-6 days, and preferred number of medical visits were once a week on Saturdays and preferred day for night cares were on Friday nights. Average treatment fee per treatment was less than 10,000 won which coincided with the preferred treatment fee per visit. 6. The very first medical institutions chosen by parents once their children are ill are the following; Western medical institutions, western medical clinics, pharmacies, oriental medical clinics, health centers, and lastly, oriental medical institutions. The major concerns in receiving oriental medical cares include pesticides in herbs and hazardous substances in heavy metals. Preferred form of oriental medicine was decoction, the negative feedback of oriental medicine was mostly due to the bitter taste of the oriental herbal decoctions. Preferred frequency of intake was twice a day with less than 10cc~20cc per single intake. Conclusions: Taken all together, we conclude that the growing recognition of Oriental Pediatric medicine is needed among parents.

• Journal of Korean Academy of Nursing
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• v.38 no.5
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• pp.685-693
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• 2008

Purpose: This study was to compare and analyze sleep patterns, satisfaction of sleep, and sleep enhancement behaviors between hospitalized and non-hospitalized elderly. Methods: Subjects were 201 older adults, who were hospitalized patients or living in U-city, Gyung-gi province. Data was collected from June 10 to August 25, 2007, and was analyzed by the SAS program. Results: 1) Non-hospitalized elderly had better sleep patterns than hospitalized elderly patients. 2) There was a strong positive correlation between sleep patterns and satisfaction of sleep in both groups. 3) In hospitalized elderly, there were significant differences in sleep patterns and satisfaction of sleep by month. 4) In non-hospitalized elderly, there was a significant difference in sleep patterns by presence or absence of spouses. There was a significant difference in satisfaction of sleep by those living with others. There were significant differences in sleep enhancement behaviors by age, religion, length of time, and sponsors. Conclusion: To relieve sleep disturbances of elderly, comprehension of sleep of the aged by nursing care givers should be obtained. Also, improving environments and elder's self-esteem with religious consideration and preparation of financial conditions are needed to promote the sleep of hospitalized and non-hospitalized elderly.

• Advances in Computational Design
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• v.2 no.4
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• pp.293-311
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• 2017

There are several claimed benefits for the impact of design patterns (DPs) on software quality. However, the association between design patterns and fault-proneness has been a controversial issue. In this work, we evaluate the fault-proneness of design patterns at four levels: the design level, category level, pattern level, and role level. We used five subject systems in our empirical study. As a result, we found that, at the design level, the classes that participate in the design patterns are less fault-prone than the non-participant classes. At the category level, we found that the classes that participate in the behavioral and structural categories are less fault-prone than the non-participant classes. In addition, we found that the classes that participate in the structural design patterns are less fault-prone than the classes that participate in the other categories. At the pattern level, we found that only five patterns show significant associations with fault-proneness: builder, factory method, adapter, composite, and decorator. All of these patterns except for builder show that the classes that participate in each one of them are less fault-prone than the non-participant classes in that pattern. The classes that participate in the builder design pattern were more fault-prone than the non-participant classes and the classes that participate in several patterns: the adapter, the composite, and the decorator design patterns. At the role level, the most significant differences were between the classes that participate in some roles and the non-participant classes. Only three pairs of design pattern roles show significant differences. These roles are concrete-product vs. concrete-creator, adapter vs. adaptee, and adapter vs. client. The results recommend the use of design patterns because they are less fault-prone in general except for the builder design pattern, which should be applied with care and addressed with more test cases.

• Health Policy and Management
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• v.29 no.4
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• pp.513-522
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• 2019

Background: South Korea operates a Medical Aid (MA) program targeting selected low-income individuals to ensure medical service delivery to the disadvantaged while enhancing self-sufficiency of work-capable beneficiaries. However, as reasons behind welfare exits are diverse and do not always infer poverty relief or the provision of appropriate levels of health care services, this study aimed to investigate the association between changes in MA status and health care utilization. Methods: This study used the 2006 to 2015 National Health Insurance claims data. The impact of changes in annual MA status on health care utilization (yearly number of outpatient visits, inpatient visits, length of stay, and emergency department [ED] visits) was investigated using the generalized estimating equation model. Results: In 117,943 adult subjects aged 20 to 64, compared to the 'MA to MA' group, the 'MA to MA exit' group showed general decreases in utilization (outpatient visits: β=-3.93, p<0.0001; hospital admissions: relative risk [RR], 0.87; 95% confidence interval [CI], 0.83-0.91; length of stay: β=-3.64, p<0.0001; ED visits: RR, 0.83; 95% CI, 0.77-0.90). Similar patterns were found in the 'MA exit to MA exit' group (outpatient visits: β=-5.72, p<0.0001; admissions: RR, 0.91; 95% CI, 0.87-0.94; length of stay: β=-5.87; p<0.0001; ED visits: RR, 0.81; 95% CI, 0.75-0.88). Likewise, in 74,747 older adult subjects aged 65 or above, the 'MA to MA exit' group showed reduced levels of utilization (outpatient visits: β=-1.51; p=0.0020), as well as the 'MA exit to MA exit' group (admissions: RR, 0.92; 95% CI, 0.89-0.95; length of stay: β, -5.45; p<0.0001; ED visits: RR, 0.90; 95% CI, 0.83-0.97). Conclusion: MA exit was associated with general decreases in health care utilization. Utilization patterns of individuals with experiences of receiving MA benefits should be monitored to promote the ideal use of health care services while preventing potential financial barriers present in accessing medical care.

• Korea Journal of Hospital Management
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• v.29 no.3
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• pp.54-69
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• 2024

Purposes: This study aims to analyze the location patterns, concentration, and accessibility of clinics in Seoul with the grids of a geographic information system(GIS) and provide useful indicators for research on hospital and clinic management and policies based on the results. The study especially sets out to identify areas falling behind in the service of the essential medical care departments based on an analysis with 250m×250m grids and contribute to efficient medical business management and public healthcare policies based on the results. Methodology: The study analyzed clinics in Seoul in terms of concentration, distribution and clustering patterns, accessibility, and hot spots by dividing the entire city into 500m×500m cells and generating grids. The accessibility analysis for the essential medical care departments was especially in detail based on grids in a 250m×250m cell size. Findings: The Herfindahl results show that plastic surgery and rehabilitation medicine recorded the highest concentration level. General medicine and dermatology recorded the highest Moran's I value, and internal medicine was the highest in hot spots. Obstetrics and gynecology capable of child delivery showed considerably lower accessibility in the grids corresponding to Gangseo-gu, Yangcheon-gu, and Gwanak-gu. Surgery had low accessibility in the grids corresponding to the northern parts of Gangseo-gu for the total population. Practical Implication: Unlike previous studies whose analyses covered wide areas, the present study examined minute spatial patterns, concentration, and accessibility based on an analysis with 500m×500m or 250m×250m grids. Based on its findings, the study expects a more minute analysis for future research on medical business management and policies.

• Journal of Internet of Things and Convergence
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• v.6 no.4
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• pp.39-48
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• 2020

This study intends to the estimate the determinants and state dependence of long-term care services in Korea. For this purpose, we analyzed the transition patterns among three states of long-term care service utilization over time by using the Korea Welfare Panel Study data with the random effect multinomial logit model. It is found that the result showed a strong state dependence in long-term care service utilization. Especially, long-term care insurance for the elderly showed a strong state dependence among others. Among the individual demographic characteristics, the higher the age, the higher the probability of using long-term care insurance for the elderly, while the lower the probability when married. The characteristics of the residential region showed that the residents of the urban-rural integrated region had a significantly higher probability of using long-term care insurance than the reference region. The results of this study suggest that the long-term care service users have a strong state dependence, which means that it is important to take into account the increase in the utilization period of existing users in future demand forecasting.

• The Journal of Korean Academic Society of Nursing Education
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• v.5 no.1
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• pp.39-57
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• 1999

Essential hypertension is a typical chronic disease requiring adequate and continuous management. And many studies supported that self-care was the essential factor to promote the wellbeing. The purpose of this study is to identify and understand the behavior patterns of self-care in hypertensives. As a research method, 35 Q-statements were collected through Individual interviews and review of the related literatures. 21 subjects were interviewed and the data were analyzed by the PC QUANL program with principal component analysis. There were 6 different self-care types classified as follows 1) Type 1 was the self-oriented control type, monitoring the blood pressure and taking the low salt diet. But they didn't take the anti -hypertensive drug and visit the health agency regularly. 2) Type 2 was the stress-control type. Their main activities were meditation to relieve the stress and communication with family. 3) Type 3 was called daily-life control type. This type tried to make their mind comfort and think positively. They also preferred walking and exercise regularly. 4) Type 4 was the medical-oriented control type, taking the anti-hypertensive drug, visiting the medical personnel and following the medical regimens. 5) Type 5 was the medication-oriented type. They only took the anti -hypertensive drug regularly and didn't any other self-care like as monitoring the blood pressure, taking the low salt diet and exercise. 6) Type 6 was called non-medication control type. This type had no medication, but tried to visit the health agency and health personnel. From the above results, it can be concluded that the self-care types were very various and self-care education have to provide individually according to the characteristics of self-care type. Another repeated study can be recommended to improve the nursing intervention the self-care behavior in chronic patient like as diabetics or rheumatoid arthritis.