• 보건교육건강증진학회지
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• 제30권4호
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• pp.111-123
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• 2013

Objectives: This study aimed to share with experiences of a demonstration program based on a community for prevention and management of hypertension and diabetes mellitus, and to supply the evidence of accessible strategies within the community through the public-private partnershipin the near future. Methods: This study case was "the program of registration and management of hypertension and diabetes mellitus patients" which was conducted in Hogncheon-gun in Gangwon-province, 2012. Results: The infrastructure of this center was constructed with the public-private sector partnership according to the basic model of demonstration program since November, 2012. So, the total registered rate of hypertension and diabetes mellitus patients were 26.6% in comparison with suspected patients (to the result of 2011 Korea National Health and Nutrition Examination Survey), 37.8% in comparison with the real number of outpatient (to the claims data of 2011 Branch Honcheon-gun, National Health Insurance Corporation), and 107.8% in comparison with the project goal, sequentially. To the patients who were not treated for 30 and 60 days among the registered patients, a recall service was conducted. Through this intervention, it was monitored that this program has enhanced the consecutive treatment rate of the registered patients. Conclusions: To improve the continuous management of hypertension and diabetes mellitus patients, we are gotten to know that the community need the joint participation and mutual cooperation with public-private sector partnership.

• 디지털융복합연구
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• 제14권7호
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• pp.309-319
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• 2016

보건의료데이터의 질적 수준을 향상시키기 위해서는 데이터 질 관리 알고리즘을 개발할 필요성이 있다. 이에 본 연구에서는 질환의 유병률, 입원율이 높은 고혈압 환자의 당뇨질환 동반에 관련된 데이터 질 관리 알고리즘을 개발하고자 하였다. 이를 위해 2011년, 2012년 퇴원손상심층조사 자료 중 고혈압 환자 61,199건을 추출하여 분석대상으로 하였다. 데이터 마이닝의 대화식 의사결정나무 방법과 Outlier Detection 방법론을 통해 데이터 질 관리 알고리즘 개발한 결과 고혈압 환자가 당뇨병을 동반상병으로 가지는데 영향을 미치는 요인으로는 성별, 연령, 당뇨병성 사구체 장애, 당뇨병성 망막병증, 당병성 다발성 신경병증 등이 있었다. 의사결정나무 결과에 따라 당뇨병을 동반상병으로 가질 확률 값이 80% 이상이거나, 20% 이하인 집단을 Outlier(극단치)로 정의하고, 고혈압 환자의 당뇨 동반에 대한 극단치를 가지는 6개 집단을 발견하였다. 이와 같이 Outlier(극단치) 집단에 포함되는 실제 데이터를 확인하여 데이터의 질적 수준을 향상 시킬 필요가 있다.

• 보건행정학회지
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• 제23권4호
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• pp.427-433
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• 2013

Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.

• 보건행정학회지
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• 제20권1호
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• pp.125-136
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• 2010

Objectives: The purpose of this study is to analyze the proportion of fundus examination of DM patients for preventing microvascular complication and to examine the factors related to fundus examination in DM patients. Methods: This study used 2005 Korean national health and nutrition survey data. We selected all 1,129 diabetes mellitus patients from the data. And we choose 8 factors related to diabetes mellitus patients. These are sex, age group, type of residential area(rural or urban), education level, income level, comorbidity with hypertension, current insulin use, and duration of suffering from DM. We have analysed these factors by whether he had been examined fundus or no through Chi-square and logistic regression analysis. Results: Female DM patients have tendency to get more fundus examination than Male DM patients. And Young patients, patients who live in urban area, well educated patients, high income patients, comorbidity with hypertension, patients have got the insulin injection, patients have long duration of suffering from DM are to get more fundus examination. According to multivariate logistic regression analysis, sex and education level, income level, and duration of suffering from DM, comorbidity with hypertension, patients have got the insulin injection are significant factors on fundus examination for prevent microvascular diabetes mellitus complications. Conclusions and Discussion: We have concluded that physicians and policy makers should consider to fundus examination especially of man and DM patients who have more shorter disease period and low educated patients and low incomed patients and patients who have taken insulin therapy.

• 보건행정학회지
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• 제33권1호
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• pp.3-18
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• 2023

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen's medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion: The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

• 디지털융복합연구
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• 제15권1호
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• pp.355-362
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• 2017

연구의 목적은 일 농촌지역의 전수조사를 통해 고혈압과 당뇨병 환자들의 관리 행태를 분석하기 위해 시도되었다. 조사는 2014년 5월 19일부터 9월 21까지 구조화된 설문지를 이용한 자기기입식으로 진행되었다. 연구결과, 고혈압으로 진단 받은 사람 355명(36.6%) 중 현재 치료를 받고 있는 사람은 337명(94.9%)이었으며, 당뇨병으로 진단을 받은 사람 109명(11.2%) 중에서 현재 치료를 받고 있는 사람은 96명(88.1%)이었다. 고혈압 잠재위험군 총 211명 중 고혈압 진단을 받은 사람은 89명(42.2%)이었으며, 당뇨병 잠재위험군 356명 중에서 당뇨병 진단을 받은 사람은 78명(22.0%)이었다. 위 결과를 바탕으로 고혈압과 당뇨병 예방을 포함한 효과적인 관리 전략을 국가 차원에서 수립하고 실행하는 방안을 제안하고자 한다.

• Journal of Preventive Medicine and Public Health
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• 제40권6호
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• pp.487-494
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• 2007

Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.

• 간호행정학회지
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• 제16권3호
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• pp.295-305
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• 2010

Purpose: This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities. Methods: The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit. Results: Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38. Conclusion: The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.

• 보건교육건강증진학회지
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• 제31권3호
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• pp.27-37
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• 2014

Objectives: This study aims to identify the factors associated with regular medical services utilization of chronic disease patients. Methods: The research selected 4,489 adults aged over 30, diagnosed with hypertension, diabetes, hyperlipidemia, hypercholesterolemia, from the Korea health panel. We analyzed states of regular medical service utilization using descriptive statistics. Multiple regression analysis was used to examine the main factors associated with regular medical services utilization in chronic disease patients. Results: In terms of socio-demographic factors, gender, age, marital status, education level, employment, household income and disability were significantly different between hypertension, diabetes, hyperlipidemia and hypercholesterolemia. Among health status and behavioral factors, number of chronic diseases, subjective health status, smoking, high risk drinking, regular meals, physical activity, obesity were significantly different. From the multiple logistic regression analysis, age, number of chronic diseases, obesity, type of chronic diseases were associated with regular medical services utilization. Conclusions: It is necessary to develop effective health education programs and individualized approach to improve continuous management in chronic diseases patients.

• Journal of Preventive Medicine and Public Health
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• 제48권4호
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• pp.188-194
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• 2015

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.