• Title/Summary/Keyword: Public health Care Facilities

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Covariance Structure Analysis of the Influence of Social Support, Physical and Mental Health Status on Quality of Life among the Elderly at Care Facilities (요양시설 노인의 사회적지지, 신체적 및 정신적 건강수준이 삶의 질에 미치는 영향에 대한 공분산구조분석)

  • Lim, Young-A;Cho, Young-Chae
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.8
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    • pp.210-220
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    • 2017
  • This study investigated the effect of social support (MOS-SSS), and physical (ADL, IADL) and mental (CES-D, MMSE-K) function on the quality of life (WHOQOL- BREF) among the elderly at care facilities. The survey respondents were 524 elderly aged 65 and older living in 15 care facilities located in D city. Data were collected through a personal interview conducted by interviewers who visited each care facility from November 2015 to January 2016. As a result, the quality of life was significantly lower in the elderly group with lower social support, with dysfunction in ADL and IADL than in the normal range group, with depression and cognitive impairment group than in the normal range group. The quality of life had a significant positive correlation with social support, ADL, IADL and cognitive impairment, but a significant negative correlation with depression. According to the results of covariance structure analysis, physical function had a greater impact on the quality of life than mental function or social support. Lower quality of life was associated with lower physical and mental function and lower social support. Therefore, concrete measures need to be devised to enhance physical function in order to improve the quality of life among the elderly in care facilities.

An Exploratory Study of Healthcare Utilization Process among Patients with Multimorbidity (복합만성질환자의 의료이용 과정에 관한 근거이론적 탐색)

  • Yu, Soo-Young;You, Myoung Soon
    • Journal of muscle and joint health
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    • v.28 no.2
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    • pp.161-173
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    • 2021
  • Purpose: This study examined: 1) what it meant for patients to have multimorbidity 2) how they manage their illness using health care facilities, and 3) what contextual backgrounds exist regarding the health care system. Methods: This qualitative research obtained individual in-depth interviews from 22 patients. Participants were selected by purposive sampling among those who saw physicians more often than the national average from the 2013 medical-claim data. The transcribed data were analyzed using Ground theory. Results: Multimorbidity patients suffered from "chain-like serial symptoms" and "pain without a breakthrough". They expressed themselves as "indeed patients among patients", "my body is a general hospital", and "an incompletely normal person". There was a demand to resolve the anxiety arising from the situation in which the body keeps getting sicker without showing any signs of recovery. In a state of reduced social support and a lack of trust in the doctor, their desire to be healed led them to receive a temporary relief through dependence on medical institutions. Conclusion: This research recognized the desire of multimorbidity patients to seek temporary relief through dependence on medical institutions. A more patient-centered directed care plan, specific to the needs of the patients with multimorbidity is required.

Development of Eligibility Criteria for Comprehensive Medication Management Programs in Long-term Care Facilities Using RAND/UCLA Appropriateness Method (RAND/UCLA Appropriateness Method를 이용한 요양시설의 포괄적 약물관리 프로그램의 대상자 기준 개발)

  • Jang, Suhyun;Kang, Cinoo;Ah, Youngmi;Lee, Ju-Yeun;Kim, Jung-Ha;Jang, Sunmee
    • Korean Journal of Clinical Pharmacy
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    • v.32 no.3
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    • pp.260-269
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    • 2022
  • Background: Comprehensive medication management is essential to achieve safe and optimal drug use for the elderly in long-term care facilities (LTCF). This study aimed to develop eligibility criteria for "Comprehensive medication management program in LTCF" using the RAND/UCLA Appropriateness Method (RAM). Furthermore, we attempted to estimate the number of beneficiaries who met the criteria by analyzing the National Health Insurance claims data. Methods: Twelve criteria were selected initially. We composed a panel of 14 experts with expertise in long-term care. We conducted two survey rounds to reach a consensus. Rating for appropriateness and decision regarding agreement were applied per RAM. We analyzed the National Health Insurance data to estimate the number of LTCF residents who met each eligibility criterion. Results: Of the 11 items agreed upon, ten items were determined to be appropriate. In 2018, 83.6% of 165,994 residents of LTCF met one or more eligibility criteria. The largest number of subjects met the "New residents of LTCF" criterion, followed by "Take high-alert drugs" and "Chronic excessive polypharmacy." Since the items evaluated as most appropriate by the expert panel and those with a large number of subjects were similar, we confirmed the external validity of our criteria. Conclusion: It is worth noting that this is the first attempt to establish the eligibility criteria for medication management in LTCF. Further preliminary research is needed to identify the selected subjects' drug-related problems and revise the criteria according to the results.

A Basie Health Survey of the Yonsei Community Health Service Area, Seoul (연세지역(延世地域)에 대(對)한 보건기초조사(保健基礎調査))

  • Yang, Jae-Mo;Kim, Myung-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.1 no.1
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    • pp.25-36
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    • 1968
  • Introduction In order to improve medical education through the introduction of a concept of comprehensive health care of a community, an area surrounding the University Campus was chosen for the Community Health Service Project. It has been on operation for last 4 years with its major emphasis on family planning services, and maternal and child health care. The major objectives of this survey at the area are to obtain: 1) The demographic data, 2) The health need and trend of medical care, 3) The attitude and practice in maternity care to be used for further improvement of the planning and the services of the project. Population and Survey Method Out of three Dongs of the Community Health Service Area, only two Dongs namely Changchun and Yonhee were selected for the survey. Total number of households and population in the area studied was 3,683 and 21,857 respectively. An interview was performed with questionnaire schedule which was recorded by interviewers. This includes the degree of utilization of health services provided by the Community Health Service Program such as family planning, prenatal care during their last pregnancy, delivery history and complications of the delivery as well as the incidence of illnesses in general. Prior to the interview, all interviewers were trained for interviewing technique for two days. The survey was carried out during the period from October December 1967. Results 1) Demographic Data : 41.3% of the population studied were children under age 15 and only 3.5% were over 60 years of age. Crude birth rate and crude death rate of this area studied during the period of November 1966-October 1967 were 20.5 and 7.7 respectively. Infant mortality rate during the same period was 35.9. 50.4% of the 2,832 households fell into the category of middle class, 39.8% to the lower class and 9.5% to the upper class in economic condition. 19.8% of 2,832 householders had no formal education, 22.7% primary school, and 57.5% middle or higher school education. 2) Health Status and Utilization of the Community Health Service: Those who suffered from many illnesses during the month of October, 1967 were 690(4.6% of 14,891 persons). Classification of these patients into the type of disease shown respiratory diseases 27.4%, gastrointestinal diseases 18.1%, tuberculosis 10.9%, skin and genitourethral diseases 4.5% and gynecologic patients 4.5%. Only 55.9% of the patients received medical care at hospital or doctor's clinic. But among TB and gynecologic patients, 70.7% and 72.4% were treated at medical facilities. 10.6% of 2,832 householders interviewed has ever utilized the Community Health Service Program provided by the Yonsei Medical School, Classifying these clients into the type of service, 35.9% utilized the wellbaby clinic, 31.0% the family planning clinic, 14.7% the home delivery care, and the rest utilized other services such as the premarital guidance cinlic and the sanitary inspection service. 3) Maternity Care: 23.6% of 2,151 deliveries were done at medical facilities such as hospital, private clinic, while 76.4% were done at home. Acceptance rate of prenatal care was 32.6% as whole, but 49.6 of 774 women who had the prenatal care service had their deliveries at medical facility. 45.1% of total deliveries were attended by medical and or paramedical personnel. 75.8% of the deliveries of those received prenatal care were attended by medical and or paramedical personnel while only 27.8% of the deliveries of those who did not have prenatal care attended by medical and or paramedical personnel. 49.8% of deliveries of the upper class, 29.8% of the middle class and 9.9% of the lower class were attended by medical and or paramedical personnel. 6.2, 3.3% and 24.8% of mothers reported about their xeperience of edema, coma and fever during the period of trimester of pregnancy and puerperium. 4) Family Planning: The rate of practice of family planning was 27.9%. 31.7% of them were by IUD, 2.9% by oral pill, 15.2% by sterilization and the rest by traditional methods. Those women who had 3 to 4 children had highest(30.2%). Practice rate among the various methods of family planning, oral pill was the most popular method to whom had 2 or less children. In relation between the practicing rate of family planning and living standard, the upper, middle and lower class practiced 37.5, 29.4 and 19.9% respectively.

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A Financial Projection of Health Insurance Expenditures Reflecting Changes in Demographic Structure (인구구조의 변화를 반영한 건강보험 진료비 추계)

  • Lee, ChangSoo;Kwon, HyukSung;Chae, JungMi
    • Journal of Korean Public Health Nursing
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    • v.31 no.1
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    • pp.5-18
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    • 2017
  • Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

The Effect of Working Mother's Job and Parenting Stress on Child Care in Korea and Japan (한국과 일본 취업모의 직무 및 육아 스트레스가 양육행동에 미치는 영향)

  • Koyama, Yoshinori;Park, Ji-Sun;Park, Chun-Man;Nakashima, Nozomi;Nakajima, Kazuo
    • The Journal of Korean Society for School & Community Health Education
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    • v.15 no.1
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    • pp.89-103
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    • 2014
  • Objectives: The purpose of the study was to clarify the relationship between parenting, job related stress and child care using data from working mother's in Korea and Japan. Methods: In this study, we conducted a survey of 125 Korean mothers who used childcare facilities in two cities and 170 Japan mothers who used childcare facilities in two cities. The questionnaire sought information about the mother's age, age of the youngest child, family composition, mother's occupation, parenting stress, job stress, appropriate parenting behavior and child maltreatment. Based on this survey data, it was tried to reveal the effective paths between parenting stress, job stress, appropriate parenting behavior and child maltreatment in order to provide the rationale for intervention by using SEM. Results: Child care was statistically significantly affected by parenting stress and job stress for both Korean and Japanese working mother's. Conclusions: The results of the research suggest the need to establish work-life balance policies to improve the balanced lives of working mother's.

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Determinant Factors for Expenditure of the Medical Insurance Program for Self-Employeds (지역의료보험(地域醫療保險) 재정지출(財政支出)의 결정요인(決定要因))

  • Kam, Sin;Park, Jae-Yong;Yeh, Min-Hae
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.1 s.49
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    • pp.153-174
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    • 1995
  • This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

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A Field Study on Managing System of Maternity Clinic at Public Health Centers in Seoul (서울시 보건소 모성실 운영실태에 관한 현장 연구)

  • Chung, Yeon-Kang;Kwon, Young-Mi;Kim, Hee-Young
    • Research in Community and Public Health Nursing
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    • v.6 no.2
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    • pp.259-274
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    • 1995
  • The study is to grasp the problems related to operation of Maternity clinic of public health centers in seoul and needs for public health of community in relation to consumers and providers in order to improve efficiency of community public health for mothers and children. Four pregnancy woman, who receive medical care at the maternity clinic of M public health centers in seoul and understand the purpose of this study, and one nurse who works at the were the objects of this field study. Participating observation and intensive interviews were conducted to collect data. All of them were performed as necessary from time to time since December, 1994, and not during a specific period. Through an data analysis in the order of sector analysis and classification analysis, the data were classified into specific patterns and the results are the following; 1. All of the subjects were using both private hospitals and public clinics, but managing activities prior to delivery were not carried out in accordence with theories for those activities. 2. The subjects showed two types of response to utilizing maternity clinic. they answered that the advantages of the clinic were 'short waiting time for medical treatment', 'medical treatment by female doctors' and 'economical benefit.' Meanwhile, they gave negative response to the problems of 'non-implementation of delivery' 'uncleanness and insufficient facilities', 'limited time of treatment', 'lack of expertise' and 'want of public health education for materity.' 3. Problems related to operation of maternity clinic were 'lack of experts', 'irrational facility structure' and 'absolutely lack budget'. In terms of the status of managing the subjects, 'programs only aimed at attaining the central-government-assigned objects' and 'limited management before and after delivery by non-implementing delivery' were pointed out to be problems. Regarding public health education before delivery and PR relations, 'superficial public health education for maternity' and 'absence of PR programs' were named. In planning and evaluation, 'absence of autonomous planning and evaluation by the clinic itself' was a major problem in operating the clinic. 4. 'Substantial health education and PR', 'supplementation of facilities and eqipment', 'development' and supply of demanded service by the subjects', 'implementation of autonomous programs', and 'reinforcement of supplementary education' were presented as alternatives for efficient opration of maternity clinics.

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Factors related to Quality of Life in the Elderly People in Long-term Care Center (장기요양시설 노인의 삶의 질에 관련된 요인)

  • Shin, Min-Woo;Ahn, Kwon-Suk;Cho, Young-Chae
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.6
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    • pp.524-537
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    • 2017
  • This study examined the relationship between the sociodemographic characteristics, health related factors, physical functions (ADL, IADL), mental functions (CES-D, MMSE-K), oral health impact profile (OHIP-14), and the quality of life (WHOQOL-BREF) for the elderly in long-term care facilities. The research was conducted in 602 facility allowance beneficiaries authorized to be eligible for long-term care in long-term care facilities through personal interviews using a structured questionnaire from May 1 to June 30, 2016. As a result, the quality of life was lower among females than males in the group receiving government subsidies than the group whose livelihood was maintained by themselves or their children, in the group with a longer period of care, in the drinking group than the non-drinking group, in the group with irregular exercise than the regular exercise, in the group with irregular meals than regular meals, in the group with poor subjective health conditions than good subjective health condition, in the group with a smaller number of daily toothbrushing, in the group with xerostomia than no xerostomia, in the group with a lower OHIP-14, in the group with a lower ADL and IADL, and in the group with a lower CES-D and MMSE-K. In particular, the quality of life was affected more by health-related factors and CES-D and MMSE-K than by other factors. Therefore, it is necessary to make efforts to prevent depression and cognitive impairment, including health-related behavior, with the objective of improving the quality of life for the elderly in long-term care facilities.

Current Status and Factors Related to Physical Activity of Older Nursing Home Residents with and without Dementia: Effects of Individual and Institutional Characteristics (장기요양시설 거주노인의 치매 여부에 따른 신체활동수준과 관련 요인: 개인 및 기관 특성의 영향)

  • Chun, Seungyeon;Kim, Hongsoo
    • Health Policy and Management
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    • v.28 no.4
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    • pp.392-401
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    • 2018
  • Background: Physical activity (PA) is critical for maintaining the health and well-being of older people in community and also institutional settings. The purpose of this study was to examine the current status of PA and related individual and organizational factors among older nursing home residents with and without dementia. Methods: This is a secondary data analysis study of a nationwide survey of 92 long-term care facilities in Korea, and the study sample includes older residents with dementia (n= 753) and without dementia (n= 480). The level of PA was measured by PA time and whether or not residents had an outdoor activity over the past 3 days. Multi-variate, multi-level analyses were conducted. Results: More than half of the sample in both groups had no or less than 1 hour of PA. About one out of four older people in our sample had no outdoor activity over the past 3 days regardless of whether or not they had dementia. Among the people without dementia, several individual-level factors were associated with PA, including dependency for activities of daily living, social activity participation, and caregivers' belief in the functional improvement of residents. Unlike the non-dementia group, individual- and organizationallevel factors including staffing level and having the relevant equipment for PA were associated with PA among those with dementia. Conclusion: Study findings provide evidence on the lack of PA among older nursing home residents, and the importance of institutional capacity with regard to human resources and physical equipment for promoting PA among people with dementia, in particular. Policies and supports are needed to promote the implementation of healthy aging programs including PA for older nursing home residents. Such programs should be person-centered with consideration to the physical and cognitive status of individual residents.