• 대한예방한의학회지
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• 제19권1호
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• pp.35-46
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• 2015

Objective : This study aims to investigate legal and regulatory status of traditional and complementary medicine (T&CM) focusing on regulation on health practitioners and health practice in 33 countries. Method : 33 countries were selected based on several factors such as interest of Korean medical doctors, strategic importance, and distribution over the world. The questionnaire was distributed to Korean embassies in 33 countries in March 2014 through Ministry of Foreign Affairs, and the answers from those countries were collected from April to September. 24 countries that provided sufficient information were included in the analysis. Results : 18 countries have law or regulation on T&CM. Only five countries regulate T&CM practitioners as medical personnel or health practitioner by law, and 12 countries have regulation on license or certificate. Half of 24 countries recognize license of T&CM practitioners issued abroad. There are nine countries that recognize T&CM practice as medical practice, and four of them regulate acupuncture as medical practice by western medical doctors or a few health practitioners recognized by the government. There are six countries that do not recognize T&CM practice as medical practice by law, but regulate it as practice that affect public health, and these countries have law or regulation on T&CM. Conclusion : As T&CM have great impact on public health, many countries have recently legislated law or regulation on T&CM. Rapid change in regulatory status of T&CM affects globalization of Korean medicine. Thus, development of timely strategies will be essential for it.

• Journal of Preventive Medicine and Public Health
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• 제52권5호
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• pp.323-332
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• 2019

Objectives: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. Methods: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. Results: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. Conclusions: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

• 한국간호교육학회지
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• 제5권1호
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• pp.97-105
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• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

• 의료법학
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• 제11권2호
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• pp.113-145
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• 2010

Nowadays, it is surely the quack which stands as one of the most controversial, problematic. the quack has been a consistent target of contested public protection strategies in the past few centuries in many countries. Recently, complementary and alternative medicine (CAM) is increasingly utilized and accepted by patients and providers throughout the health care system in the world, most accounts attribute this growing acceptability to the shortcomings of conventional medicine, the appeal of CAM's core beliefs, and the growing body of research indicating that CAM actually works. However, the governments of western countries have called for measures to ensure that the public are protected from incompetent and dangerous practitioners. Common to these controversies has been a suggestion to ban, exclude or limit the medical practice of those deemed to be damaging rather than improving the health of individuals as a measure of public protection. This article describes the experiences of western counties' health care system which is moving in a more pluralistic direction. By examining the ways in which regulatory efforts in the countries have come to address what is invariably described as a growing interest in CAM, this study show how the problem of CAM/quackery today is increasingly located in an ethical field of practitioner competency, qualifications, conduct, responsibility and personal professional development, regardless of the form of therapy in question. Many countries developed a series of measures and strategies to contain the acceptance of CAM groups, such as insisting on scientific evidence of safety and efficacy, resisting integration of CAM with conventional medicine and opposing government support for research and education. In a sense, those countries' movements serve to protect not only patients, but the dominant position of medicine and its allied professions, and to maintain existing jurisdictional boundaries within the healthcare system. The popular support for CAM will require that health professional stakeholders continue to address the challenges this poses, and at the same time protect their position at healthcare system. To cope with the quack, professional body, public sector and health authorities should consider the safety of consumers of healthcare and responding to the demands of the community for CAM therapies as well as the claims of the established healthcare professions. Finally, some implications for future health care were suggested.

• 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.

• 한국농촌간호학회지
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• 제3권2호
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• pp.96-103
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• 2008

Purpose: The Study of vaccination for infants and children business in Primary Health Care Posts from 1980 to 2009. Method: look for national essential vaccination look for the change of vaccination by the times in Primary Health Care Posts and the rate of vaccination for infants and children by a administrative report statistics survey of a vaccine delivery system of Public health care institutions investigation about assistance details of vaccination cost in order to raise the rate of vaccination for infants and children. Results: In 1980s, there are many infants and children management object, but now there are rapidly decreasing infants and children management subject of a Primary Health Care Post because of rural exodus phenomenon of 1990's and a low birthrate of 2000's. Currently, the infants and children that registed, and managed to a Primary Health Care Post is most multi-cultural families. A multi-cultural family assistance program is provided these infants and children to the objects. Conclusions: Infant vaccination execution in Primary Health Care Posts showed to high vaccination rate because the prevention of vaccination delay or omission of the interior child who raised geographical accessibility to object sons nowadays it difficult to management of transportation of vaccine and storage management for a little shroud objects limited and management of inoculation business in quality. A main problem is as follows. There are a little vaccine transportation, trouble of proper temperature maintenance of a storage process, and having a lot of vaccine abolition as a little objects, educational training shortage of health care practitioner regarding to execute an inoculation. Therefore, vaccination business needs measures for management in quality in Primary Health Care Posts.

• 한국보건간호학회지
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• 제29권3호
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• pp.594-607
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• 2015

Purpose: The purpose of this study was to test the effectiveness of a weight reduction program on the body weight, BMI, self-esteem, and self-efficacy of chronic mentally ill persons. Methods: A nonequivalent control group pre-posttest design was employed. Participants were 46 chronic mentally ill persons who agreed to participate in this study, and were assigned to an experimental group (n=23) and a control group (n=23). The weight reduction program was modified by the author, based on the Wellness program (Lilly Pharmaceutical Company, 2003), Lee (2007) and Kim (2013). Data analysis with frequency, ${\chi}^2$-test, Fisher's exact test, and t-test was performed using SPSS/Win 18.0 version. Results: The results showed a significant decrease in body weight and BMI and an increase in self-esteem in the experimental group compared to the control group. Conclusion: The weight reduction program had a positive effect on body weight, BMI, and self-esteem. Evaluation of drug compliance and vocational rehabilitation is recommended for long term effect of the program and conduct of further studies will be required for use of various resources for self-efficacy for inclusion in drug education in a program for improved health outcome.

• 보건행정학회지
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• 제3권2호
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• pp.100-129
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• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• 한국직업건강간호학회지
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• 제7권1호
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• pp.97-114
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• 1998

The occupational health services for the minor enterprises are poor comparing with that of large enterprises in Korea. In 1997, Korean government announced officially the law on joint employment system of occupational health practitioners to solve the problems. This study is to develop the model on the joint employment system of occupational nurse practitioners for minor enterprises in Korea based on the opinions of occupational health nurses (OH Ns). The data were collected by questionnares from October to November in 1997. The number of subjects was 210 occupational health nurses who had participated the mandatory nursing education program provided by the Korean Occupational Health Nurses Association(KOHNA). The response rate was 47.1%. The contents of questionnaires were general characteristics, occupational & job characteristics of OHNs, and the views on the joint employment system. The SAS-PC program was used for the statistical analysis. The results were as followed, (1) The proper number of industies was 3 and the appropriate number of workers was 448 for one joint employed occupational nurse practitioner (J EONP). (2) 44.7% of the OHNs wanted that the Ministry of Labor monitored the way and content of contraction b/w JEONP and minor emterprises, 82.6% of the OHNs wanted that KOHNA managed the employment informations. (3) The OHNs of occupational health agencies showed more positive attitude than the OHNs of private industries on the joint employment system. (4) 88.3% of the OHNs wanted the education training for JEONP. Especially in occupational hygiene and safety control. (5) The OHNs expected the role expansion of Occupational Health Nursing by JEONP system. At the same time they worried the adverse effects. For the successful execution of this system, it is necessary the cooperation among the Ministry of Labor, KOHNA, the minor enterprises, and the OHNs.

• Journal of Preventive Medicine and Public Health
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• 제24권2호
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• pp.171-180
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• 1991

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The mar results were as follows. First, physicians were more prevalent $35{\sim}44$ group (30.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization,'city (78.0%) in geographical location. Age group of 35-54 and specialist were mere prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatients load of all physician were 77.1 persons on average. Age group of $35{\sim}44$ had the most outpatient load (90.3 persons) among all age group, $6{\sim}10$ years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factors-number of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.