• Journal of Korean Academy of Nursing
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• v.11 no.2
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• pp.5-8
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• 1981

This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

• Journal of Korean Academy of Rural Health Nursing
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• v.18 no.2
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• pp.92-98
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• 2023

Purpose: This study describes a case report of wound care performed by a community health practitioner for a rural older adult with diabetic ulcers. Methods: Data were collected from a rural older adult who had a diabetic lower extremity ulcer, and wound dressing was applied over 20 weeks after the skin graft operation. Results: The patient visited a primary healthcare post for regular ulcer care, and a community health practitioner applied appropriate wound dressings and managed the patient's diabetic condition. Conclusion: In rural areas, where healthcare resources are scarce compared with urban areas, rural nurses, such as community health practitioners, are primarily required to manage rural residents' health problems. Advanced nursing practices such as complicated wound care should also be appropriately provided to patients by enhancing rural nurses' competencies in the changing health care environment.

• Journal of Korean society of Dental Hygiene
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• v.24 no.3
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• pp.229-242
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• 2024

Objectives: The purpose of this study was to explore and analyze experiences with home-visiting oral health education in vulnerable populations and to provide foundational data necessary for the development of preventive strategies for oral health promotion among these patients. Methods: Using a phenomenological research, in-depth interviews were conducted between August 29 and October 31, 2023 with 20 vulnerable individuals participating in the Home Visit Oral Health Education Program under the Gwangju+ Gwangsan Integrated Care Service project spearheaded by the Gwangju Medical Welfare Cooperative. Results: After analyzing the contents of the participants' experiences, 130 meaningful words and 14 subcategories were identified and categorized into five major themes. Participants expressed discomfort when chewing or swallowing food and felt burdened by visits to the dentist. Although they experienced considerable loneliness because they spent a significant amount of time alone, they enjoyed communicating through visitation care and expressed gratitude for receiving oral health education. Conclusions: Oral health education through home visits cam increase awareness of oral health management among vulnerable populations and serve as an important means of improving their quality of life.

• Health Policy and Management
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• v.19 no.4
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• pp.78-97
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• 2009

This study examined the factors related to family caregiver satisfaction with institutional care services for beneficiaries under the Public Long-Term Care Insurance(PLTCI) system. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. A national cross-sectional descriptive survey was conducted from November to December 2008, using proportionate quota sampling based on the location and level of Long-Term Care of the beneficiaries. Total 1,745 family caregivers wrote informed consents and 733 (response rate 42%) completed questionnaires, which included caregiver characteristics, organizational resources, primary objective and subjective stressors, perceived quality of services, and family caregiver satisfaction. Family caregivers were satisfied overall with institutional care. In multiple regression analysis, there was a statistically significant difference in degree of family caregiver satisfaction according to caregiver characteristics(relationship to beneficiary), primary objective stressors (insurance type of beneficiary), perceived quality of services(respect to family caregivers' idea, ADL support, expertness of staff, careful concern of staff, fulfillment of client's requests, and safety of institution's environment). In public long-term care, satisfaction efforts are in an early stage of development. This study is meaningful as the first attempt to measure family caregiver satisfaction with institutional care for beneficiaries under the PLTCI system, and to identify factors affecting the satisfaction. Among the identified factors, the policy makers, the insurer, and the providers need to pay attention to perceived quality of services, in particular, to improve customer satisfaction. Our findings can provide quality care improvement initiatives in the public long-term care setting.

• Journal of Preventive Medicine and Public Health
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• v.9 no.1
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• pp.139-146
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• 1976

This survey attempted to determine the overall health situation in Kyunggido in terms of sickness prevalence, sickness distribution, demand for medical care by type, and utilization of medical care. The survey was conducted on 766 households, or 4,065 people, from July 1-31, 1975. The findings from the survey are as follows: 1) In terms of age distribution, 28.7% of the sample was from 10-19, the 40-49 age group was the next largest group, and those over 60 made up 7% of the sample. 2. The education distribution is as follows, 30.4% completed primary school, 22.4% had no formal education, 20.6% attended but did not onplete primary school, and 1.8% attended unversities or higher. 3) In terms of occupation, 55.9% were unemployed or family employees, which represents a large dependent population, 30.4% of the workers were employed in farming or fisheries. 4. The marital status is as follows, 58.8% of the women were married, 32.3% unmarried, and 7.5% divorced. 5) The prevalence rate of mouthy illness was 19.7% of 100 infant, 42.8% became fatally ill within the first year of life. This is a very high percentage compared with more developed nations. 6) Of those reportion on illness, 54.6% sought treatment. The rate of treatment was highest in infants at 77.7%. Us age increased, demand for treatment decreased to 43.1% for those in the aldest age group. The oldest age group also had the highest rate of non treatment at 56.8%. 7) The demand for medical care showed that 65.6% utilized drug stores, 20.2% utilized hospitals and clinics, 5.4% used herbdrug-stores and herb clinices, and 3.9% relied upon folk medicine and withch craft. 8) The utilization of medical facilties by sex is as follows, 65.1% of the men and 66.0% of the women used drug stores, and 19.2% of the men and 20.2% of the women used hospitals and clinics. However, more men (3.5%) were hospitalized than women (1.8%) 9) In terms of out-patient care, the largest age group of males was 10-19 (28.2%), and the largest age group of females was 0-9 (30.8%). There was no sex difference in the use of western pharmacies. Menaged 30-39 and women aged 50-59 were the most frequent users of herb clinics. 10) The rate of receiving treatment at drugstore hospitals went towards declining level in the second case of what While increaing much more at herb clinics and folk medicines in the second case than the first one. 11) After primary utilization of hospitals, 32.7%. of the adults aged 20-59 used drug-stores as a secondary source of care, and 12.8% of children and youth under age 20 continued receiving care at hospitals. 12) After primary utilization of drug-stores, 32.5 % of the adults continued to seek care at drug stores and 1.8% used hospitals. 4.2% of those over age 60 utilized folk medcine and witch craft.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.12
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• pp.456-468
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• 2020

This exploratory study, related to the introduction of Western-style family doctors, was conducted based on a comparative survey of medical care satisfaction in foreign residents of the U.S. and Canada based on a consumer-centered perspective. As a result of statistical analysis based on 493 collections of empirical data from 2016 to 2018, the main conclusions of this study are as follows. First, there was no evidence that satisfaction with US and Canadian family doctors was higher than the satisfaction with Korean primary care physicians. Second, satisfaction with Korean primary care physicians was high with regard to treatment, promptness, etc., and there was no evidence that foreign family doctor systems were better in terms of sufficient counseling and explanation. Third, overseas Koreans in the United States showed less satisfaction with their family doctors than Koreans in Canada. Fourth, overseas Koreans preferred to visit a hospital directly, without a referral from the family doctor. In conclusion, there is insufficient evidence showing that satisfaction with family doctors in the U.S. and Canada is higher than satisfaction with primary care doctors in Korea. Therefore, a more in-depth, additional analysis on the Western-style family doctor is needed before introducing such a system in Korea.

• Tuberculosis and Respiratory Diseases
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• v.74 no.6
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• pp.256-263
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• 2013

Background: Health status measure is not only important for clinical research studies but also for clinical practices of chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to evaluate the validity of the Korean Version of COPD Assessment Test (CAT) in primary care clinics as well as in referral hospitals. Methods: Smokers or ex-smokers, aged 40 years or older, with a smoking history of >10 pack-years; and a COPD diagnosis in the past 6 months or more, were recruited from 4 primary care clinics and 2 referral hospitals. Demographic, medical, and spirometry data was collected from patients who completed the CAT and St. George Respiratory Questionnaire (SGRQ), and had their dyspnea been assessed. The primary endpoint was the correlation between of the Korean version of CAT with SGRQ in patients with COPD. Results: A total 100 patients were enrolled. The mean age and smoking amounts were $69.2{\pm}8.4$ years and $40.6{\pm}22.3$ pack-years, respectively. Sixty-seven percent of the patients reported at least one exacerbation in the past year. The mean CAT score was $16.9{\pm}8.0$. The internal consistency assessed by Cronbach's alpha was 0.85. The CAT score was positively correlated with the SGRQ score (r=0.76, p<0.0001) and each component of SGRQ: symptoms, activity and impacts; r=0.68, r=0.61, and r=0.72, respectively (all p<0.0001). These positive correlations were preserved in the different groups (r=0.86, p<0.0001 in primary care clinic group; r=0.69, p<0.0001 in hospital group). The CAT score was also positively correlated to the Medical Research Council dyspnoea scale (r=0.46, p<0.0001). Conclusion: The Korean version of CAT had good internal consistency and showed good correlations with SGRQ. It can be used for assessing the impacts of COPD on the patient's health including primary care setting.

• The Korean Society of Law and Medicine
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• v.20 no.3
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• pp.235-262
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• 2019

While traditionally threatening human infectious diseases are decreasing, chronic diseases such as cancer and diabetes, including cardiovascular diseases, are spreading rapidly. Reflecting the characteristics of chronic diseases that are difficult to treat, the management of risk factors and the preparation of health promotion policies corresponding to them have emerged as important concerns around the world. Providing so-called multi-sector approach such as health promotion and disease prevention policy and solution for community response, The value of primary care is once again highlighted in the changed medical environment. As the existing medical delivery system has become difficult to cope with the people's desire for rapid aging, disease paradigm change, and quality of life improvement, European Union countries have made various efforts to improve the quality of their primary medical system, which provides continuous, com- prehensive and coordinated management. This paper examines the current status and problems of the healthcare delivery system in Korea, draws implications from the European Union examples related to the strengthening of primary care, and discusses the plans for establishing a patient-centered future medical delivery system.

• Journal of Korean Academy of Rural Health Nursing
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• v.3 no.2
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• pp.104-115
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• 2008

Purpose: A study of the family planning and Maternal-Child Health Services that disciplined itself in primary health care post form 1980 to 2009. Method: Investigation studies family planning in primary health care post and a change process of a Maternal-Child Health Services into case by case until 2009 from 1980. Results: Our country family planning business began at economic development dimensions in order to solve a poverty issue. This business goal were childbirth decrease of pregnancy possibility couple aged 19~49 and improve to mother and child health. For this goal, all kinds of health education included sex education and contraception education, contraception service, comprehensive maternal and child health service that management of front and back of childbirth etc. are provided. According to fail down a birthrate from 6.0(1962) to 1.25(2009), the nation reached to a dilemma called childbirth encouragement policy. Conclusions: Decrease of labor supply by low birthrate, decrease numerical an employed person by aging was brought a labor shortage and decrease of productivity of labor of industrial manpower. Deterioration phenomenon of financial income and expenditure by consumption and investment contraction caused decrease of slowdown of economic growth and potential growth rate, and a social cost burden is increased by deterioration financial old man support burden increase by this and pensions and health insurance, a sharp increase of social welfare cost etc. Now, in order to solve a low birth issue, the government establishes a whole nation forwarding system and establishes basic plan social low birth and advanced age, and to prepare for childbirth fault factors removal and advanced age society shall endeavor.

• Safety and Health at Work
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• v.11 no.1
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• pp.10-18
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• 2020

Background: The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods: The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011-2012 were compared with follow-up internal audits in 2014-2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results: At baseline, 25% of 60 facilities were "noncompliant" (audit score<50%), 48% "conditionally compliant" (score >50 < 80%), and only 27% "compliant" (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion: Low baseline compliance with OHS-IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.