• 제목/요약/키워드: Status of National health insurance

검색결과 470건 처리시간 0.025초

약물군-약물군 조합으로 도출한 약력학적 기전의 추가 병용금기성분 (Pharmacodynamic Drug-Drug Interactions Considered to be Added in the List of Contraindications with Pharmacological Classification in Korea)

  • 제남경;김동숙;김주연;이숙향
    • 한국임상약학회지
    • /
    • 제25권2호
    • /
    • pp.120-129
    • /
    • 2015
  • Objectives: Drug utilization review program in Korea has provided 'drug combinations to avoid (DCA)' alerts to physicians and pharmacists to prevent potential adverse drug events or inappropriate drug use. Seven hundred and six DCA pairs have been announced officially by the Ministry of Food and Drug Safety (MFDS) by March, 2015. Some DCA pairs could be grouped based on the drug interaction mechanism and its consequences. This study aimed to investigate the drug-drug interaction (DDI) pairs, which may be potential DCAs, generated by the drug class-drug class interaction method. Methods: Eleven additive/synergistic and one antagonistic drug class-drug class interaction groups were identified. By combining drugs of two interacting drug class groups, numerous DDI pairs were made. The status and severity of DDI pairs were examined using Lexicomp and Micromedex. Also, the DCA listing rate was calculated. Results: Among 258 DDI pairs generated by the drug class-drug class interaction method, only 142 pairs were identified as official DCA pairs by the MFDS. One hundred and four pairs were identified as potential DCA pairs to be listed. QT prolonging agents-QT prolonging agents, triptans-ergot alkaloids, tricyclic antidepressants-monoamine oxidase inhibitors, and dopamine agonists-dopamine antagonists were identified as drug class-drug class interaction groups which have less than 50 % DCA listing rate. Conclusion: To improve the clinicians' adaptability to DCA alerts, the list of DCA pairs needs to be continuously updated.

가정산소치료의 보험급여 실시 이후 처방 실태: 다기관 조사 -만성기도폐쇄성질환 임상연구센터 제3세부과제 만성기도폐쇄성질환 진료지침 개발/보급 연구- (Long-term Oxygen Therapy for Chronic Respiratory Insufficiency: the Situation in Korea after the Health Insurance Coverage: a Multi-center Korean Survey -Study for the Development and Dissemination of the COPD Guidelines, Clinical Research Center for Chronic Obstructive Airway Disease-)

  • 박명재;유지홍;최천웅;김영균;윤형규;강경호;이승룡;최혜숙;이관호;이진화;임성철;김유일;신동호;김태형;정기석;박용범
    • Tuberculosis and Respiratory Diseases
    • /
    • 제67권2호
    • /
    • pp.88-94
    • /
    • 2009
  • Background: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. Methods: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. Results: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3${\pm}$13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56${\pm}$0.68 L/min at rest, 2.08${\pm}$0.91 L/min during exercise or 1.51${\pm}$0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18${\pm}$10.48% and 91.64${\pm}$7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85${\pm}$6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414${\pm}$15,618 won/month and 40,352${\pm}$36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). Conclusion: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

서울지역 의료기관의 임상영양서비스 현황조사 (Clinical Nutrition Service at Medical Centers in Seoul)

  • 김혜진;김은미;이금주;이정주;임정현;이정민;전현정;이해영
    • 대한영양사협회학술지
    • /
    • 제17권2호
    • /
    • pp.176-189
    • /
    • 2011
  • The purpose of this study was to investigate the status of clinical nutrition services at various medical centers in Seoul, Korea. A questionnaire was distributed to the departments of nutrition at 44 hospitals in Seoul on July 2009. Nutritional screening carried out at a rate of 59.1% at the medical centers, and a significant difference was found according to the type of center, from 100% in tertiary hospitals to 18.8% in normal hospitals. On annual average, the numbers of inpatients, inpatients for malnutritional screening, inpatients with malnutrition, and inpatients for malnutrition management were 15,169.5, 10,870.9, 2,224.8, and 1,546.2, respectively. On average the group nutrition education was done 36.1 times/year for diabetes, 8.2 times/year for cancer, and 1.9 times/year for renal disease, and the numbers of participants 423.1, 95.1, and 31.5, respectively. On average the individual nutrition education of inpatients with diabetes was done 135.4 times/year for ordered-type, and 119.3 times/year for unordered-type, 106.2 times/year for paid-type, and 148.5 times/year for unpaid-type. The mean fee for education and counseling was the highest for peritoneal dialysis (73,090.9 won) but the lowest for heart disease (23,609.1 won). On average the individual nutrition education of outpatients with diabetes was done 234.6 times/year for ordered-type, and 2.5 times/year for unordered-type, 204.4 times/year for paid-type, and 32.7 times/year for unpaid-type. The mean fee for education and counseling was also the highest for peritoneal dialysis (63,500.0 won) but the lowest for heart disease (21,336.4 won). To implement more effective clinical nutrition service, a national medical insurance imbursement policy should be urgently instituted such that diseases left as unpaid are covered by health insurance, including all nutrition-related disease.

재가암환자 요구도 조사 (Need Assessment of Home-based Cancer Patients)

  • 김태숙;양병국;정은경;박노례;이영숙;이영성;이석구;김영택;윤영호;허길자
    • Journal of Hospice and Palliative Care
    • /
    • 제2권1호
    • /
    • pp.36-45
    • /
    • 1999
  • 목적 : 우리나라의 주된 사망원인인 암은 최근 들어 진단기술의 발전과 치료방법의 개선으로 전점 만성화되고 있어 결과적으로 집에서 치료받고 있는 재가암환자의 수가 증가추세에 있다. 그러나 지속적이고 체계적인 암환자 관리체계의 미비로 많은 환자들이 적정한 보건의료서비스를 받지 못하고 방치되고 있는 실정이다. 본 연구는 재가암환자의 삶의 질을 높이고 가족의 부담을 줄여주기 위한 지역사회 재가암환자 관리체계를 개발하기 위한 전단계로서 재가암환자의 서비스 요구를 파악하고자 한다. 방법 : 본 연구는 재가 암환자와 환자를 주로 돌보고 있는 가족을 대상으로 그들이 겪고 있는 어려움과 보건의료 분야의 도움을 필요로 하는 요구를 직접 면접 조사를 실시하여 조사하였다(연구대상, 중앙암등록본부 등록 환자, 455명). 결과 : 1) 암환자의 가장 중요한 증상인 통증조절에 대한 만족도는 경증 환자에서는 25.5%, 중증환자의 경우에는 46.5%가 불만이라고 응답하여 만족스러운 통증조절이 안되고 있었다. 2) 재가 암환자 및 보호자에 대한 요구도 조사결과를 보면 가장 필요한 도움으로는 경제적인 도움, 통증 및 증상조절 의료에 대한 정보제공 및 상담이었다. 3) 기본간호에 대해서는 간호필요율에 대한 충족율이 대부분 $20{\sim}30%$ 대로 낮았다. 특수간호의 경우에는 요구도가 있는 재가암환자가 많지 않았으며(5% 이내), 기본간호에 비해 간호충족율이 높았으나, 여전히 50% 정도로 낮아, 충분한 서비스가 충족되고 있지 않았다. 결론 : 재가암환자들의 서비스 요구도를 분석한 결과 암환자들이 충분한 통증 및 증상조절이 이루어지지 않고 있으며, 기본 및 특수간호의 충족률이 매우 낮은 실정이다. 향후에 재가암환자의 삶의 질을 높이고 가족의 부담을 줄여주기 위한 재가암환자 관리체계를 개발이 필요하다.

  • PDF

노인요양시설의 산림복지서비스 인프라 및 제공 실태 (An Analysis of Infrastructure and Provision of Forest Welfare Service in Nursing Homes for the Elderly)

  • 이인숙;김성재;방경숙;이윤정;김미주;문효정;연평식;하이얀;진영란
    • 한국산림휴양학회지
    • /
    • 제22권4호
    • /
    • pp.59-69
    • /
    • 2018
  • 우리나라 노인요양시설의 산림복지서비스 인프라 및 서비스 실태, 관련 인식을 조사하여 산림복지서비스 활성화 방안을 제시한 횡단적 조사연구이다. 전국 노인요양시설을 대상으로 2016년 8월 한 달간 우편설문조사를 통해 수집한 123개 기관의 설문지를 분석하였고, 응답자는 대부분 원장 혹은 사무국장이었다(75.0%). 복합건물의 일부 층을 사용 중인 노인요양시설(16.3%)은 시설 내에 산림복지서비스 인프라를 갖추기 힘들 것으로 사료되고, 인근에 숲이 없는 경우(약 30%)와 숲이 있더라도 휠체어나 경사로가 없는 경우가 많아 이용에 제약이 많았다. 노인요양시설 운영자들도 산림복지서비스가 노인에게 긍정적인 효과가 있다고 인식하지만, 장기요양보험 급여의 필수항목은 아니고, 비용과 노력이 많이 소요되면서도 낙상, 이식증 등 사고위험이 있어 수행하지는 못하고 있었다. 국민건강보험공단이 노인요양시설을 평가할 때, 숲 등 산림치유적 요소를 갖추었는지를 평가할 필요가 있다. 시설 내 정원에 화장실 접근성을 높이고, 시설 인근 숲에 휠체어 진입이 가능한 통로와 리프트 이동로, 안전손잡이를 설치하는 등 산림복지서비스가 가능한 환경으로 조성할 필요가 있다. 또한, 정부는 노인요양시설 산림복지서비스 가이드라인을 개발 보급하여 시설 내외부에서 간편하게 따라할 수 있도록 지원할 필요가 있다. 이러한 노력을 통해 생의 마지막 단계에 있는 노인요양시설 입소노인에게 신체적 정신적 편안함과 적절한 인지자극을 줄 수 있을 것이다.

유전자 치료를 받는 암 환자가 지각하는 사회적 지지와 삶의 질과의 관계 연구 (A Study of the Relationship Between Perceived Social Support and Quality of Life of Cancer Patients receiving Gene therapy)

  • 장미경;김경희;정연강
    • 지역사회간호학회지
    • /
    • 제8권1호
    • /
    • pp.74-88
    • /
    • 1997
  • The purpose of this study was to identify the relationship between perceived social support and the quality of life of cancer patients receiving gene therapy. The subjects for this study were 50 cancer patients receiving gene therapy at two general hospital in Seoul. The data were collected during the period from October 14, 1996 to November 11, 1996. The perceived social support was measured by the family support scale made by Hyun Sook Kang, by the medical support of life scale developed by Ok Soo Kim. The quality of life scale developed by Bang-Whal-Ran was used, among the questionnaire, physical factors was developed by U.S.A National Conference on Cancer Nursing. The data was analysed by the SAS statistical program. Percentile, means and standard deviations, t -test, ANOVA, Scheffe test, Pearson correlation were utilized for analysis. The results of this study were as follows. 1. The mean score of the perceived social support of the subjects was 83.66, the item score was 3.8. 1) The mean score of the perceived family support of the subjects was 44.96, the item mean score was 4.5. 2) The mean score of the perceived professional medical support of the subjects was 38.70, the item mean score was 3.2. 2. The mean score of quality of life of the subjects was 120.38, the item mean score was 3.17. For each factor in quality of life scale, the mean score was follows: for attitude toward life, 3.95, for familial relationship and financial status, 3.53, for social activity 3.24, for emotional status, 3.08, for healthy perceptive, 2.90, for physical symptom, 2.80. 3. The result of the analysis of the relationship between perceived social support and quality of life showed a positive correlation(r=.4853, p=.0004). Therefore, the higher the perceived social support of the patients, the higher the quality of life. 1) The result of the analysis of the relationship between perceived family support and quality of life showed significant correlation(r=. 3566, p=.0110). Therefore the higher the perceived family support of the patients, the higher the quality of life. 2) The result of the analysis of the relationship between perceived professional medical support and quality of life showed significant correlation (r=.4477, p=.0011). Therefore, the higher the perceived professional medical support of the patients the higher the quality of life. 4. There was a significant difference in perceived social support according to sex(F=2.1437, p= .0371), others coping non-family (F=2.4863, p=.0164) and duration of treatment (F=4.16, p=.0218). 5. There was a significant differance in quality of life according to sex(F=2.6932, p=.0097), degree of education(F=2.3610, p=.0223), others coping non-family(F=2.0502, p=.0458). In conclusion, this study revealed that social support is an important factor that associated with the quality of life in cancer patients receiving gene therapy.

  • PDF

40세 이후의 사망에 영향을 주는 요인에 관한 코호트내 환자-대조군 연구 (What Factors Affect Mortality over the Age of 40?)

  • 박종구;고상백;김춘배;박기호;왕승준;장세진;신순애;강명근
    • Journal of Preventive Medicine and Public Health
    • /
    • 제32권3호
    • /
    • pp.383-394
    • /
    • 1999
  • 공 교의료보험 적용대상자들 중 1992년 건강검진 수검 피보험자와 1993년 건강검진 수검 피부양자를 대상으로 사망에 영향을 미치는 요인에 관한 코호트내 환자-대조군 연구를 실시한 결과는 다음과 같다. '93-'97년도 자료의 분석에서 사망과 정상관 관계를 보인 변수는 수축기 혈압, 이완기 혈압, 혈당, AST, 요당, 요단백, 음주('자주 마신다'), 흡연, 건강인지, 영양제 복용, 수혈이었다. 사망과 역상관 관계를 보인 변수는 커피 음용이었다. 비만도와 혈중 콜레스테롤은 사망과 J형의 상관관계를 보였다. '96-97년 자료만을 이용하여 분석한 경우도 '93-'97년 자료와 관련성의 방향은 동일하였으나, 비만$(25-30kg/m^2)$과 콜레스테롤(240 mg/dL이상)의 사망 예방효과는 '93-'97년 자료에 비해 '96-'97년 자료에서 감소함으로써 '93-'94년 자료에 결과-원인 관계가 일부 개재되었을 가능성을 배제할 수 없었다.

  • PDF

노인주간보호시설에 대한 잠재이용자의 이용욕구 및 발전방향 (A potential user' Need of Utilization and Development Direction of Day Care Center)

  • 정지나
    • 디지털융복합연구
    • /
    • 제18권4호
    • /
    • pp.479-487
    • /
    • 2020
  • 본 연구의 목적은 노인주간보호시설에 대한 잠재이용자들이 지각하는 이용욕구와 운영 현황을 파악하여 문제점과 발전방향을 제안하는 것이다. 자료수집은 J도에 거주하는 일반인 320명을 대상으로 기관 인식과 이용욕구를 설문지로 조사하였으며, 6개 시설의 기관장 및 종사자에 대한 심층인터뷰, 기관의 운영 현황을 파악하고자 하였다. 분석결과 잠재이용자들은 주간보호시설의 기능 및 구체적인 역할에 대해 많이 인지하고 있지 않았으며, 시설비용 부담은 국가에서 부담하며, 시설을 이용 시 중요한 요인은 시설 및 환경인 것으로 나타났다. 심층인터뷰에서는 지금의 정책이나 제도는 현실과 괴리가 커 종사자들의 지위나 역할 그리고 기관의 운영 상태와 맞지 않는 것으로 나타나, 현장형 시스템의 재정립이 요구되고 있다. 연구결과를 바탕으로 주간보호시설의 발전방향은 국가차원에서 시민들에게 주간보호시설의 인식 개선 및 제고를 위한 적극적인 홍보와 가족지원강화가 필요하다. 둘째, 이용자의 욕구를 반영한 시설과 환경의 개선을 통한 요양서비스의 질을 높여야 한다. 셋째, 종사자의 열악한 고용 여건과 처우를 현실에 맞게 개선해 요양서비스의 질을 높여 나가야 한다.

우리나라 의료기관 입원손상환자의 자체충족도에 관한 연구 (A Study on Self-sufficiency for Hospital Injury Inpatients in Korea)

  • 이희원;박종호;강성홍;김원중
    • 한국산학기술학회논문지
    • /
    • 제12권12호
    • /
    • pp.5779-5788
    • /
    • 2011
  • 본 연구는 우리나라 의료기관 입원손상환자의 지역별 자체충족도의 현황을 파악하고 이를 기반으로 지역별 자체충족도를 높이기 위한 방안을 마련하기 위해 수행되었다. 이를 위해, 2005년, 2008년 환자조사 자료, 건강보험공단의 지역별 의료이용 자료, 중앙응급의료센터 연보자료, 응급의료기관 평가결과 자료를 수집하였다. 자료분석에는 빈도분석, 교차분석, 의사결정나무, 로지스틱회귀분석 기법을 이용 하였다. 광역시 도 단위별 자체충족도는 2005년, 2008년 모두 충청남도가 가장 낮았으며, 경상북도, 경기도, 전라남도의 순으로 자체충족도가 낮은 것으로 조사되었다. 시 군 구 단위별 거주지 의료 공급 현황에 따른 의료이용 자체충족도는 2005년, 2008년 모두 거주지에 종합병원, 권역응급의료센터, 지역응급의료센터, 지역응급의료기관이 있는 지역 입원손상환자들의 자체충족도가 높았다. 또한, 거주지 응급의료기관의 질적 수준이 높을수록 자체충족도가 높아지는 것으로 나타났다. 손상환자를 위한 국가 정책 추진시도 단위의 응급 의료 공급수준이 낮은 지역을 우선 사업대상지역으로 하고, 또한 응급실 의료기관의 질적 수준을 높이는 것이 자체충족도 향상에 도움이 된다는 것을 확인할 수 있었다.

인력수급 대책을 위한 치과기공사의 보건지소 진출에 관한 연구 - 2012년 틀니보험화 정책을 중심으로 - (The study on the entry of dental technicians in the public health center for a manpower supply and demand plane (Centering around a denture insurance policy in 2012))

  • 이종도;김정숙;박광식
    • 대한치과기공학회지
    • /
    • 제32권4호
    • /
    • pp.417-433
    • /
    • 2010
  • Purpose: This study evaluated the manpower planning of dental technicians. Methods: Methods : Survey was conducted regarding subject's general characteristics, characteristics of dental technician's occupational view and working conditions, and reason to enter into branches of the public health enter. The survey sample consisted of 323 dental technicians (221 male/ 102 female). Survey was conducted for one month from August 1 to September 1 in 2010. Following results were obtained. Results: 1. Regarding general characteristics of the subjects, there was a slight male predilection with 68.4%. Subjects in their 40s occupied the highest proportion of 32.2%. Majority of subjects worked in the big cities (71.5%). Favored working places were dental laboratory (57.6%) and dental hospital or dental clinic (19.5%). Although no position is available in the public sector such as public health center or health care civil servant, 9.3% preferred working in the public health center. Public sector is more favored than 2-year technical colleges or dental supply and equipment companies. In respect to education, 57% of the subjects graduated college. 67.8% were married. Subjects who specialize in the porcelain or all-ceramic were 57.9%. With regard to current position, head of the dental laboratory was most common. 2. Following occupation characteristics were found. Economic reason took the highest proportion when deciding their occupation (39.9%) followed by gaining social experience (36.5%). Majority of the subjects (76.5%) wanted to work as dental technicians until their retirement. 71.5% pursuit to become a manager of the dental laboratory. 76.1% agreed on opening a dental technician position in the public health center. Regarding an authority to lead developing the dental technician position in the public sector, majority of the subject chose ministry of health and welfare (35.6%) and Korean dental technologist association (34.7%). Employment (average, 30%) and turnover rate (average, 36.5%) of dental technology college graduates ranged from 40% to 60%. Most important factors for the employment were practical experience (41.2%) and competency (34.4%). With regard to job satisfaction, so-so as 46.7% and satisfactory was 42.7% 3. In respect to the reason for opening a position in the public health center, 'It is needed to continue denture rogram for elderly patients' obtained the highest score (4.14 point). 'Institutional devices are required to open a position for dental technicians as a public healthcare provider' received high score (4.11 point). 4. Concerning the working conditions, 'professional knowledge is required' received the highest score (4.23) followed by 'too short maternity and parental leave' (4.21). 5. Relationship between general characteristics of the subjects and favor of working in the public health center was investigated. Significant differences were found according to the current and favored working area, favored occupation, education level, marital status, and specialty. Working in the public health center was favored by following subjects: working in mid- or small-sized cities (4.16 point, p<0.05); PhD degree-holder (4.59 point, p<0.01). 6. Among general characteristics of the subjects, significant difference of working conditions was found in the following factors: gender; working areas; favored working areas; favored working positions, and education level. Majority of subjects favored working in big cities and currently work in big cities although satisfaction was comparatively low (3.75 score). 7. Future plan to work in public health center was evaluated according to occupational characteristics. Subject's intention to work in the public healthcare center was significantly affected by opening of dental technician position, leading authority, average turnover rate, and factors affecting employment. Working in the public health care center was favored by the following subjects: Dental technicians who actively supported opening of the dental technician position (4.34 point, p<0.001); subjects who thought the Korean dental technologist association is responsible for the opening of positions in the public sector (4.26 point, p<0.001); and subjects who thought that attitude and character are important for the employment (p<0.001). 8. Concerning difference of working conditions according to the occupational characteristics, significant difference was demonstrated by factors such as a reason to choose to be a dental technician, work plan, pursuing position, responsible authority, average employment rate, and job satisfaction. High standard of working conditions was required in subjects who selected to be a dental technician for the leisure time after work (s.05 point, p<0.01), who planted to work until their marriage (4.25 point, p<0.001), and who pursuit to be a manager (3.98, p<0.05). 9. In respect to influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.068 and age affected the working condition with significant difference according to the pvalue. 10. Regarding influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.335 and work plan, opening of dental technician position in the public sector, and responsible authority had significant influence over the subject's intention to work in the public health center according to the p-value. 11. With regard to the influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.091 and reason to choose to be a dental technician, work plan, and responsible authority significantly affected subject's working conditions. Conclusion: Korean society is becoming a super-aged society according to several statistics. As aged population is rapidly increasing, national health insurance plans to cover denture for senior citizen over 75 years old from 2012. Therefore, dental technicians are urgently needed in the public health centers all over the nation. Many subjects in this study planed to work until their retirement and recognized dental technician's expertise. Ministry of health and welfare and Korean dental technologist association should co-operate each other to prepare foundation and institutional devices for dental technicians to advance into the public health center. This will improve oral health of the population. This study showed urgency of medical facilities and services which meets increasing number of aged population and welfare of the population.