• Title/Summary/Keyword: patient compliance

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An effective patient training for deep inspiration breath hold technique of left-sided breast on computed tomography simulation procedure at King Chulalongkorn Memorial Hospital

  • Oonsiri, Puntiwa;Wisetrinthong, Metinee;Chitnok, Manatchanok;Saksornchai, Kitwadee;Suriyapee, Sivalee
    • Radiation Oncology Journal
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    • v.37 no.3
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    • pp.201-206
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    • 2019
  • Purpose: To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. Methods: Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. Results: Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. Conclusion: Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.

Clinical and Bacteriologic Characteristics of Retreated Tuberculosis Patients (재치료 폐결핵환자의 임상적 세균학적 특성)

  • Oh, Seoung-Joon;Yoon, Ki-Heon;Yoo, Jee-Hong;Kang, Hong-Mo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.1
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    • pp.19-24
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    • 1995
  • Background: Although pulmonary tuberculosis is effectively controlled with 6 months or 9 months short course standard regimens, comparable numbers of treatment failures ensued because of inadequate treatment mainly due to patient's poor compliance. Indequate treatment with standard regimens during initial treatment may cause emergence of drug resistance and prolong the duration of chemotherapy. Also it may make the patient lesser compliant and finally increase the morbidity and the mortality. Methods: A clinical study was done to evaluate clinical and bacteriological characteristics of 94 patients who were retreated for pulmonary tuberculosis. Results: 1) 62 of the 94 patients were male and 32 patients were female. Mean age is 51 years old in male and 45 years old in female. 2) The extent of the disease on the chest radiograph was minimal in 10(11.1%) patients, moderate in 31(33.3%) patients, and far advanced in 52(55.6%) patients. 3) On sputum bacteriologic examination, 73(77.7%) patients were positive in sputum AFB smear and/or culture for Mycobacterium tuberculosis. 4) Results of drug sensitivity test performed in 42 patients showed that the resistance to one drug is in 9(20.5%) patients, two drugs in 18(40.8%) patients, and more than three drugs in 14(31.8%) patients. 5) Poor patient's compliance was the leading cause of the retreatment of pulmonary tuberculosis(43.6%) 6) Only 24(25.5%) patients of the 94 retreatment patients were successfully treated and 39(41.6%) patients were dropped out during follow-up. Conclusion: We concluded that poor patient's compliance was the most important cause of treatment failure not only in primary treatment patients but also in retreatment patients. Primary treatment of pulmonary tuberculosis should be completed under strict monitoring of the patient because significant number of retreatment patients had multiple drug resistance and poor outcome.

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Therapeutic Compliance for Calcium Supplements and Its Related Factors in Rural Osteoporotic Women (일부 농촌지역 여성 골다공증 환자의 칼슘보조제 치료순응도와 결정요인)

  • Chun, Byung-Yeol;Kam, Sin;Lee, Young-Ja;Lee, Sang-Won;Lee, Kyung-Eun;Lee, Young-Seok;Kim, Bong-Kee
    • Journal of agricultural medicine and community health
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    • v.26 no.2
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    • pp.111-132
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    • 2001
  • This study was conducted to examine the therapeutic compliance and its related factors in rural women with osteoporosis. A questionnaire survey was performed from April to May in 2000 for 140 osteoporotic patients who were diagnosed from April to June in 1999 through community health program. The study employed the health belief model for predicting and explaining sick role behavior. The analysis techniques employed included contingency table analysis and path analysis using LISREL. The major results of this study were as follows: Of the subjects, 12.1% were continuously complaint, 53.6% were intermittently compliant, and 34.3% were non- compliant to calcium supplement therapy. As the result of path analysis, the therapeutic compliance was significantly higher(${\mid}T{\mid}$ >2.0) as patients had higher perceived severity of disease, lower perceived barriers of treatment, and when patients thought their disease status as severe. As the patients had higher educational level, more experience of mass media contact or health education about osteoporosis, and when family had more concern for patient treatment, they had higher perceived susceptibility of complication(bone fracture)${\mid}T{\mid}$ >2.0). The patients had higher perceived severity(${\mid}T{\mid}$ >2.0) as they had more educational level, more advice for treatment from their doctors, and when family had more concern for their treatment. As the patients had more advice for treatment from their doctors and when family had more concern for their treatment, they had higher perceived benefit of treatment and lower perceived barriers to treatment(${\mid}T{\mid}$ >2.0). In order to improve the therapeutic compliance in rural osteoporotic women, it would be necessary that the patient should recognize their disease severity properly. And the perceived barriers should be removed through supportive environments for osteoporosis treatment such as doctor 's more advice and family 's more concern for treatment. In addition, effective and continuous management system for osteoporotic patients should be established.

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Development and Clinical Application of Critical Pathways for Vaginal Delivery and Cesarean Section (정상산모의 질식분만 및 제왕절개술에 대한 표준진료지침서의 개발과 임상 적용)

  • Park, Yong Won;Bai, Sang Wook;Jung, Young Nae;Lee, Hae Woo;Kim, Young Ran;Hong, Sun Bok;Park, Heun Ju;Tark, Kwan Chul
    • Quality Improvement in Health Care
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    • v.7 no.1
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    • pp.32-45
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    • 2000
  • Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

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Nurse's Power and Tactics in Nursing Practice (간호사의 업무수행상의 권한과 행사전략)

  • Han, Hye-Ja
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.1
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    • pp.23-37
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    • 1999
  • This study is to understand and to describe the power that a nurse experiences on nursing practice and then. to present a basic data for nurse's power-development, power improving and empowering. Ethnography was used to understand and to describe experience on exercising various powers occurred on nursing practice. and to analyze and to understand the meaning of a nurse's power. The objects was nurses. Ten nurses who have more than three year's experience were selected as objects from Cuniversity's hospital in Seoul from May of 1996 to August of 1997 through in-depth interview. participant observation, and phone interview. Instruments werw a portable recorder and field notes. I described a case appeared in a data using Agar's 'Pencil and scissors' method right after collecting materials. Then, Idescribed a theme discovered commonly. Followings are the results of the study. 1. There were three categories of relationships with main objects when nurses exercised their power on their practices: a therapeutic caring relationship with patients, a relationship of companion, vertical cooperation, and a constituent person with a doctor, and a relationship of cooperation, and a constituent person with administrative workers and medical technicians. 2. There were many types of nurse's power, tactics and various patient's responses about them. 1) Types of nurse's power to patients were giving information, controling environment, helping for cure, emotional support, and performing discretion. 2) Nurse's tatics for performing power were positive tactics neutral tactics, and negative tactics. 3) Patient's responses were appeared as compliance and noncompliance. Compliance were agreeing. taking nurse's advice, trusting, understanding, being admitted, exposuring himself, and appreciating. 3. There were types of nurse's power and performing tactics. 1) Types of power to a doctor were advice, informing, demanding and mediation. 2) Performings of tactics to a doctor were positive tactics, neutral tactics, and negative tactics. 3) Doctor's responses were appeared as accepting and unaccepting. Acceptings were taking in and appreciating, and unacceptings were denying nurse's advice and authoritative. 4. There were types of nurse's power and tactics about administrative workers and medical technicians and responses about them. 1) Types of power about administrative workers and medical technicians were suggestions and demands. 2) Power performings tactics were positive tactics.neutral tactics, and negative tactics. 3) Responses of administrative workers and medical technicians about nurse's power performing were appeared appeared as accepting and unacce pting. Acceptings were taking in, and unacceptings were denying. Therefore, it can be said that types of nurse's power and performing tactics on nursing practice and nurse's power based on responses of a patient, a doctor, an administrative worker, and a medical technicians are power or influence for agreeing, taking advice, trusting, understanding, exposuring himself, appreciating, and taking in to objects. The results of this study helped to understand nurse's power. I expect that this study will improve nure's power by using expert power, referent power, and legitimate power effectively among powers acmpanied with the origin and that nurses make ef-ort to improve professional knowledge and human nature so that they use this study as a chance to develope expert nursing practice.

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The Effect of Doctor's Payment Method on Patient's Medical Care Use: Revisit of the Patient's Asymmetric Information Problem (환자의 의료이용에 대한 의사의 지불방식의 효과: 재방문 환자의 비대칭적 정보의 문제)

  • Jo, Changik;Lim, Jae-Young
    • KDI Journal of Economic Policy
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    • v.33 no.1
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    • pp.125-148
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    • 2011
  • Although the patient's problem with access to health information has been improved due to rapidly developing information technologies, such as the internet, some patients still do not have enough ability to understand, interpret, and analyze the health information. Given this view on the patient's asymmetric information problem, if a doctor provides sufficient effort to help patients understand and interpret medical information, the efficiency of patient's medical care use could be improved. This paper shows firstly that the patient's inefficient use of medical care originates from his information problems, such as the misperception of the effectiveness of medical care and secondly suggests that if the doctor makes sufficient effort to correct patient's information problems, the inefficiency can be ameliorated. This paper also suggests the manipulation of a doctor's payment method can lead a doctor to provide optimal level of efforts which can in turn lead patients to use the optimal level of medical care. With an optimal level of effort, a doctor can more easily achieve a patient's compliance with the newly recommended amount of medical care.

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Development of a Critical Pathway for the Chemotherapy of Non-small Cell Lung Cancer Patients and Its Effects (비소세포성 폐암 환자의 항암화학요법을 위한 Critical Pathway개발과 적용효과)

  • Choe, Ja-Yun;Jang, Geum-Seong;Choe, Eun-Yeong
    • Journal of Korean Academy of Nursing Administration
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    • v.8 no.1
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    • pp.85-95
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    • 2002
  • The purpose of this study was to develope a critical pathway for the chemotherapy of non-small cell lung cancer patients and to identify its effects after implementation. Critical pathway was developed through 5 steps including content and clinical validity tests with collaborative efforts of nurses, clinicians, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimizing cost to the patients. This paper was described an evaluation of the impact of a developed critical pathway on complication rate, length of stay, costs, the interval of treatment and patient satisfaction by nonequivalent control group posttest-only non-synchronized research design.Results were compared between the two groups of patients. There were no significant differences in demographic variables and the occurrence of bone marrow suppression between experimental group and control group(t=-0.01, p=0.992). There were statistically significant decreases in the average length of stay(t=-10.45, p=0.000), in the average cost(t=-2.988, p=0.004), and in the interval of treatment(t=-6.75, p=0.000) after implementation of the critical pathway compared to control group. Also, there was a statistically significant improvement of the patient satisfaction after implementation of the critical pathway compared to control group(t=4.57, p=0.000). This paper concludes that critical pathway in chemotherapy for lung cancer, implemented in the context of an general hospital, is the useful tool to shorten the hospital stay, reduce treatment costs, and improve the quality of life in cancer patients. Further study needs to be conducted to identify other clinical outcomes including job satisfaction, collaboration among health professionals and potential for use in education. Also, it is recommended that nurses should revise continuously the developed critical pathway through clinical implementation and maintain their role of patient advocacy through monitoring pathway compliance.

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Adherence to Capecitabine Treatment and Contributing Factors among Cancer Patients in Malaysia

  • Zahrina, Abdul Kadir;Norsa'adah, Bachok;Hassan, Norul Badriah;Norazwany, Yaacob;Norhayati, Md Isa;Roslan, Mohd Haron;Wan Nazuha, Wan Rusik
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.21
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    • pp.9225-9232
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    • 2014
  • Ensuring adherence to chemotherapy is important to prevent disease progression, prolong survival and sustain good quality of life. Capecitabine is a complex chemotherapeutic agent with many side effects that might affect patient adherence to treatment. This cross sectional study aimed to determine adherence to capecitabine and its contributing factors among cancer outpatients in Malaysia. One hundred and thirteen patients on single regime capecitabine were recruited from Hospital Sultan Ismail and Hospital Kuala Lumpur from October 2013 to March 2014. Adherence was determined based on adherence score using validated Medication Compliance Questionnaire. Patient socio-demographics, disease, and treatment characteristics were obtained from medical records. Satisfaction score was measured using the validated Patient Satisfaction with Healthcare questionnaire. The mean adherence score was 96.1% (standard deviation: 3.29%). The significant contributing factors of adherence to capecitabine were Malay ethnicity [${\beta}=1.3$; 95% confidence interval (CI): 0.21, 2.43; p value=0.020], being female [${\beta}=1.8$; 95%CI: 0.61, 2.99; p value=0.003]), satisfaction score [${\beta}=0.08$; 95%CI: 0.06, 1.46; p value=0.035], presence of nausea or vomiting [${\beta}=2.3$; 95%CI: 1.12, 3.48; p value <0.001] and other side effects [${\beta}=1.45$; 95%CI: 0.24, 2.65; p value=0.019]. Adherence to capecitabine was generally high in our local population. Attention should be given to non-Malay males and patients having nausea, vomiting or other side effects. Sufficient information, proactive assessment and appropriate management of side effects would improve patient satisfaction and thus create motivation to adhere to treatment plans.

The Survey on Satisfaction of Outpatient Using Physical Therapy in part of Kyeong-sang Province (경상도 일부 지역에서 물리치료서비스를 이용하는 외래환자의 만족도 조사)

  • Lee, Hae-Jung;Han, Jin-Tae
    • The Journal of Korean Physical Therapy
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    • v.21 no.3
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    • pp.103-108
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    • 2009
  • Purpose: The purpose of this survey was to assess the satisfaction of patients suffering from musculoskeletal pain with physical therapy (PT) in Busan, Daegu, and Kyeongsang provinces using a Korean-language version of the patient satisfaction questionnaire with physical therapy service (PSPT). Methods: A total of 654 patients, having PT for their musculoskeletal pains, participated. Consenting subjects completed a 20-item PSPT on their $6^{th}$ or last treatment day. Simple descriptive statistics were used for respondent characteristics, and mean of satisfaction score in each item. Regression analysis was performed on each item of the questionnaire. Results: 654 subjects responded during or after their PT services. 297 (45.5%) of them were male and the most common site of pain was the spine. The mean of each item score (1-5) ranged from 2.14 for "my therapist did not listen to my concerns" to 4.12 for "my therapist treated me respectfully". Receptionist's attitude, registration process, service time of the hospital, and answer to the patient's questions greatly affected the general satisfaction of the respondents. Conclusion: The results showed high levels of satisfaction to the general process for obtaining treatment as well as the therapist's attitudes toward their patients. They may provide valuable patients' feedback regarding PT service for musculoskeletal pain. Therefore, it may be used by physical therapists to improve future patient experiences with a view to improving the patient's attendance and compliance with the PT service protocols for patients suffering from musculoskeletal pain.

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Study on Clinical Patient-oriented Education System for Medical Organizations (의료기관에서의 환자 중심 교육 시스템 연구)

  • Park, Hwagyoo
    • Journal of The Korean Association of Information Education
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    • v.17 no.4
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    • pp.475-486
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    • 2013
  • Recent healthcare studies evaluate the effective impacts of a patient educational information intervention in hospitals on adherence to communicating knowledge, life quality, and therapeutic response in patients treated with highly active therapy in medical organizations. Therefore, the aim of this study is to design and implement the effective and systematic frameworks by providing clinical patient-oriented education system(CPES), which enhances health promotion and medical cures. CPES initiatives accelerate positive financial returns with network-driven educational system. To validate the CPES, the author analyzes the efficiency and effectiveness using statistical survey works. With this outcome, it is compared with previous system. One of the findings is that the system can improve compliance with treatment right dietetics and give patients self-manage their conditions in S hospital. Patients' acknowledge of their condition and its treatment process can be improved through the educational systems.