• 농촌의학ㆍ지역보건
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• 제47권3호
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• pp.143-153
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• 2022

목적: 병원에서 재가 및 시설로 퇴원한 환자가 지역사회에서 건강을 유지하기 위해서는 전환기 돌봄서비스(Transitional care services)가 필요하다. 이를 위해 지역사회 내 의료서비스와 자원을 연계하는 주치의의 역할이 중요시된다. 본 연구에서는 선행연구를 바탕으로 일차진료 의사들의 환자중심성에 대한 인식을 파악하여 환자중심 기반의 서비스 제공을 위해 필요한 정책을 제시하였다. 또한 Transitional Care Service에 대한 일차진료 의사들의 인식을 확인하고 인구사회학적 요인과의 관계를 확인함으로써 서비스 우선순위를 도출하고자 하였다. 방법: 본 연구는 전국의 가정의학과, 내과, 신경과 등 노인 질환과 관련 있는 과의 전문의 자격증이 있으며 자발적으로 온라인 설문조사에 참여할 의사를 표현한 일차진료 의사 259명을 대상으로 수행되었다. 환자중심성 및 전환기 돌봄서비스에 대한 인식을 살펴보기 위해 구조화된 설문지를 개발하였으며, 조사전문업체를 통해 2019년 10월 28일부터 2019년 11월 22일까지 온라인으로 설문조사를 수행하였다. 결과: 본 연구에 대한 주요 결과는 다음과 같다. 첫째, 일차진료 의사들을 대상으로 9가지 전환기 돌봄서비스 인식에 대해 살펴본 결과 "입원 시 진단, 건강상태, 치료계획 및 결과 에 대한 설명(4.4)"과 "퇴원 후 자가 건강관리를 위한 정보 및 훈련 (4.2)"에 대한 필요성이 높게 나타났다. 둘째, 35세 이상 일차진료 의사가 34세 이하 일차진료 의사보다 전환기 돌봄서비스에 대한 인식이 높게 나타났다(F=7.3, p<0.01). 또한, 환자중심성에 대한 인식이 높을수록, 연령이 높을수록, 서울 외 지역에서 근무할수록 전환기 돌봄서비스에 대한 인식이 높게 나타났다. 결론: 본 연구에서는 일차의료를 제공하는 의료진들을 위한 교육프로그램과 지역사회에서 일차의료 의사들을 중심으로 하는 지역 연계 방안을 제시하였다는 점에서 의의가 있다.

• Journal of Hospice and Palliative Care
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• 제14권2호
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• pp.71-80
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• 2011

The growth of the aging population in Korea will challenge health and social services. As Korean society changes, the U.S. models of end-of-life care and geriatric care for frail older adults may have increasing relevance for the Korean healthcare system. This article reviews three U.S. models of care for frail older adults: hospice and palliative care, the Program for All-Inclusive Care for the Elderly (PACE), and the transitional care model. We describe the strengths and limitations of each model and discuss ways in which these models could be adapted for the Korean healthcare system.

• Journal of Yeungnam Medical Science
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• 제36권1호
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• pp.1-7
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• 2019

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.

• 한국임상약학회지
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• 제32권1호
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• pp.27-36
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• 2022

Background: Medication-related problems (MRPs) frequently occur during the discharge period. Elderly patients, particularly, are at high risk for these problems due to polypharmacy and the use of potentially inappropriate medications. The purpose of this study was to build and implement collaboration between general hospital and community pharmacies to address MRPs among high-risk elderly patients before/after discharge. Methods: This retrospective study was conducted between June and December of 2020. The inclusion criteria were patients with aged ≥65 years; residents of Jeonju; discharged from Jeonbuk National University hospital; either on medication of exceeding 10 medications (or high-risk medications) after hospitalization through the emergency room, or having severe illness. Patients received medication reconciliation and counselling by hospital pharmacists before discharge and home-visit pharmaceutical care as follow-up by community pharmacists after discharge. Results: Twenty-two patients agreed to home-visit pharmaceutical services. Fifteen and 11 patients completed the first and second home-visit pharmaceutical care service, respectively. Forty-two MRPs were identified in 15 patients. The types of high-frequency MRPs were incorrect administration of drug, adverse drug reactions, medication non-compliance, drug-drug interactions, lifestyle modifications, and expired medication disposal. After consultation with the pharmacist, 34 out of 42 MRPs were resolved. Conclusions: Transitional care for high-risk elderly patients before and after discharge was successfully built and implemented through a collaboration between general hospital and community pharmacies. This study suggests that home-visit pharmaceutical services may have positive effects on the safe use of drugs during the transition period; however, additional research is needed to expand on these findings.

• 한국보건간호학회지
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• 제33권3호
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• pp.311-325
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• 2019

Purpose: This study examined the definition of care coordination, and the activities and roles of nurse care coordinators. The study also proposed suggestions for establishing and expanding the role of nurse care coordinators in community health practice. Methods: This study derived its conclusions by conducting a literature review. Results: The definition of care coordination is a comprehensive concept that includes case management and transitional care, and can be summarized as organizer and integrator of care. According to the literature review, 12 activities and 6 roles of nurse care coordinator were identified such as a collaborator, an individualized care planer, an educator/counselor, a direct nursing care providers, a population care coordinator, and a program evaluator. Training for nurse care coordinators is currently addressed in the Primary Medical Chronic Disease Management Program. Visiting nurses working at the Eupyeong-dong visiting health and welfare service are expected to act as nurse care coordinators, and the role of nurse care coordinators will, in the future, gradually increase in various nursing facilities. Conclusion: In addition to developing competencies to act as a nurse care coordinator, there is need for approaches to health policy that develop both independent role and population focused role as care coordinators.

• 보건행정학회지
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• 제32권3호
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• pp.247-257
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• 2022

The presidential election and the inauguration of the new government are a period of the policy window opening. The newly launched government is expected to improve the quality of life of the people. The Yoon Suk-yeol Government is also launched with new expectations with a transitional period in health care. The sustainability of health care in Korea is threatened. The environment of health care and the main policy issues of health care are difficult to secure the necessary finance for health care in spite of the increasing health care burden. Accordingly, the Yoon Suk-yeol Government's health care policy aims to provide intensive support to those in need of health and welfare and to improve the health of the people through investment in health. And for integrating fragmented health care and welfare services and creating people-centered community-based health care, a health care innovation center will be established for the evaluation platform of new delivery and payment systems, a health care development plan will be established for the blueprint of health care, and reorganizing the central & local government should be reviewed. Although we are facing unfavorable situations such as the distribution of the National Assembly, inflation, and the possibility of economic recession, we expect that announced health care policies will be implemented, recognizing that health care innovation is the only way to improve health care sustainability.

• 대한소아치과학회지
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• 제42권3호
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• pp.226-232
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• 2015

소아 청소년치과에서 장애아동 및 청소년을 안전하고 효율적으로 치료하기 위해서는 여러 사람의 다양한 협조가 필요하다. 이 연구는 장애아동의 치과치료 시 자주 이용되는 의식하진정치료의 진료용 표준지침을 시범적으로 개발, 적용하고, 진료과정에 참여한 사람들의 만족도를 평가하기 위해 시행되었다. 의무기록 분석을 통하여 표준진료지침을 개발하고 치료과정에 적용한 후 환자, 보호자, 의료진 및 스탭의 만족도를 설문을 통하여 평가한 결과, 표준진료지침의 적용은 환자, 보호자 및 의료진과 보조자가 전반적으로 만족한 것으로 나타나 임상적 유용성이 높을 가능성을 암시하였다. 결론적으로 표준진료지침의 개발과 적용은 임상진료과정의 표준화를 통하여 진료에 대한 예측가능성을 높이고, 환자 안전에 대한 불안을 감소시켜 환자와 의료진의 만족도 향상과 진료의 질적 향상을 기대 할 수 있을 것이다.

• 근관절건강학회지
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• 제26권2호
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• pp.90-101
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• 2019

Purpose: This study was aimed to describe older adults' experiences of living with urinary incontinence and using diapers for its management in long-term care facilities. Methods: Qualitative data were collected through in-depth interviews with 22 participants in long-term care facilities. Content analysis was used to analyze the data. Results: Three themes and six categories were emerged. Participants navigated through those three categories as stages, including the initial stage of confronting the unacceptable reality, transitional stage of physical and emotional suffering, and adaptive stage of accepting the diaper usage as a part of life and hoping improvement. Six categories were feeling terrible with unavoidable use of diapers, being frustrated by nursing staff shortage and unsatisfactory care for urinary incontinence, physical discomfort from of wearing diapers and remaining unchanged, emotional difficulties due to using diapers, accepting and adapting to diaper usage as a part of life, hope for gender-specific quality care for urinary incontinence. Conclusion: The findings suggest that using diapers should not be mandatory to manage older adults' urinary incontinence in long-term care facilities. It is also critical to establish policies to address issues of nursing shortage and financial support for qualitative care to manage urinary incontinence in long-term care settings.

• 지역사회간호학회지
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• 제33권2호
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• pp.153-163
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• 2022

Purpose: A care coordinator is an emerging nursing professional role in South Korea. The purpose of this study was to identify educational needs and priorities for care coordinators among nurses. Methods: An online survey was conducted on 661 current or retired nurses from January 30 to February 28, 2021. A total of 17 essential competencies for care coordinators, recognized based on literature review, were used to analyze the educational needs. The data were analyzed using descriptive statistics, a paired t-test, and one-way analysis of variance with SPSS 25.0. The educational needs analysis was conducted by using a paired t-test, the Borich Needs Assessment Model, and the Locus for Focus Model. Results: Five contents were identified as the first priorities for educational needs: 'Health program planning and evaluation', 'Care planning', 'Coordinating community-based services', 'Case management', and 'Transitional care'. The second priorities for educational needs included 'Population health management' and 'Welfare resource linkages via communicating with social workers'. Conclusion: The priority items derived from this study offer underpinning insights for the development of care coordination training program.

• Child Health Nursing Research
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• 제28권2호
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• pp.154-165
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• 2022

Purpose: This study aimed to analyze the concept of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards. Methods: The hybrid model by Schwarz-Barcott and Kim was used to analyze the characteristics of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards. Results: Transfer anxiety was defined by the following attributes: 1) stress concerning the adaptation process, 2) concern about the child's condition worsening due to the parent's caregiving, and 3) involuntary changes in daily life due to the treatment. Transfer anxiety has the following antecedents: 1) uncertainty; 2) a lack of knowledge about the illness, medical devices, and caregiving; and 3) a lack of social support. It resulted in 1) caregiver burden, 2) a decrease in the capacity for coping with caregiving, 3) delays in the child's physical and psychological recovery, and 4) decreased quality of life. Conclusion: It is necessary to develop an assessment scale that considers the attributes of transfer anxiety in parents of children transferred from pediatric intensive care units to general wards. Furthermore, an effective nursing intervention should be developed to reduce transfer anxiety.