• Journal of Preventive Medicine and Public Health
• /
• 제20권1호
• /
• pp.165-203
• /
• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Journal of Genetic Medicine
• /
• 제4권2호
• /
• pp.167-178
• /
• 2007

목 적:최근 들어서 국내 의료계에서도 Non-MD 전문 유전상담사의 필요성이 대두되고 있으며, 유전상담과 전문유전상담자 수요에 대한 전국적 기초조사를 수행함으로서, 향후 중장기 계획 Master plan을 가지고 유전상담교육 및 상담사 배출을 체계적으로 할 수 있게 될 것이다. 방 법:2007년 9월 3일부터 2007년 10월 4일까지 1개월 동안 이메일, 전화, 팩스, 직접수령의 방법으로 의료기관, 유전자 검사평가원에 등록된 비 의료기관, 정책연구기관, 자조회 등을 통하여 주임연구원, 교수 등을 대상으로 총 16문항의 설문을 하였다. 결 과:설문 내용의 분석 결과 "유전상담의 필요성을 느끼고 있는지"에 대하여 응답자의 90명(88%)에서 유전상담의 필요성을 느끼고 있었으며, 그 중 "매우 필요하다"는 답변은 31명(34%)으로 나타났다. 또 "응답자 또는 응답자가 근무하는 기관에서는 의학유전학 석사학위 이상의 교육을 받은 전문직 유전상담사의 필요성을 느끼고 있는지"에 대한 문항에서는 필요하다는 의견이 68명(77%)을 차지하였고, 그 중 "매우 필요하다"는 의견은 16명(23%)의 결과를 보였다. 전문 유전상담에 대한 수가 책정이 건강보험급여로 인정되어야 한다고 생각하는 응답자가 78명(77%)으로 나타났으며, 그 중 23명(29%)이 매우 필요하다고 응답하였다. 이에 전문 유전상담사를 채용할 계획이 있다고 응답한 57명의 답변으로, 5년 이내 채용계획이 있다는 의견이 41명(71%)이었고, 채용 시 기대하는 담당 업무는 "유전 카운슬링" 34명(60%), "학술담당" 24명(42%), "교육담당" 10명(18%), "임상검사담당" 11명(19 %)으로 나타났다. 결 론:이번 조사에는 대상자 650명 중에 총 102명이 설문에 응하였고, 국내 유전상담과 전문 유전상담사 수요에 대한 전국적 기초조사 결과를 토대로, 향후 5-10년 중장기계획을 가지고 유전상담교육, 유전 상담의 의료보험 적용과 전문 유전상담사 배출을 체계적으로 하는데 있었으며 이에 효율적인 유전질환 관리와 국가차원의 시스템 구축 및 유전질환 환자에 대한 양질의 의료서비스를 제공할 수 있을 것으로 기대된다.

• Tuberculosis and Respiratory Diseases
• /
• 제66권3호
• /
• pp.192-197
• /
• 2009

연구배경: 재택산소요법의 건강보험 급여 혜택이 있기 이전에 이뤄진 국내 보고는 특수한 일부 환자군만을 대상으로 하였을 가능성이 높아 재택산소 사용의 정확한 실태를 반영하지 못했을 가능성이 높다. 저자들은 재택산소요법의 보험 혜택 이후 시점부터 본 병원에서 재택산소처방을 받은 환자군의 임상적 특성, 산소사용의 실태 및 순응도에 대해 조사하여 이전의 국내 보고들과 비교해 보고자 하였다. 방 법: 자가산소요법의 건강보험 급여 혜택이 시작된 2006년 11월부터 2008년 9월까지 인제대학교 백병원 호흡기 내과를 방문하여 재택산소처방을 받고 외래에서 추적관찰 중인 환자를 대상으로 하여 의무기록 검토와 설문조사를 하였다. 결 과: 대상 환자수는 총 105명, 평균 나이 69세이고, BMI 19.1 $kg/m^2$, 남녀의 비는 60:45명이었다. 산소를 처방하게 된 기저 질환은 COPD 64명, 폐암 14명, 결핵으로 파괴된 폐가 13명, 기관지확장증 3명이고 그 외 폐성심, 기관식도루, 천식, 울혈성 심부전, 폐렴이 있었다. 평균 동맥산소분압은 54.4 mmHg, 산소포화도는 86.3%, 평균 헤모글로빈은 11.9 g/dL이었고, 평균 심실구혈률은 61.1%, 우심실수축기압력 42.7 mmHg이었다. 88명에서 시행한 폐기능검사에서 평균 FVC 2.05 L (66.5%), $FEV_1$ 1.12 L (52.0%), $FEV_1$/FVC 55.6이었다. 평균 산소처방기간은 8.2개월이었고, 하루 평균 산소시간은 9.8시간이었다. 그 중 평균외출시간 5.4${\pm}$3.7시간 동안은 산소를 사용하지 못했다. 산소사용을 중단한 사람은 66명으로 62.8%를 차지하였고 그 원인으로 사망이 33명(50%), 임의중단 24명(36%), 저산소증 호전 8명(12%), 입원한 경우가 1명 있었다. 임의 중단 환자는 산소처방 후 평균 7.0${\pm}$4.7개월 의 시점에 산소를 중단하였다. 임의중단 사유는 증상호전 11명(45%), 사용불편 6명(25%), 증상호전 없음 4명(17%), 경제적 비용부담 3명(13%) 순이었다. 결 론: 재택산소 처방 후 충분한 산소사용 시간 확보 및 산소의 지속적인 사용을 유지하려면 산소사용에 대한 환자 및 보호자에 대한 교육, 일반인을 대상으로 한 홍보, 경제적 부담 완화 등의 추가적인 노력이 있어야겠고, 야외활동 중에도 사용이 가능한 휴대용 산소장치에 대한 보험 혜택 확대가 필요하다고 하겠다.

• 한국노년학
• /
• 제37권2호
• /
• pp.281-291
• /
• 2017

본 연구의 목적은 한국의 65세 이상 노인의 의료요구 미충족 경험률을 알아보고, 고용형태와 의료요구 미충족 경험률 및 경제적 이유로 인한 의료요구 미충족 경험률의 관련성을 분석하는 것이다. 연구방법은 2013년 한국의료패널자료를 이용하여 65세 이상인구 5,528명을 대상으로 고용형태에 따른 의료요구 미충족 경험률과 경제적 이유로 인한 의료요구 미충족 경험률의 관련성을 알아보기 위해 로지스틱 회귀분석을 실시하였다. 연구결과, 65세 이상 노인의 의료요구 미충족 경험률은 18.9%로 유렵연합국 노인인구집단보다 의료요구 미충족 경험률이 2-3배 높았다. 그리고, 의료요구 미충족을 경험한 노인 중 의료요구 미충족을 경험한 이유가 경제적 이유라고 응답한 노인은 42.8%였으므로 경제적 이유로 인한 의료요구 미충족 경험률은 8.1%이다. 임시직으로 경제활동을 하는 노인은 은퇴로 경제활동을 하지 않는 노인보다 의료요구 미충족 경험률이 높았고(ORs=1.75), 일용직으로 경제활동을 하는 노인은 경제적 이유로 인한 의료요구 미충족 경험률이 높았다(ORs=1.92). 경제활동 상태에 따른 의료요구 미충족 경험률의 차이는 '질병과 손상'을 가진 노인을 제외하고는 종사상의 지위에 따른 차이가 크지 않았다. 의료요구 미충족 경험 이유가 높은 의료비 부담이라고 응답한 경우에도 경제활동 상태에 따른 의료요구 미충족 경험률의 차이는 '질병과 손상'을 가진 노인을 제외하고는 종사상 지위에 따른 차이가 크지 않았다. 다만, 경제활동자 중에서는 '일용직' 노인의 경제적 이유로 의료요구 미충족 경험률이 가장 높았다. 또한, 소득이 적을수록 의료요구 미충족을 경험할 가능성이 높았다. 결론적으로 한국 노인의 의료요구 미충족을 해결하기 위해서는 노후소득보장제도의 개선뿐만 아니라 평균수명 증가에 따른 경제활동에 참여하는 노인의 일자리 형태 및 임금수준에 대한 개선방안이 필요할 것으로 보이며, 더불어 의료비를 해결할 수 있는 건강보험의 보장성이 강화되어야 할 것으로 보인다.

• 지능정보연구
• /
• 제29권3호
• /
• pp.287-316
• /
• 2023

최근 전 세계적으로 기업의 환경(Environmental)·사회(Social)·지배구조(Governance)의 비재무적 요소를 고려한 지속가능경영이 필수적으로 요구되면서, 각 기업들은 이에 대응할 수 있는 전략적 방향 수립이 중요해지고 있다. 특히 기업이 속한 산업별로 상이한 ESG 이슈에 대한 이해를 바탕으로 산업과 개별 기업의 특성을 반영한 전략을 개발하고 추진할 수 있어야 할 것이다. 이에 본 연구에서는 금융, 제조, IT 분야별로 나누어 주요 국내 기업들의 ESG 보고서와 관련 뉴스 기사를 이용하여 산업별 ESG 동향과 활동을 비교 분석하였다. 키워드 빈도분석과 토픽 모델링을 활용한 분석 결과, 국내 ESG 선도 기업들의 지속가능경영 활동에서의 산업별 차이를 도출 할 수 있다. 금융 분야에서는 '고객 중심 경영'과 '기후 변화 대응', 제조 분야에서는 '지속가능한 공급망 관리'와 '탄소중립', IT 분야에서는 '기술혁신'과 '디지털 책임'이 강조되었다. ESG 요소별 우선 순위가 높은 활동의 예를 들면, 환경 측면에서는 '에너지 절감과 친환경 활동', 사회 측면에서는 '사회공헌과 상생', 지배구조 측면에서는 '이사회 독립성 강화와 리스크 관리' 등으로 나타났다. 더 나아가 산업별 각 ESG 요소의 핵심 이슈 뿐 아니라 ESG 보고서와 뉴스 기사의 내용 유사성 및 차별점도 확인하였다. 연구의 결과는 산업별 동향을 고려한 ESG 경영 전략 및 정책의 방향성을 제시하고 있으며 이는 산업별 ESG 평가체계 수립에도 도움이 될 것으로 기대한다.

• 대한간호학회지
• /
• 제22권4호
• /
• pp.636-652
• /
• 1992

This study identified the impact of childhood cancer on the Korean family. The purpose was to contribute knowledge for family nursing and pediatric hospice care practice with sick children and their families. This descriptive study was conducted during a 6 month period with children who were being treated for cancer at six university hospitals in Seoul. The data were gathered from members of 68 families ; 24(Group A), with a child newly diagnosed with cancer : 27(Group B), with a child under treatment and without complications, and 17 (Group C), with a child in relapse. Medical records, structured questionnaires and interviews were used for data collection. The questionnaires and interview schedules had been used previously in Martinson's research in the USA and China. The findings, conclusions, and suggestions are as follows. 1. The impact of childhood cancer on the family. Members of the family experienced fear, helplessness, guilty feelings, and anger at the time of the initial diagnosis and at relapse. Mothers complained of headache, anorexia and poor appetite, weight loss, sleep disturbance, and bad dreams. Many of the fathers either lost or changed jobs, and all working mothers stopped working. Half the parents reported changes in their marital relationships such as frequent quarrels but also stronger unity. Family members perceived cancer as the most frightening disease. Change in their world view was expressed as living on faith understanding suffering, determining to live a better life, wanting to live an upright life and valuing health as the most important. Religious activities are found most helpful through this difficult experience. Financial debt due to the treatment and care of the sick child, burdened 22 families. The above mentioned impact was most evidant in Group B(those presently undergoing treatment) and Group C(those in relapse). Findings indicate that nursing care should embrace the family of a child who is being treated for cancer. 2. Characteristics of the child with cancer The majority of the children in this sample had a diagnosis of leukemia. Their mean age was 6.8 and the ratio of boys to girls was 1.12 ; 1. The mean hospitalization frequency was 13.5 times and the mean duration of illness was 16.8 months. Most of 1.he children perceived cancer as the most frightening disease ; 32.7% of the children described their sickness as serious. Children in Group C were hospitalized more frequently, stayed in hospital for longer periods, and expressed their sickness as quite serious more often than the other two groups. These findings indicate how much comprehensive pediatric hospice nursing care services are needed along with relevant research and nursing education. 3. Characteristics of the families. The mean age of the father was 39.5 and the mother, 36,6 ; they are in their most productive life period. Mothers especially expressed feelings of financial uneasiness and powerlessness about giving up their jobs, and guilty feelings for not providing enough care and concern to other children due to taking care of the sick one. The burden of caring for the sick child can bring negative changes in family dynamics which they think provoke potential health problems in members of the family These findings suggest a need for nursing support and counselling resources. Findings also suggest the need for ethical inquiry about such questions as who should give information to the child in regard to diagnosis and prognosis, when, and how. Other suggestions included : 1) Quality health care for childhood cancer such as home care and pediatric hospice programs should be established. 2) Special and practical consideration for long-term patients should be made in the present insurance coverage. The reimbursement period for long-term patients should be lengthened. 3) Further in-depth qualitative studies are needed. 4) Education programs including guided practice experience for pediatric hospice care practitioners are needed.

• 한국산학기술학회논문지
• /
• 제17권8호
• /
• pp.654-661
• /
• 2016

치면열구전색술이 건강보험급여 항목에 포함된 이후 진료경향을 분석하여 치아우식예방을 파악하고자 2009년 12월 1일부터 2014년 12월 31일까지 건강보험심사평가원 대전지원에 접수된 요양급여비용 명세서를 분석하였다. 연도별 치면열구전색술 현황을 살펴보면, 2010년에 수진자 수와 수진자 처치 치아수가 가장 많았고, 1인당 평균 처치 치아수는 2013년에 3.39개로 가장 높게 나타났다. 일반적 특성에 따른 2010년 제1대구치 치면열구전색술을 분석한 결과 남자가 여자보다 높았고, 연령별에서는 7세에서 가장 높게 나타났고 계절별로는 여름이 가장 높았다. 각 제1대구치 분포에서는 상악좌측 제1대구치가 가장 높았으며 그 외는 상악우측 제1대구치, 하악우측 제1대구치, 하악좌측 제1대구치 순으로 나타났다. 2010년에 상악 우측 제1대구치에 치면열구전색술한 후 치아우식이 발생되어 2011년부터 2014년에 충전을 시행한 치아를 분석한 결과, 남자가 여자보다 높게 나타났고, 연령별에서는 7세에서 가장 많은 충전을 실시하였으며, 계절별로는 여름에 가장 많이 실시한 것으로 나타났다. 2009년 12월부터 2014년 11월까지의 치료 치아수를 토대로 2015년 12월까지 치아 치료수를 예측한 결과 2015년도 8월에 가장 높은 수요가 나타날 것으로 예측되고 2014년에 비해 감소될 것으로 예측된다. 따라서, 칫솔질만으로는 치아우식증 예방에 한계가 있으므로 높은 예방효과를 보이는 치면열구전색술 실시를 영유아 및 초,중,고 구강보건실등에서 정기적인 실시한다면 치아우식 예방효과가 있을것으로 기대된다.

• 치위생과학회지
• /
• 제7권3호
• /
• pp.147-152
• /
• 2007

본 연구는 치과진료기관의 고객 불만처리 실태를 파악하고, 불만처리 서비스 및 불만 예방서비스 시행 정도를 조사하기 위하여 2007년 1월 20일부터 2월 20일까지 치과진료기관을 대상으로 총210부의 설문지를 수거하였으나 이 중 4부는 응답자료에 결측치가 있어 분석에서 제외시키고 총 206(98%)부의 설문지를 SPSS WIN 12.0 프로그램을 이용하여 분석한 결과 다음과 같은 결과를 얻었다. 1. 치과진료기관에서 불만처리서비스에 대해 32.5%가 인지하고 있는 것으로 조사되었고, 64.6%는 불 만처리서비스를 시행 하지 않는 것으로 조사되었으며, 94.7%가 불만을 경험한 것으로 나타났다. 2. 의료소비자의 불만 내용으로는 '진료 및 대기시간이 길다'가 40.3%로 가장 높게 나타났으며 '의료보험 미적용'이 30.6%, '진료에 대한 설명부족' 6.3%, '진료비 과다청구' 5.8% 순으로 나타났으며, 월 불만건수는 1~10건이 91.3%로 가장 높은 것으로 조사되었다. 불만표현방법에서는 '직원에게 직접 말한다'가 88.2%로 가장 높게 나타났으며, 주된 불만처리 담당자는 '치과위생사'가 56.8%로 높게 나타났다. 치과진료기관의 불만대처방법으로는 '즉각적인 조치'가 34.5%로 가장 높게 나타났으며, '환자의 성향을 분석 후 불만을 처리' 30.0%, '불만에 대해 변명으로 대처' 11.1%, '불만처리센타를 설치해 적극적으로 대처' 7.0% 순으로 나타났다. 3. 불만처리서비스 시행 정도는 총평균 3.02로 나타났으며, 불만처리 담당자가 '치과위생사'일 경우 접수담당자 보다 의료소비자 불만처리서비스 시행 정도가 높은 것으로 나타나 통계적으로 유의한 차이를 보였다(p < .01). 월 불만건수가 '없다'고 응답한 경우가 '1~10건'과 '11건 이상'의 경우보다 불만처리 시행 정도가 높은 것으로 나타나 그룹 간에 통계적으로 유의한 차이를 보였다(p < .05). 4. 불만예방서비스 시행 정도는 총 평균 2.59로 나타났으며, 서울, 인천 경기의 경우 지방보다 불만예방서비스 시행정도가 높은 것으로 나타나 통계적으로 유의한 차이를 보였으며(p < .01), 치과위생사 가 불만처리를 담당했을 경우 접수담당자 담당한 경우 보다 불만예방서비스 시행 정도가 높은 것으로 나타나 통계적으로 유의한 차이를 보였다(p < .05).

• 대한간호학회지
• /
• 제30권5호
• /
• pp.1156-1169
• /
• 2000

The study was aimed at developing an independent hospice center model that would be best suited for Korea based on a literature review and the current status of local and international hospices. For the study, five local and six international hospice organizations were surveyed. Components of the hospice center model include philosophy, purpose, resources (workers, facilities, and equipment), allocation of resources, management, financial support and hospice team service. The following is a summary of the developed model: Philosophies for the hospice center were set as follows: based on the dignity of human life and humanism, help patients spend the rest of their days in a meaningful way and accept life positively. On the staff side, to pursue a team-oriented holistic approach to improve comfort and quality of life for terminally ill persons and their families. The hospice center should have 20 beds with single, two, and four bed rooms. The center should employ, either on a part-time or full-time basis, a center director, nurses, doctors, chaplains, social workers, pharmacists, dieticians, therapists, and volunteers. In addition, it will need an administrative staff, facility managers and nurses aides. The hospice should also be equipped with facilities for patients, their families, and team members, furnished with equipment and goods at the same level of a hospital. represented by a center director who reports to a board and an advisory committee. Also, the center director administers a steering committee and five departments, namely, Administration, Nursing Service, Social Welfare, Religious Services, and Medical Service. Furthermore, the center should be able to utilize a direct and support delivery systems. The direct delivery system allows the hospice center to receive requests from, or transfer patients to, hospitals, clinics, other hospice organizations (by type), public health centers, religious organizations, social welfare organizations, patients, and their guardians. On the other hand, the support delivery system provides a link to outside facilities of various medical suppliers. In terms of management, details were made with regards to personnel management, records, infection control, safety, supplies and quality management. For financial support, some form of medical insurance coverage for hospice services, ways to promote a donation system and fund raising were examined. Hospice team service to be provided by the hospice center was categorized into assessment, physical care, emotional care, spiritual care, bereavement service, medication, education and demonstrations, medical supplies rental, request service, volunteer service, and respite service. Based on the results, the study has drawn up the following suggestions: 1. The proposed model for a hospice center as presented in the study needs to be tested with a pilot project. 2. Studies on criteria for legal approval and license for a hospice center need to be conducted to develop policies. 3. Studies on developing a hospice charge system and hospice standards that meet local conditions in Korea need to be conducted.

• 대한토목학회논문집
• /
• 제38권3호
• /
• pp.417-428
• /
• 2018

본 연구의 목적은 상하수도 시설을 중심으로 한 물 인프라의 지속가능성을 평가하는 지수들을 활용하여 경제, 사회, 환경적 측면에서의 지속가능성을 평가하고 지속가능성 확보 필요성을 제고하기 위함이다. 경제, 사회, 환경적 지수 중 중요하게 고려해야할 세부지수들을 파악하고, 전국 지자체를 유형화하여 집단 간 특성을 비교분석하였다. 세부 지수의 가중치 산출은 주성분 분석을 활용하였으며, 지자체를 유형화하는 과정에는 K-평균 군집분석을 시행하였다. 가중치 분석 결과, 전체 12개의 지수 중 재정자립도, 자본수입비율, 보조금비율, 서비스보급률, 노후화율, 수생태건강성, 하천수질이 지속가능성을 평가하기 위한 주요한 변수로 분석되었으며, 특히, 경제부문 지수의 영향력이 가장 높은 것으로 나타났다. 다음으로는 군집분석 결과를 통해 지자체를 크게 두 가지 유형으로 분류하였고, 각 유형 별 특징을 살펴보았다. 먼저 경제부문의 지속가능성이 우수한 집단에서는 환경부문에 대한 개선이 필요한 것으로 나타났지만, 대체로 지속가능성 상태가 우수한 것으로 나타났다. 환경부문이 우수한 집단에서는 지속가능성 상태가 열악한 지자체가 많이 포함되어 있으며, 특히, 경제부문 상태를 향상시키기 위한 집중적인 노력이 필요한 것으로 보인다.