• Journal of Preventive Medicine and Public Health
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• 제20권2호
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• pp.287-300
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• 1987

Island regions suffer from a shortage of health care in part because they are less developed, they cover a widespread area relative to the population, and due to transportation barriers. The purpose of this study was to assess the level of illness and the magnitude of medical care utilization, and to investigate the determinants of utilization in these area. The data were collected by means of a household survey conducted from February 16 to 25, 1987 on S islands which were selected in consideration of the size of the population, the distance from the main land, and the distribution of health care facilities. The household response rate was 89.1% (491 of 551 households), and 1971 persons were surveyed. The major findings of this study are as follows: 1) The morbidity rate of the island inhabitants was 27.7% during the two weeks, and 25.5 chronic illnesses and 9.1 acute illnesses per 100 persons, were noted. Differences in the magnitude of illness were statistically significant by sex, age, education, and family size. 2) The magnitude of total ambulatory carl utilization was 16.8 visits per 100 persons during the two weeks, which was less than that of other regions; and differences in the magnitude of total ambulatory care were statistically significant by sex, age, education, occupation, and family size. 3) Unmet needs were classified as 56.0% in chronic illnesses and 19.6% in acute illnesses; and differences in unmet needs were statistically significant by sex, age, education, occupation, income, and family size. 4) Statistically significant determinants in medical care utilization included the frequency of acute illness and chronic illness, and income in total utilization; the frequency of chronic illness and acute illness, and medical care insurance in physician visits. 5) According to the results of the path analysis, need factors had the greatest effect on utilization, and predisposing factors had more indirect effects through enabling or need factors than direct effects.

• 농촌의학ㆍ지역보건
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• 제21권2호
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• pp.231-241
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• 1996

The estimation of medical care status and the planning of health service program should be done according to each community resident's socio-medical background and public health service. In this point, it is most necessary to be set the exact and new socio-economic statistics data in Nepal, one of the worst countries in national health status. We surveyed 668 house, 3,425 residents in Dolka area, Nepal from January 25th to February 1st, 1995. 1. In personal characteristics, the ratio of men and women was similar, the person who were below 19 years old were 28.1% and the single were 52.4%. The illeterate person were 50.3% and the lower group in economic status which had been estimated by interviewers were 46.9%. 2. In sanitational characteristics, the person who used stream water or rainwater to drink were 42.2% and the person who always boiled water to drink were only 8.3%. The person who had not toilet in their house were 67.3% and the lower group in sanitational status which had been estimated by interviewers were 61.8%. 3. The prevalence rate of illness during the last one month were 8.6% and the chronic were 26.1% and the acute were 72.5%. The distribution of sickness symptom were headache, fever and joint pain in order and the person who took no medical treatment among the sick were 37.0%. The patterns of medical utilization were public health center, hospital and pharmacy in order. 4. Illness prevalence was significantly related to sex, age, merital status and educational experience. The residents who were women, 40 years old or more, married and had not educational experience were apt to take illness. 5. Medical utilization was significantly related to educational experience, job, distance from home to medical facilities and economic status. The person who had educational experience, were officer workers or merchants, lived near by medical facilities and had higher economic status took medical treatment very well.

• 농촌의학ㆍ지역보건
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• 제28권2호
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• pp.1-14
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• 2003

이 연구는 농촌지역 정신보건의료서비스의 필요도와 공급수준을 파악하고 일차정신보건시설로서 보건소가 운영하는 정신보건사업을 평가하고자 하였다. 필요도는 유병률과 정신보건서비스 이용률로 한정하여 2001년도에 보건복지부가 주관하여 실시한 정신질환 실태 역학조사 결과를 이용하여 도농간 차이를 비교하였다. 공급수준은 입원 및 요양 병상수와 일차정신보건의료시설의 기초자치 단체별 설치율로 한정하여 전자는 2002년도에 보건복지부 산하 지역사회 기술지원단이 작성한 보고서 결과내용 중 일부를 발췌하였고 후자는 보건복지부의 2003년도 정신보건사업 안내서와 정신보건의료기관 총람의 내용을 토대로 재구성하였다. 농촌지역의 보건소 정신보건사업을 평가하기 위하여 2002년도에 각 기초자치단체가 중앙에 제출한 제3기 지역보건 의료계획서들 중 농촌형지역과 도농복합형지역으로 구분하여 각각 중앙 및 광역자치단체 정부의 지원 여부에 따라 지원한 경우 1-2개, 지원하지 않는 경우 광역자치단체별로 각각 2개소를 무작위 추출하여 정신보건사업내용부문을 사업대상 및 등록, 구조, 과정으로 나누어 정신보건사업안내서에 제시한 기준을 가지고 평가하였고 담당자들이 작성한 정신보건사업의 문제점들을 분석하였다. 이 연구는 2003년 4월 1일부터 5월 10일까지 이루어졌고 그 결과는 다음과 같다. 첫째, 니코틴 장애를 제외한 평생유병률과 일년유병률은 도시지역이 24.9%, 13.2%, 농촌지역이 28.2%, 17.7%이었으며 정신분열증, 주요우울증, 불안장애, 알코올 사용장애 등 주요 정신질환 역시 도시보다 농촌지역이 더 높은 것으로 나타났다. 또한 지난 일년간 정신보건의료서비스 이용률은 전체적으로 8.9%에 불과하였다. 둘째, 입원 및 요양 병상수는 2001년 현재 인구 천명당 0.97병상이며 요양시설을 포함할 경우 1.27병상으로 세계 보건기구가 권장하는 인구 천명당 1.0병상, 그리고 병상 감소정책을 추진하고 있는 유럽이 0.93병상임을 고려할 때 양적으로 부족하지는 않다. 그러나 광역자치단체간 편차가 큰 것으로 나타났는데 서울, 인천, 울산 등 대도시지역이 충북, 충남, 경남, 전남지역의 1/6내외수준이었다. 셋째, 일차정신보건의료시설의 기초자치단체 충원율을 살펴보면, 정신과 의원은 광역시 및 특별시형은 100%인 반면 농촌형지역 89곳 중 15곳(16.9%)만이 설치되어 있었으며 사회복귀시설은 전반적으로 낮았으며 농촌지역의 충원율이 7.9%로 가장 낮은 것으로 나타났다. 보건소 정신보건사업에 대한 중앙 및 광역자치단체의 지원율이 광역시 및 특별시형이 42%인 반면 농촌형지역은 22.5%인 것으로 나타났다. 다섯째, 농촌형지역과 도농복합형지역 모두에서 지원을 받지 않은곳이 자체예산을 추가로 확충하지 않아 사업인력 및 예산이 매우 취약하고 중앙정부가 제시하는 기본사업에 대한 충실도가 매우 낮은 것으로 나타났다. 이상의 결과를 종합해볼 때 농촌지역이 도시지역에 못지 않게 정신보건의료서비스에 대한 필요도가 높으나 서비스 이용률은 매우 낮았으며 도시지역에 비해 농촌지역의 일차정신보건의료시설들이 매우 부족한 것으로 나타났다. 또한 일차정신보건의료시설로서 보건소가 도시지역 보다 농촌지역에서 더 중요한 역할을 수행해야 하나 중앙의 지원율은 오히려 농촌지역 보다 도시지역이 더 높았고 지원을 받지 않는 보건소의 정신보건사업프로그램은 매우 형식적으로 진행되고 있었다. 앞으로 중앙정부는 일반의료서비스에 있어서 농어촌의료서비스 개선정책을 추진하듯이 정신보건정책에 있어서도 이러한 고려가 필요하다.

• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.311-329
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• 1996

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview Survey performed by the Korean Institute of Health & Social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions ; There were more elderly people over the age of 65: unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionaly, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only. However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제26권3호
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• pp.27-35
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• 2020

Purpose: A solid system in the process of establishing guidelines can increase social acceptance and utilization. The paper aims to comparatively analyze the system in which guidelines for health care facilities in the US, Australia, and the UK and suggest implications for Korea. Method: It conducted literature analysis of the system in the framework of composition, governance, and procedure for the Facility Guidelines Institute's Guideline for US, Australia's Australasian Health Facility Guidelines for Australia, and Health Building Notes for UK. Results and Implications: First, in terms of composition, the guidelines for health care facilities can be divided into composition by space and composition by issue. It is proposed to establish a system that space and issues are clearly separated, such as Australia's AusHGF, and complete it step by step. Second, in terms of governance, despite the fact that the medical supply is privately oriented, the medical system is controlled by the government in Korea. Therefore, it is suggested to form a separate organization in the public sector that establishes, researches, and revises the guideline that will serve as a focal point for experts in various fields to participate. Third, in terms of procedure, it is suggested to establish a guideline that reflects the experiences and demands of consumers by clearly organizing procedures including collecting opinions.

• 농촌의학ㆍ지역보건
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• 제27권1호
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• pp.143-153
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• 2002

경상북도 일개면 지역에 거주하는 65세 이상 재가노인 355명을 대상으로 방문보건의료 요구도를 알아봄으로써 향후 보건기관의 효율적이고 효과적인 방문보건의료서비스 제공방안의 기초자료를 제시하고자 하였다. 주관적 건강상태는 64.5%가 허약하다고 하였고, 저ADL과 저IADL이 각각 14.1%, 14.9%였다. 의료인의 도움을 받아야할 건강문제가 있다고 응답한 노인이 73.5%이었는데, 성, 연령, 결혼상태, 의료보장상태, 직업유무, 경제적 상태, 치료여건, 주관적 건강상태, 일상생활수행정도, 수단적 일상생활수행정도에 따라 차이가 있었다(p<0.05). 의료인의 도움을 받아야 할 건강문제가 있다고 느끼는 노인의 주관적인 방문보건의료 요구도는 19.5%였다. 방문보건의료 요구도는 75세 이상인 경우(p<0.05), 직업이 없는 경우(p<0.01) 유의하게 높았고, 가족이 화목하지 않을수록, 주관적 건강상태가 허약한 경우, 저 IADL인 경우 유의하게 높았다(p<0.01). 방문보건의료를 받기를 원하는 경우 이유는 돌봐줄 사람이 없어서가 64.7%로 가장 높았고, 거리가 너무 멀어서(지역적 문제)가 23.5%로 그 다음이었다. 제일원하는 방문보건의료서비스는 투약이 82.3%로 가장 높았다. 방문보건의료를 원하지 않는 경우 이유는 거동이 가능하므로 60.0%, 의사와 직접 만나기를 원하므로 25.7%의 순이었다. 방문보건의료 요구여부를 종속변수로 한 다중 로지스틱 회귀분석 결과, 가족이 화목하지 않을수록, 주관적 건강상태가 허약할수록 방문요구도가 높았다(p<0.05).

• 지역사회간호학회지
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• 제28권4호
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• pp.513-523
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• 2017

Purpose: We evaluated the psychometric properties of a questionnaire on the acceptance of the quality improvement information system (QIIS) among long-term care workers (mostly nurses). Methods: The questionnaire composes of 21 preliminary questions with 5 domains based on the Technology Acceptance Model and related literature reviews. We developed a prototype web-based comprehensive resident assessment system, and collected data from 126 subjects at 75 long-term care facilities and hospitals, who used the system and responded to the questionnaire. A priori factor structure was developed using an exploratory factor analysis and validated by a confirmatory factor analysis; its reliability was also evaluated. Results: A total of 16 items were yielded, and 5 factors were extracted from the explanatory factor analysis: Usage Intention, Perceived Usefulness, Perceived Ease of Use, Social Influence, and Innovative Characteristics. The five-factor structure model had a good fit (Tucker-Lewis index [TLI]=.976; comparative fit index [CFI]=.969; standardized root mean squared residual [SRMR]=.052; root mean square error of approximation [RMSEA]=.048), and the items were internally consistent(Cronbach's ${\alpha}=.91$). Conclusion: The questionnaire was valid and reliable to measure the technology acceptance of QIIS among long-term care workers, using the prototype.

• 한국의료질향상학회지
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• 제5권2호
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• pp.176-189
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• 1998

This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.

• 보건교육건강증진학회지
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• 제11권2호
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• pp.146-159
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• 1994

The conecpt of hospice care for the terminally ill is a development of relatively modern times, although it has its origins in antiquity. The hospice will be able to handle progressively more and more patient, to the limit of its resources. The purposes of this study were to review of demand and issues of the hospice care programes and to recommand the hospice care approaches in south Korea that using the book-review method. At this point, although at present there is a general unawareness of hospice throughout Korean society, the public will become gradually aware of hospice. This will thus aid the development of hospices. Awareness will come about because of the educational efforts of medical schools, nursing schools, allied health training programs, practicing hospice care giver, universities, and others interested in hospice education. At present, there are many issues of the hospice care program that are hospice resources problems of manpower, facilities, finances, and cost of hospice services, quality of care, and ethics. Additional studies are needed to determine the most efficacious organizational hospice models for varying conditions. They will insist upon reasonable regulatory agency regulations that will promote the hospice idea and. permit adequate remuneration for services provided. More research is needed on health professionals', patients', and others' attitudes towards death.

• Journal of Preventive Medicine and Public Health
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• 제56권4호
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• pp.319-326
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has increased the workload of healthcare workers (HCWs), impacting their health. This study aimed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and identify factors associated with poor sleep among HCWs in Vietnam during the COVID-19 pandemic. Methods: In this cross-sectional study, 1000 frontline HCWs were recruited from various healthcare facilities in Vietnam between October 2021 and November 2021. Data were collected using a 3-part self-administered questionnaire, which covered demographics, sleep quality, and factors related to poor sleep. Poor sleep quality was defined as a total PSQI score of 5 or higher. Results: Participants' mean age was 33.20±6.81 years (range, 20.0-61.0), and 63.0% were women. The median work experience was 8.54±6.30 years. Approximately 6.3% had chronic comorbidities, such as hypertension and diabetes mellitus. About 59.5% were directly responsible for patient care and treatment, while 7.1% worked in tracing and sampling. A total of 73.8% reported poor sleep quality. Multivariate logistic regression revealed significant associations between poor sleep quality and the presence of chronic comorbidities (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.17 to 5.24), being a frontline HCW directly involved in patient care and treatment (OR, 1.59; 95% CI, 1.16 to 2.16), increased working hours (OR, 1.84; 95% CI,1.37 to 2.48), and a higher frequency of encountering critically ill and dying patients (OR, 1.42; 95% CI, 1.03 to 1.95). Conclusions: The high prevalence of poor sleep among HCWs in Vietnam during the COVID-19 pandemic was similar to that in other countries. Working conditions should be adjusted to improve sleep quality among this population.