• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.67-77
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• 2003

Objectives: This study is designed to suggest the health service goals necessary for providing the more efficient services relevant to the requests of the community, through the evaluation on the operating status of the unified health subcenters. Methods: We visited total 5 unified health subcenters comprising 3 ones located in Gyeongsangbuk-do and 2 ones located in Gyeongsangnam-do from December 2000 to January 2001, and interviewed about the pre- and post-unified status related to manpower, facilities, equipment, medical service and health service quality, and the problems and improvement plans of the unified management. Results: According to the evaluation on the manpower before and after the unification of the health subcenters, the total employees increased by 2.8 persons on average from 6.8 to 9.6 persons in the investigated subjects. The numbers of doctors, dentists and nurses were almost the same as before. There were no clinical pathologic technician and radiological technician before but they were appointed to duty in 3 unified health subcenters later. The unification of the health subcenters has produced slight increases in the frequency of the medical service and dental treatment and considerable increases in that of the physical therapy and laboratory tests. In relating to the changes of the health service, the cases of visiting health care and ambulatory medical service, and the total number of health education participants were greatly increased after the unification. The number of cases undergoing the vaccination and cervical cancer screening was similar to that of the pre-unification while the patient number of the registration to hypertension or diabetes showed a tendency to increase a little. Since the unification of the health subcenters, the frequency of laboratory tests has been increased, but the quality of health service has not been improved yet. Nevertheless, the unification seems to be positive according to the result of the great improvement in visiting health care, ambulatory medical service and health education service. The problems of the unification of the health subcenters were indicated in indefiniteness of the service details between the workers; excessively large building hard to be effectively managed; insufficient medical instruments, inappropriation of working expenses, lack of professional training for the health education, etc. Conclusions: For further active functions of the unified health subcenters, the minimal allocation basis to appoint doctors, nurses and administrative workers to do the duty should be differentiated from the basis for a health subcenter, and the fundamental instruments needs to be expanded to improve the quality of the medical service and visiting health care service. Moreover, the unified health subcenter needs to have definite service details between the workers, and should improve the working efficiency through the development of service-related guidelines.

• Journal of agricultural medicine and community health
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• v.25 no.2
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• pp.427-440
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• 2000

A comparative study was made about health resources, medical care service statistics and public health service statistics by health subcenters at Jangdong and Jangpyung townships, Jangheung County, Chollanamdo before and after the unification of two health subcenter to improve their function. 1. While two general physicians, one dentist, 4 nurse aids arid one oral hygienist were working at two health subcenters with simple facility with examination room and public health office in 1997 prior to the unification, in 1999 after the unification of two health subcenters 14 staff including a specialist physician, a general physician, a dentist, a herb hygienist, a radiology technician and a physical therapist were working in the new health subcenters equipped with appropriate facilities in two storey building. 2. In 1997 before the unification the yearly total income of two health subcenters was 78,815 thousand won(about 14,000 won per capita) and the amount was 140,376 thousand won(about 25,000 won per capita) in 1999 after the unification. And the income was used for operation of health subcenters excluding personnel expense. 3. While 90.5% of visitors to the health subcenters came for general medical care, and 91.6% came for the revisit before the unification, after the unification 71.2% came for general medical care, 10.8% for dental care, 16.5% for oriental physician's care, 29.7% for the first visit and 70.3% for revisit. Most common problem cared for was musculoskeletal disorder like arthralgia. Average treatment cost per person per month was 9,363 won before the unification and 8,309 won after the unification. 4. Through the comparison of execution rate of public health services before and after the unification. the practice rate of most health service among target population including visiting service for chronic illness, maternal and child health service and immunization service increased after the unification. The practice rate of tuberculosis control service, hypertension control and diabetes management was a little decreased. In conclusion, continuous effort to satisfy all persons in two townships and evaluation are necessary to coincide with the spirit of unification of two health subcenters.

• Health Policy and Management
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• v.2 no.2
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• pp.57-89
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• 1992

This study is aimed both to reorient the Health net-works focused to Health Subcenters in times of development of local autonomy in Korea and to collect the fundamental data such as attitude and practice of the directors of Health Subcenter. The materials are collected from 134 out of 258 sampling directors of Health Subcenters with a questionaire by mailing(respond rate 51.9%). The major findings of this fundamental data are as follows. 1. Current average number of outpatients cared by a director of Health Subcenter is found to be 21.6. 2. The directors of Health Subcenter have little deducted hours for Public Health Programme. 3. Number of the Preventive Health Programme worked by a director of Health Subcenter is from 0 to 3. The most major group worked only 1 programme marked at 69.4%. 4. The directors of Health Subcenter express approval opinin marked at 80.2% that their qualification to appoint has to finish intern course. 5. The average diagnosis allowance a month is approximately twenty hundred thousand won. 6. Most of Health Subcenter(market at 94%) adopted a self-supporting account system. 7. The most complaining subject of directors of Health Subcenter is their working environment. The second complaining subject is governmental officier's interference. 8. The average number of outpatients cared by a director of Health Subcenter is found to be certain differentials by their marriage and the duration of employment. Some proposals of development on Health Subcenter based on the result of this research is as follows : 1. The reorganization on Health Subcenter under line of National Health Center Net-work 2. The psychological reorientation of directors of Health Sucenter and officers. 3. Autonomy management of Health Subcenter. 4. Reorientation of status on directors of Health Subcenter.

• Journal of agricultural medicine and community health
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• v.27 no.2
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• pp.35-54
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• 2002

This study was performed to investigate the task status and performance improvement plan of dental hygienists of Health Centers and Subcenters. The Data collected by self-administered Questionnaire survey of 203 dental hygienists of Health Centers and Subcenters located in Gyeongsangbuk-do were analyzed. The major results are as follows: For the degree of satisfaction in tasks, 73.9% of dental hygienists of Health Centers and Subcenters felt proud, 52.2% felt overwork, 32.0% hoped transferring to other worksite and the major reason of transferring was lack of promotion opportunity in officials of dental hygiene department. Dental hygienists received job education in addition continuous job education in last 3 years were 47.3%, 19.2% of dental hygienists performed the special dental health program for residents in last 3years. Almost half(53.7%) of dental hygienists replied that dental hygienists who were not engaged in dental health tasks should be engaged in dental health tasks. The major dental hygienic tasks performed by dental hygienic officials were support for dental treatment(41.6%). Dental hygienic officials answered that dental health tasks, school dental health program, vertical dental health program should be conducted as important tasks in order. And they replied that the most serious problem of dental hygienic tasks was not conducting dental health affairs due to 'lack of dental doctor'(40.9%), 'lack of concern for dental health tasks'(26.4%), and 'lack of budget and personnels for dental tasks'(19.0%), and the most important thing to improve dental hygienic tasks was 'posting dental hygienists in ministry of health and welfare(MOHW) and province', 'securing of budget and personnels for dental health tasks'.

• Quality Improvement in Health Care
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• v.3 no.1
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• pp.126-143
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• 1996

Background : Little work has been carried out regarding quality assessment research in a primary care setting, comparing with that of hospitals. This study aims to evaluate the process of diagnosis and management of hypertension by public health doctors on the basis of pre-established clinical guideline, and to identify several modifying factors associated with them. Methods : Hypertension was selected as the target disease, because it is a chronic disease which is of great public health importance. Self-administered questionnaires were mailed to public health doctors practicing at health centers and health subcenters across the nation. The response rate was 20.9%. The questionnaire included the diagnosis and management process such as measuring blood pressure, history taking, physical examinations, and treatment approches and potentially modifying factors such as level of training, duration of practice as a public health doctor, and education on management of hypertension. Results : Public health doctors pay little attention in measuring BP, hypertension related history taking, performing physical examination and laboratory examination. But they devoted much effort in diagnosing hypertension exactly and giving nonpharmacological treatment. Among various antihypertensive drugs, calcium-channel blockers were the most preferred agent(50.9%). Level of training, duration of practice ad a public health doctor, and education on management of hypertension made no difference on quality of care(p>0.05). Conclusion : These public health doctors showed poor compliance with the pre-established clinical guidelines, which leaves much to be desired in diagnosing and managing hypertensive patients by public health doctors. This study might be able to contribute to develop some strategies, such as educational programs, which would be able to improve the process of care in hypertensives.

• Research in Community and Public Health Nursing
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• v.10 no.2
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• pp.480-493
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• 1999

The visiting nursing service is an essential part of public health. The purpose of this study was to analyze the visiting nursing service in primary health service centers. The data were collected from visiting nurse records in Wonju City Health Center, Myun Health Center and Community Health Subcenters. The period of data collection was from April 6 to July 15, 1998. The major findings were as follows: 1. Characteristics of 36 service providers. 1) Age : Over 40 years old - 66.7% 2) Educational level: The proportion of registered nurses was 47.2% and nurse aids 52.8% 3) Career: The proportion of providers who worked over 11 years in Public Health Service was 7.8% 2. Characteristics of Subjects 1) The major health problems were cerebro vascular attack, hypertension, D. M., arthritis, gastrointestinal problems and psychiatric problems. The prevalence of chronic health problems increased with age, except for mental illness. 2) The prevalence of cancer was 4.3/1000. 3. Contents of Home Visiting Nursing Services. 1) The major service was education and counseling. 2) The other services were Direct Care(ROM exercise, wound care, physical therapy, basic nursing care etc,) as 56.5%, of the work involved Indirect Care(teaching, counseling, emotional support, etc,) 30.3%, medication - 11.7%, and referral to hospitals - 1.5%.

• Journal of dental hygiene science
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• v.9 no.1
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• pp.83-89
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• 2009

About 380 dental hygienists who were working in public health centers in 2004 joined this study with questionnaires about the evaluation of job training programs regarding oral health care. The findings are as follows. 1. As for the general characteristics of subjects including location, age and career, the dental hygienists in Public Health Subcenters outnumbered the dental hygienists in Public Health Centers, as the former accounted for 61.1 and the latter 35.3 percent. And the dental hygienists in their 36~40s made up the largest age group. The group in their 11~15 years career revealed 48.4, over 16 years career 35.7, under 10 years career group 15.9 percent, respectively. 2. The portion of certification in the respondents was 28.9 percent, as compared to the 71.1percent of non-certification. The major reasons of non-certification were not-applying(44.6%), participation rejected (29.3%). 3. Freqently requested curriculums were school based oral health program(4.42, the highest by Linkert 5 point scale), followed by oral health education(4.41), public oral health services for the toddler and for the elderly(4.04), for the disabled(3.92), oral health planning evaluation(3.85) and oral health survey& investigation(3.69). The gap between Dental hygienists at Public Health Center and Public Health Subcenter was statistically significant different(p < 0.001) in oral health survey& investigation and oral health planning evaluation.

• Journal of agricultural medicine and community health
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• v.18 no.2
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• pp.105-119
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• 1993

The purpose of this study was to evaluate the program for the control of acute respiratory infections(ARI) in children in a Korean rural area(Yonchon county). Evaluating the program, we focused on the pattern of prescription and appropriateness of antibiotics prescribed by the health personnel who had participated in the ARI Control Program. It was implemented at the primary health care setting in rural area, such as district hospital, health subcenters, and health posts. During six-months programme monitoring period, medical records were reviewed and collected data were analysed by the pediatrician, research coordinator of this study. The baseline data were collected from medical records of the same period(six months) of one year before the implementation of the ARI programme. The study results were as follow : 1. Common cold was the most prevalent disease(78.7%. 594 cases) among the all ARI cases (755 cases). The less frequent cases were bronchitis(11.9%), acute pharyngitis(5.2%), and pneumonia(1.8%). 2. Significant reduction in the use of antibiotics was observed after the programme implementation. Ninety three(15.7%) of 594 common cold cases were received antibiotics compared with 282(35.2%) of 802 in the baseline period. In the cases of bronchitis and acute pharyngitis, the reduction rates were 15.1% and 23.2% respectively compared to the baseline period. 3. Mean duration of antibiotics prescription was 1.81-1.75 days, similar to the baseline data. 4. The appropriateness rate of antibiotics prescriptions were 84.3%(common cold), 35.6% (bronchitis) and 28.2%(acute pharyngitis). In the case of pneumonia, the antibiotics prescription was compatible to the criteria developed. 5. Pediatrician prescribed antibiotics more appropriately for all cases than general practitioners in health sub-center, and nurse practitioners in health posts. 6. Antibiotics therapy was shown to be of no effect in the treatment of the all ARI cases. At the 5 and 10 days check-up of common cold cases after visits, proportion of improved patients were 58.3% in the antibiotics-used group and 51.4% in the control group. In the other cases of ARI, the patterns of response were similar to common cold. None of the differences in outcome between the antibiotics-used and control group was statistically significant. This ARI programme may have substantial a substantial impact on antibiotics use at the public health institutions(district hospital, health subcenters, health posts) which are of major domain for primary health care in Korean rural areas.

• Research in Community and Public Health Nursing
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• v.9 no.1
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• pp.89-103
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• 1998

The elderly population will increase from 5.8% in 1996 to 12.5% in 2020. The related problems of health will also become a very important issue in the future. Therefore it is important to address the problems of geriatric nursing and geriatric health. 87.6% of the aged were ill with chronic degenerative diseases in 1994. In 1995, hospital admission rates (86.8) for those aged 60 or older were higher than that (56.3) of the total age group. Such high medical utilization will increase national health costs. For the development of geriatric nursing, active nursing intervention in various settings combined with education and research should be developed. Considering the health and welfare of the aged and the present status and views in Korea, I suggest the following: First, the health needs of the elderly in the institution, must be met by a plan that fosters geriatric nurses and programmed service development. Second, health service for the residential elderly must be provided in day care centers, short stays, nursing homes and geriatric hospitals. Geriatric nursing services should be provided in home residential areas, public health centers, public health subcenters as well as having, community health practitioners in primary health care posts and home health nurses. Third, geriatric nursing curriculum must be developed adjust to situations and culture of Korea and be included in the nursing curriculum. And gerontological nurse practitioner or geriatric specialist must be fosteraged to provide the professional care for the aged. Geriatric nursing research should be also achived for geriatric nursing improvements.

• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.97-119
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• 1991

Korea has made a rapid economic development since the last three decades. This has helped Korea narrow the gap in health service differences in resource availability and in quality of care. However urban and rural differentials are still remarkable. This study has maintained that health status of rural residents is inferior to that of urban dwellers. Therefore, this study was carried out to develop policy measures for improving health services in rural areas. In order to achieve the objective of this study the authors collaborated closely and made field visits, interviews and conducted an extensive literature review regarding rural health services. The following policy options are recommended as a summary ; First, the quality of rural health personnel is a single most important factor influencing the level of rural health services. An innovative program for public health doctors to the internship and/or residency training program such as specialty board program of family medicine. Second, dissatisfaction regarding employment of public health doctors is problematic. More rational employment and deployment programs are needed to meet their personal desire. One way to do this is to make it wide open and competitive. Third this study shows how to increase physician productivity in the rural public health sector. Incentive system needs to be elaborated for the career development of rural health workers. University linked job opportunity as clinical professor is an example. Fourth, without straightening the function of health centers and subcenters, the future of rural health services is doomed to failure. Straightening primary health care is one way to enrich the program of public health facilities and reactivating the operation of health center/hospital is another. A close linkage of public facilities with private hospitals is a minimum requirement for the operation of health delivery system within a health district. Fifth, some measures are urgently required to enhance hospital services in medically underserved areas. Financial subsidy, tax exemption, long-term public loans and higher priority of health manpower deployment are some of them. Sixth, new health programs should be in tiated to meet changing needs of peoples in rural areas. Home health care program, hospice program, nursing home, residential program for the elderly are recommended.