• Journal of Preventive Medicine and Public Health
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• v.56 no.6
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• pp.504-514
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• 2023

Objectives: This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes. Methods: This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients' first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%. Results: The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intra-class correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples. Conclusions: This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

• Korean Journal of Clinical Pharmacy
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• v.28 no.1
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• pp.30-39
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• 2018

Background: Clinical Pharmacy Practice Experience (CPPE) is an important curriculum that offers students patient-centered disease prevention and treatment with evidence-based optimal pharmacotherapy for better clinical outcomes. However, few studies have evaluated the perception of pharmacy students regarding CPPE in tertiary and secondary hospitals. This study aimed to evaluate the perception of pharmacy students regarding the learning program of CPPE. Methods: The survey questionnaire consisted of 15 self-administered questions regarding pharmacy practices, barriers, and improvement of practical training. Fourteen institutional pharmacies located in seven regions responded to a survey questionnaire from March 1 to June 30, 2017. The participants were pharmacy students doing clerkship in a hospital setting. Results: The response rate was 73.6%. Thirty-five participants (22.4%) had used a hospital library, but 121 (77.6%) had never used the library for drug information resources. Eighty-one (50.0%) responded that clinical knowledge and drug information was the most beneficial practice. Thirty-seven (31.1%) respondents in the tertiary hospitals and 19 (46.3%) in the secondary hospitals answered that they were filling prescriptions during the daily break. On the other hand, 72 respondents (60.5%) in the tertiary hospitals and 17 (41.5%) in the secondary hospitals did literature research to prepare for presentation. Conclusion: More students in secondary hospitals continue to fill prescriptions during the daily break, as compared to those in tertiary hospitals. Therefore, the authors suggest self-directed learning to improve clinical performance and each institution considers offering onsite or online library service to improve evidence-based CPPE for pharmacy school students.

• Korean Journal of Radiology
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• v.21 no.9
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• pp.1027-1035
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• 2020

Objective: To assess the appropriate follow-up interval, and rate and timepoint of cancer detection in women with Breast Imaging Reporting and Data System (BI-RADS) 3 lesions on screening ultrasonography (US) according to the type of institution. Materials and Methods: A total of 1451 asymptomatic women who had negative or benign findings on screening mammogram, BI-RADS 3 assessment on screening US, and at least 6 months of follow-up were included. The median follow-up interval was 30.8 months (range, 6.8-52.9 months). The cancer detection rate, cancer detection timepoint, risk factors, and clinicopathological characteristics were compared between the screening and tertiary centers. Nominal variables were compared using the chi-square or Fisher's exact test and continuous variables were compared using the independent t test or Mann-Whitney U test. Results: In 1451 women, 19 cancers (1.3%) were detected; two (0.1%) were diagnosed at 6 months and 17 (1.2%) were diagnosed after 12.3 months. The malignancy rates were both 1.3% in the screening (9 of 699) and tertiary (10 of 752) centers. In the screening center, all nine cancers were invasive cancers and diagnosed after 12.3 months. In the tertiary center, two were ductal carcinomas in situ and eight were invasive cancers. Two of the invasive cancers were diagnosed at 6 months and the remaining eight cancers newly developed after 13.1 months. Conclusion: One-year follow-up rather than 6-month follow-up may be suitable for BI-RADS 3 lesions on screening US found in screening centers. However, more caution is needed regarding similar findings in tertiary centers where 6-month follow-up may be more appropriate.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3641-3645
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• 2013

Background: Assessment of the nursing staff knowledge, attitude and practices about cervical cancer screening in a tertiary care teaching institute of rural India. Materials and Methods: A cross sectional, descriptive, interview-based survey was conducted with a pretested questionnaire among 262 staff nurses of a tertiary care teaching and research institute. Results: In this study 77% respondents knew that Pap smear is used for detection of cervical cancer, but less than half knew that Pap smear can detect even precancerous lesions of cervix. Only 23.4% knew human papilloma virus infection as a risk factor. Only 26.7% of the respondents were judged as having adequate knowledge based on scores allotted for questions evaluating knowledge about cervical cancer and screening. Only 17 (7%) of the staff nurses had themselves been screened by Pap smear, while 85% had never taken a Pap smear of a patient. Adequate knowledge of cervical cancer and screening, higher parity and age >30 years were significantly associated with self screening for cervical cancer. Most nurese held a view that Pap test is a doctor procedure, and nearly 90% of nurses had never referred a patient for Pap testing. Conclusions: The majority of nursing staff in rural India may have inadequate knowledge about cervical cancer screening, and their attitude and practices towards cervical cancer screening could not be termed positive.

• Health Policy and Management
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• v.8 no.2
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• pp.1-24
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• 1998

There exists a general consensus in Korea that patients tend to concentrate in large hospitals and this tendency is partly responsible for inefficiency in health services. The process of choosing a medical care provider for health care services and evaluating the provider after utilization seems to involve many diverse factors to become very complex. Therefore a systemsatic study is needed to achieve sufficient understanding of the proeess. For this point of view, this study investigates patient's selection of medical care institution for delivery care services and their evaluation of the institution after delivery. In more specific, the objectives of the study are twofold: 1) to identify the factors associated with expectant mothers' choice of type of medical care institution for delivery among tertiary hospitals, general hospitals, small hospitals, and clinics: and 2) to understand the factors affecting patient evaluation of the medical care institution after delivery. The data used for the analysis were collected through face-to-face interviews with those women who had childbirth during the period from January 1, 1996 to the date of interview in February 1998. The survey was conducted using preqared structured questionnaire in Seoul. The sample was drawn from each of arbitrarily defined four regions of Seoul, Northeast, Northwest, Southeast and Southwest, in proportion to the number of births reported in 1996 in each of them. The distribution of the interviewed women by educational level was made similar to that of mothers of new babies reported in 1996. The sample size was planned to be about 300, but ended up with analytical sample of 319. Major conclusions emerged from the analysis can be summarized as follows: 1) Large hospitals were evaluated as much better for technical quality than other types of institutions, whereas they were compared similar to or worse for other attributes. And it was found that technical quality of care is considered as the most important condition of medical care institution for delivery, while the amount of direct cost is considered as the least important one. Taken together, the utilization of large hospitals is not likely to decrease even though they cannot give satisfaction to patients in other aspects than technical quality. 2) The activeness in the search for information affected the respondents' evaluation of medical care institutions, which would influence their later decision or recommendation to other persons as to the choice of source of health care services. Therefore, increased efforts should be directed to improving availability of useful and correct information for patients in relation to the utilization of health care services. 3) Since the findings of this study were obtained from the analysis of delivery care services, their applicability to other kinds of services may be limited. Thus it would be useful to conduct a comparative study of several kinds of services explicitly taking into account the characteristics of those services in the analysis.

• Journal of Convergence for Information Technology
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• v.12 no.2
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• pp.184-191
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• 2022

This study aims to provide basic information necessary to find an efficient management plan for patients using auto insurance. The analysis was conducted on the five-year auto insurance medical expenses review data registered in the health care bigdata Hub from 2016 to 2020. As a result of the analysis, the number one composition ratio of auto insurance inpatient treatment expenses was treatment and surgery fees for Certified tertiary hospitals, hospitalization fees for general hospitals, hospitals and clinics, and treatment and surgery fees for oriental medical institutions and dental hospitals. outpatient treatment expenses was doctor's fee for medical institution, treatment and surgery fees for oriental medical institutions and dental hospitals. The ratio of medication, anesthesia, and special equipment significantly affected the cost of inpatient. And the ratio of physical therapy significantly affected the cost of outpatient.

• Korea Journal of Hospital Management
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• v.20 no.1
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• pp.13-24
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• 2015

The purpose of this study is to examine the preparation of medical institutions for Russian medical tourists. The data for this study include 44 cases which were selected from Korea Health Industry Development Institute list. Data were collected through the e-mail survey from Feb. 24 to Jul. 1 in 2014. The results of the study are as follows. Overall, tertiary hospitals were well prepared in hardware resources and structure(e.g. the number of coordinators and marketers, accreditation)compared to hospitals and clinics. On the other hand, hospitals were well prepared in service process protocol.

• Tuberculosis and Respiratory Diseases
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• v.80 no.2
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• pp.143-152
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• 2017

Background: Fluoroquinolones are considered important substitutes for the treatment of tuberculosis. This study investigates the current status of fluoroquinolone for the treatment of tuberculosis. Methods: In 2009, a retrospective analysis was performed at one tertiary referral center for 953 patients diagnosed with tuberculosis. Results: A total of 226 patients (23.6%), who received fluoroquinolone at any time during treatment for tuberculosis, were enrolled in this study. The most common reasons for fluoroquinolone use were adverse events due to other anti-tuberculosis drugs (52.7%), drug resistance (23.5%), and underlying diseases (16.8%). Moxifloxacin (54.0%, 122/226) was the most commonly administered fluoroquinolone, followed by levofloxacin (36.3%, 82/226) and ofloxacin (9.7%, 22/226). The frequency of total adverse events from fluoroquinolone-containing anti-tuberculosis medication was 22.6%, whereas fluoroquinolone-related adverse events were estimated to be 2.2% (5/226). The most common fluoroquinolone-related adverse events were gastrointestinal problems (3.5%, 8/226). There were no significant differences in the treatment success rate between the fluoroquinolone and fluoroquinolone-$na{\ddot{i}}ve$ groups (78.3% vs. 78.4%, respectively). Conclusion: At our institution, fluoroquinolones are commonly used for the treatment of both multidrug-resistant tuberculosis and susceptible tuberculosis, especially as a substitute for adverse event-related drugs. Considering the low adverse event rates and the comparable treatment success rates, fluoroquinolones seem to be an invaluable drug for the treatment of tuberculosis.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.12
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• pp.4885-4891
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• 2014

Background: Successful implementation of pain management procedures and guidelines in an institution depends very much on the acceptance of many levels of healthcare providers. Aim: The main purpose of this study was to determine the level of knowledge and attitudes regarding pain among nurses working in tertiary care in a local setting and the factors that may be associated with this. Materials and Methods: This cross-sectional research study used a modified version of the Nurses' Knowledge and Attitudes Survey (NKAS) regarding pain. Basic demographic data were obtained for further correlation with the level of pain knowledge. Results: A total of 566 nurses, 34 male and 532 female, volunteered to participate in this study. The response rate (RR) was 76%, with an overall mean percentage score of $42.7{\pm}10.9$ (range: 5-92.5). The majority of participants were younger nurses below 40 years of age and more than 70% had worked for less than 10 years ($6.6{\pm}4.45$). Up to 92% had never had any formal education in pain management in general. The total mean score of correct answers was $58.6{\pm}9.58$, with oncology nursing staff scoring a higher percentage when compared with nurses from other general and critical care wards ($63.52{\pm}9.27$, p<0.045). Only 2.5% out of all participants obtained a score of 80% or greater. The majority of the oncology nurses achieved the expected competency level (p<0.03). Conclusions: The present findings give further support for the universal concern about poor knowledge and attitudes among nurses' related to the optimal management of pain. The results reflected that neither number of years working nor age influenced the level of knowledge or attitudes of the practising nurses. Oncology nursing staff consistently scored better than the rest of the cohort. This reflects that clinical experience helped to improve attitudes and knowledge concerning better pain management.

• Korean Journal of Clinical Pharmacy
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• v.24 no.4
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• pp.255-264
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• 2014

Objective: The aims of this study are to investigate the total volume of prescribed medicines against Alzheimer's disease (AD) and the trends of usage by analyzing the claims-data from the Korea National Health Insurance Service. Method: The demographic and claims-data were included the major AD treating medicines such as donepezil, galantamine, rivastigmine and memantine, and analyzed during the period of 2010~2012. The assessing criteria were gender, age, habitation, types of medical institution, code of ingredients, outcomes of treatment, volume and amount of claims, and the numbers of patients with dementias. After trimming the data, it were analyzed by the market size, demographic traits, characteristics of medical service, characteristics of each anti-AD medicine, etc. Results: Among the chosen 4 medicines, donepezil had the top prescription volumes. Most prevalent prescribing preparations of donepezil were conventional types. However, among the non-conventional types, oro-dispersible formulation is the fast increasing one in both volume and growth rate. This specialized preparations to improve both toleration and adherence, tend to being prescribed generally at the tertiary medical institutions. While the younger patients with mild-to-moderate AD mostly treated by expensive medicines in resident at the tertiary hospitals, the rest older patients with severe AD have been treated non-expensive one at long-term care facilities. Conclusion: AD is a chronic illness therefore, long-term use of therapeutic medications are highly important. If an anti-AD treatment was applied steadily in the earlier stages, it would be achieved not only improving the quality of life of patient but also reducing the expenses in the medical and nursing cares. As the socioeconomical impacts of AD is expanding, healthcare professionals need to aware the importance of pharmacotherapy and to improve sociopolitical fundamentals.