• Title/Summary/Keyword: Physicians Health Care Services

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The Current Status of Utilization of Palliative Care Units in Korea: 6 Month Results of 2009 Korean Terminal Cancer Patient Information System (말기암환자 정보시스템을 이용한 우리나라 암환자 완화의료기관의 이용현황)

  • Shin, Dong-Wook;Choi, Jin-Young;Nam, Byung-Ho;Seo, Won-Seok;Kim, Hyo-Young;Hwang, Eun-Joo;Kang, Jina;Kim, So-Hee;Kim, Yang-Hyuck;Park, Eun-Cheol
    • Journal of Hospice and Palliative Care
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    • v.13 no.3
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    • pp.181-189
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    • 2010
  • Purpose: Recently, health policy making is increasingly based on evidence. Therefore, Korean Terminal Cancer Patient Information System (KTCPIS) was developed to meet such need. We aimed to report its developmental process and statistics from 6 months data. Methods: Items for KTCPIS were developed through the consultation with practitioners. E-Velos web-based clinical trial management system was used as a technical platform. Data were collected for patients who were registered to 34 inpatient palliative care services, designated by Ministry of Health, Welfare, and Family Affairs, from $1^{st}$ of January to $30^{th}$ of June in 2009. Descriptive statistics were used for the analysis. Results: From the nationally representative set of 2,940 patients, we obtained the following results. Mean age was $64.8{\pm}12.9$ years, and 56.6% were male. Lung cancer (18.0%) was most common diagnosis. Only 50.3% of patients received the confirmation of terminal diagnosis by two or more physicians, and 69.7% had an insight of terminal diagnosis at the time of admission. About half of patients were admitted to the units on their own without any formal referral. Average and worst pain scores were significantly reduced after 1 week when compared to those at the time of admission. 73.4% faced death in the units, and home-discharge comprised only 13.3%. Mean length of stay per admission was $20.2{\pm}21.2$ days, with median value of 13. Conclusion: Nationally representative data on the characteristics of patients and their caregiver, and current practice of service delivery in palliative care units were obtained through the operation of KTCPIS.

Survey on Quality of Hospice.Palliative Care Programs in Korea (한국 호스피스.완화의료기관 실태 조사)

  • Yun, Young-Ho;Choi, Eun-Sook;Lee, In-Jeong;Rhee, Young-Sun;Lee, Jung-Suk;You, Chang-Hoon;Kim, Hyun-Sook;Paek, Yu-Jin
    • Journal of Hospice and Palliative Care
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    • v.5 no.1
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    • pp.31-42
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    • 2002
  • Purpose : The purpose of this study was to evaluate the present status of hospice palliative care programs in Korea as a basic database for standardization of hospice palliative care. Method : The data was collected from July to October, 2001. The instrument used for this study was the questionnaires which was consisted of the general characteristics of organization, recipient of service, manpower, contents of service, financial conditions and facilities. Sixty-four hospice palliative care programs answered the questionnaires, confirmed by telephone. Results : They were 40 hospital-based hospice palliative care programs and 24 nonmedical hospice palliative care programs. 11 Hospital-based hospice palliative programs have isolated unit or hospital affiliated free standing hospice. 6 Non-hospital hospice palliative programs have a free standing hospice. Major subjects of hospice palliative program were terminal cancer patients but patients with non-terminal illness were also included. Only 24 of 64 hospice palliative programs had all of the essential professionals : physicians, nurses, social workers, and clergies. Home hospice palliative care programs have a referral system in hospital based (89.7%) and nonmedical programs (73.7%). 24hr hospice are were provided in 26 hospital-based (65.0%) and 9nonmedical programs (37.5%). There were rooms for family in half of hospital-based programs. 73.9% of hospice palliative care programs have financial problems. 62.0% of Hospice palliative care programs need financial support from government. Conclusion : 64 Hospice palliative care programs provided hospice palliative services but had many problems in manpower, quality of care and facility. For improving the quality of terminal patients' life and promoting the cost effectiveness of health care resources, it is necessary to consider the standardization and institutionalization of hospice palliative care.

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A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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Perception of Patients with Cancer towards Support Management Services and Use of Complementary Alternative Medicine - a Single Institution Hospital-Based Study in Saudi Arabia

  • Sait, Khalid Hussain;Anfinan, Nisrin Mohammad;Eldeek, Basem;Al-Ahmadi, Jawher;Al-Attas, Maha;Sait, Hesham Khalid;Basalamah, Hussain Abdullah;Al-Ama, Nabeel;El Sayed, Mohamed Ezzat
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.6
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    • pp.2547-2554
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    • 2014
  • Background: To evaluate the perception of cancer patients toward treatment services and influencing factors and to inquire about the use of complementary alternative medicine (CAM). Materials and Methods: Information was obtained through pre-tested structured questionnaires completed by cancer patients during treatment at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Results: Of 242 patients, 137 (64.6%) accepted to enter this study. Most were Saudi (n=93, 68%), female (n=80, 58%), educated at university (n=71, 52%), married (n=97, 72%) and with breast cancer (n=36, 26%). One-hundred (73%) patients were satisfied with the services provided; 61% were Saudi. Ninety-four (68%) respondents were satisfied with the explanation of their cancer. Twenty-eight (21.6%) patients received CAM, of them 54.0% received herbal followed by rakia (21.0%), nutritional supplements/vitamins (7.0%) and Zamam water (18.0%), with significant differences among them (p =0.004). Seven (5%) patients believed this therapy could be used alone; 34 (25%) patients believed it could be used with other treatments, regardless of whether they themselves used this therapy. Fifty-three (53%) satisfied patients felt they received enough support; 31 (58%) patients received support from family and friends; 22 (41.6%) patients received support from the health-care team. Patients who received information about their disease from their physicians and those who felt they had enough support were more satisfied. The patients who took alternative treatment were older age, mostly female and highly educated but values did not reach significance. Conclusions: We stress enhancing the educational and supportive aspects of cancer-patient services to improve their treatment satisfaction and emphasize the need for increasing the educational and awareness programs offered to these patients.

A Study of The Secure Mobile Healthcare System for Medical Grid Devices (메디컬 그리드 장치를 위한 안전한 모바일 헬스케어 시스템에 관한 연구)

  • Choi, Gyoo-Seok
    • The Journal of the Institute of Internet, Broadcasting and Communication
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    • v.8 no.6
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    • pp.89-95
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    • 2008
  • The introduction of wireless information technology gives rise to new mobile services in all kinds of areas of out daily life. Mobile healthcare system is a production of composite ICT (Information and Communication Technology) which focused on signal sensing, processing, and communication in wireless environment. The mobile and wireless revolution promises not only expanded access to patient health information, but also improved patient care. In this paper, we describe a surrogate host based mobile healthcare information system which utilized Grid computing for real-time ECG signal processing. The surrogate host provides seamless interface between mobile device and Medical Grid portal. The security extension of GSI (Grid Security Infrastructure) allows mobile users to access Grid portal in a secure and convenient manner. The presented system architecture can be used as a secure enterprise mobile healthcare system for hospital physicians.

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Burnout among Medical School Faculty Members: Incidence and Demographic Characteristics at Three Medical Schools in the Busan and Gyeongnam Area of Korea (의과대학 교수들의 탈진: 부산·경남지역 3개 의과대학 교수 탈진 빈도와 양상)

  • Seo, Ji-Hyun;Kim, Bukyung;Bae, Hwa-Ok;Im, Sun Ju;Kim, Kyung Han
    • Korean Medical Education Review
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    • v.16 no.2
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    • pp.67-76
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    • 2014
  • Few studies have examined burnout among the faculty of medical schools in the Republic of Korea. The aim of this study was to determine the level of burnout and its associated factors among the faculty members of three medical schools in the Busan-Gyeongnam area, and to summarise the available literature on burnout. We conducted the survey using a validated questionnaire that incorporated the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) as well as questions about demographic characteristics, working experience, health, lifestyle, most time spent and most difficult work, and suicidal ideation and job quitting ideation of the survey participants. MBI-HSS scores were analysed in the three dimensions of emotional exhaustion (EE), depersonalization (De), and personal accomplishment (PA). Through the survey, the 186 professors, 49% among the total, provided data which were included in the present analysis. More than thirty per cent (37.1%) of the professors reported at least 1 symptom of burnout. For burnout dimensions, 11.8% of the respondents scored high for EE burnout, 25.3% for De, and 14.5% for PA, with 1.6% scoring high on all three dimensions of burnout. High burnout was found to be strongly associated with several of the variables under study, especially hours worked per week, self-rated health, career (range, 4 to 9 years), and age (range, 50 to 59 years). The EE score was highest for the professors who chose 'patient care' as the most difficult type of work. This study showed that just over one-third of professors have at least 1 symptom of burnout and working more hours per week, short length of work (years), and especially suicidal ideation seem to be associated with the burnout of medical school faculty members in the Busan-Gyeongnam area. In summary, a greater risk of burnout of physicians (including medical professors) seems to be associated with specialties at the front line of care, working more hours per week, work-life imbalance, low self-efficacy, depression, and conflicts with colleagues and patients.

Clinical Characteristics and Prognosis of Elderly Patients Receiving Prolonged Mechanical Ventilation in the Medical Intensive Care Unit at a University Hospital (한 대학병원 내과계 중환자실에서 장기간 기계환기를 받은 노인 환자들의 특징 및 예후)

  • Han, Min Soo;Moon, Kyoung Min;Lee, Yang Deok;Cho, Yongseon;Na, Dong Jib
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.6
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    • pp.445-450
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    • 2008
  • Background: As the number of older-aged people increases, the number of elderly patients who receive critical care services is expected to increase substantially. The objective of this study was to examine the clinical characteristics and outcomes of elderly patients who receive mechanical ventilation for more than 30 days in the medical intensive care unit (MICU) at a university hospital. Methods: We retrospectively examined forty-one elderly patients (${\geq}65$ years old) who were receiving mechanical ventilation, from April 2004 to March 2007, for periods exceeding 30 days at the MICU at Eulji University Hospital. Results: The MICU and hospitalmortality rate were 60.9% and 65.9%, respectively. The mean length of the ICU stay was 57.5 days and the mean duration of mechanical ventilation was 49.3 days. The most common reason for MICU admission was acute respiratory failure (73.2%), followed by sepsis (12.2%), neurological problems (9.8%), and gastrointestinal bleeding (4.9%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher for the nonsurvivors than for the survivors (28.0 vs. 25.0, respectively, p=0.03). The nonsurvivors received more red blood cell (RBC) transfusions during their ICU stay than did the survivors (84.0% vs. 43.8%, respectively p=0.007). The factors associated with hospital death were the APACHE II score and if the patient had received a RBC transfusion. Conclusion: The APACHE II score and a RBC transfusion were predictors of increased hospital mortality for the elderly patients who were on prolonged mechanical ventilation. These predictors may assist physicians to make clinical decisions for this patient population.