• Health Policy and Management
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• v.2 no.1
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• pp.17-41
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• 1992

During the month of October, 1990, 676 practicing physicians in Taegu City were surveyed by mail questionnaires about their general characteristics and the reasons why they chose Taegu as a practice location and 331 out of them responded completely. Collected data were analyzed to provide basic reference data for future health manpower policy which intends to solve the problem of geographical maldistribution of physicians, The major findings are as follows: For the question asking why Taegu area is favored, following lists are as the order of their magnitude of the reasons replied by more than 20% of the respondents: 1) Taegu is a foundation of life until now(81.3%) 2) Better educational environments are available for their offsprings(73.7%) 3) They can have intimate relationship with acquaintances or friends sharing same or similar interests(61.0%) 4) Due to characteristics of their specialty, metropolitan seems to fit better(52.0%), 5) They graduated from the medical school in Taegu(49.8%) 6) Never thought of selecting practice location in other area than Taegu without any specific reasons(45.9%) 7) Intelligent communications are available with other physicians(39.9%) 8) More opportunities to participate in social life, such as medical, or alumni association etc., can be given(33.2%) 9) No specific knowledge or relationships with other area are available(32.6%) 10) They finished internship or residency training in Taegu area(31.4%) 11) Facilitation of transferring patients including emergent patients can be obtained (30.8%) 12) Continuing medical educational programs are available(29.9%) 13) Sufficient medical demands are provided because of the large population(28.1%) 14) More chances to be grown up as a medical professionals can be achieved(25.7%) 15) More leizure time can be utilized for cultural activities(23.9%) 16) They had experiences to work in hospitals or facilities in Taegu area(23.3%) 17) Medical facilities of fellow physicians or alumni can be used(20.5%) In addition, 37% of female physicians answered that their spouse strongly influenced them to choose Taegu, and 33.3% of physicians with age of thirty replied that parents did so. Physicians of specialty in radiology, clinical pathology, anatomical pathology, and anesthesiology considered that patients from other hospitals and medical facilities would be referred often to them and that less competition seemed to be expected in their specialty (30.8%). In contrast, general practitioners anticipated that larger population would increase the medical demand(62.5%). 28.6% of medical practitioners who graduated medical schools in other are than Taegu and 22.0% of medical practitioners who were trained in hospitals of other area than Taegu were influenced to choose Taegu by their spouses. In consideration of above findings, we may conclude that long term and rational manpower policies should be implemented to solve the problem of geographical maldistribution of physicians as well as short term physician-inducing policies, and they have to be incorporated with equitable community development.

• Journal of Preventive Medicine and Public Health
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• v.28 no.3 s.51
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• pp.623-639
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• 1995

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance. By the way researchers concerned are beginning to propose some kinds of innovative and detailed ideas to government these days. They are Diagnosis-related group(DRG) and Resource-based .elative value scale(RBRVS). In the light of this situation it is so encouraging that our government can come up with that and move. In case of RBRVS research we have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. However there might be something different conditions between USA and Korea to apply the same Dr. Hsiao's method and it must be vital to check so called' total work approach' compared with 'intra-service work approach' before expanding to the whole medical fields. According to the' Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, pre, and post service work. These sub-works, again should be merged together to be the pre-postwork subset through some statistical methods of the estimation process applied by Dr. Hsiao's methodology in RBRVS development later on. But in this paper that estimation process was not taken because we could have real values for all of those surveyed items related to just one specialty, OB & GY. Instead, We used some statistical comparison procedures relevant to demographic characteristics, reliability & validity and correlation analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach. The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach through statistical sampling method based on national population of OB & GY physicians in Korea. And also with the thankful help of Advisory Committee under Korean Association of OB & GY, questionnaires were made and mailed to the subjects, two times. As a result there were not any statistically significant differences in demographic characteristics between the two approaches except for the variable 'Response time for the questionnaires', but in other sections of comparisons, response rate, representative values, reliability & validity test, correlation analysis with American RVU, all showed 'Total approach' was not only more rational and statistically meaningful than 'Intra-service approach' but also had considerable merits. But we are not absolutely sure about this paper's robustness. Because of some limitations, we'd rather like to suggest further researches should be followed. In that sense the first thing would be a research for the influence of doctor's characteristics, especially 'frequency' on the rating of work and the way to define total work more clearly.

• Research in Community and Public Health Nursing
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• v.5 no.2
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• pp.130-146
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• 1994

Our medical care system is trying to diversify in order to meet the client's needs, and to adjust to a medical environment which is changing very rapidly. Because current nursing theory and practice focus on holistic care, health care management, education, and research, contrary to the traditional emphasis on only assisting a physician, more autonomy and specialization for the implementation of nursing are required. Considering these trends and actual needs, the category of clinical nurse specialist should be established as soon as possible. In order to develop strategies for implementing this new professional specialty, the authors conducted a field survey and literature review of the current system in Korea. As a result, various obstacles and constraints were discovered as follows : 1) There are few accredited educational programs for the training of CNS's. 2) Several hospitals already have staff designated as clinical nurse specialist (CNS) even though the term CNS is not yet standardized or adopted in nationwide. 3) The role of the CNS is not clearly understood by the medical societies, or even nursing societies. A nurse who works in specific nursing areas such as central supply, kidney dialysis, intensive care, coronary care, etc. for a long time, considers herself /himself a CNS. Based upon the above findings, the following alternatives are recommended. 1) The role of the CNS should be defined according to specified functions and authority : professional autonomy ; counselling and educating patients and their familes, nurses, and even other medical personnel ; research on improvement of nursing ; and management of the nursing environment including medical resources, information, and cases. 2) the qualification of CNS should be attained only by a nurse who has an RN license and clinical experience of more than 3 years in a specific nursing field: passes a qualifying examination; and contributes to the professional development of peers, colleagues, and others. A master's degree should only be optional, because of the insufficient of graduate programs which are well designed for the CNS. 3) The CNS should initially be a head nurse rather than line staff in order to deal with as wide an experience base as possible. 4) The nursing specialty could be divided into two areas such as a clinical field and a community field. The clinical field could then be categorized by the Styles' classification such as diseases and pathogenics, systems, ages, acuity, skills/techniques, and function/role ; the community field could be classified according to work site.

• Health Policy and Management
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• v.19 no.3
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

• Korean Journal of Clinical Pharmacy
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• v.25 no.4
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• pp.273-279
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• 2015

Objective: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. Method: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were subclassified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. Results: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). Conclusion: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

• The Korean Journal of Pain
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• v.31 no.3
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• pp.147-154
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• 2018

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.

• Safety and Health at Work
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• v.3 no.2
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• pp.92-100
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• 2012

Objectives: The French National Occupational Diseases Surveillance and Prevention Network (RNV3P) is a French network of occupational disease specialists, which collects, in standardised coded reports, all cases where a physician of any specialty, referred a patient to a university occupational disease centre, to establish the relation between the disease observed and occupational exposures, independently of statutory considerations related to compensation. The objective is to compare the relevance of disproportionality measures, widely used in pharmacovigilance, for the detection of potentially new disease ${\times}$ exposure associations in RNV3P database (by analogy with the detection of potentially new health event ${\times}$ drug associations in the spontaneous reporting databases from pharmacovigilance). Methods: 2001-2009 data from RNV3P are used (81,132 observations leading to 11,627 disease ${\times}$ exposure associations). The structure of RNV3P database is compared with the ones of pharmacovigilance databases. Seven disproportionality metrics are tested and their results, notably in terms of ranking the disease ${\times}$ exposure associations, are compared. Results: RNV3P and pharmacovigilance databases showed similar structure. Frequentist methods (proportional reporting ratio [PRR], reporting odds ratio [ROR]) and a Bayesian one (known as BCPNN for "Bayesian Confidence Propagation Neural Network") show a rather similar behaviour on our data, conversely to other methods (as Poisson). Finally the PRR method was chosen, because more complex methods did not show a greater value with the RNV3P data. Accordingly, a procedure for detecting signals with PRR method, automatic triage for exclusion of associations already known, and then investigating these signals is suggested. Conclusion: This procedure may be seen as a first step of hypothesis generation before launching epidemiological and/or experimental studies.

• Archives of Craniofacial Surgery
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• v.22 no.5
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• pp.254-259
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• 2021

Background: Prophylactic antibiotics are commonly used in craniofacial surgeries. Despite the low risk of surgical site infection after nasal surgery, a lack of consensus regarding the use of antibiotic prophylaxis in the closed reduction of nasal bone fractures has led to inappropriate prescribing patterns. Through this study, we aimed to investigate the status of prophylactic antibiotic use in closed reductions of nasal bone fractures in Korea. Methods: This retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea from 2005 to 2015. We analyzed the medical records of patients who underwent closed reduction of nasal bone fractures. The sex, age, region of residence, comorbidities, and socioeconomic variables of the patients were collected from the database. Factors that affect the prescription of perioperative antibiotics were evaluated using multivariate logistic regression analysis. Results: A total of 3,678 patients (mean±standard deviation of age, 28.7±14.9 years; 2,850 men [77.5%]; 828 women [22.5%]) were included in this study. The rate of antibiotic prescription during the perioperative period was 51.4%. Approximately 68.8% of prescriptions were written for patients who had received general anesthesia. The odds of perioperative prophylactic antibiotic use were significantly higher in patients who received general anesthesia than who received local anesthesia (odds ratio, 1.59). No difference was found in terms of patient age and physician specialty. Second-generation cephalosporins were the most commonly prescribed antibiotic (45.3%), followed by third- and first-generation cephalosporins (20.3% and 18.8%, respectively). In contrast, lincomycin derivatives and aminoglycosides were not prescribed. Conclusion: The findings of this study showed that there was a wide variety of perioperative antibiotic prescription patterns used in nasal bone surgeries. Evidence-based guidance regarding the prescribing of antimicrobial agents for the closed reduction of nasal bone fractures should be considered in future research.

• Korean Journal of Clinical Pharmacy
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• v.33 no.4
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• pp.261-269
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• 2023

Background: Acute rhinosinusitis (ARS) is a common condition encountered in ambulatory practice and is one of the most common reasons for antibiotic prescriptions. This study aimed to evaluate the potentially inappropriate antibiotic prescribing for ARS in South Korea and identify influencing factors. Methods: We analyzed Health Insurance Review and Assessment Service-National Patient Samples data. We selected outpatients aged 20 to 64 with ARS, prescribed antibiotics between February and November 2020. Potentially inappropriate antibiotic prescribing was categorized as: 1) inappropriate antibiotic selection and 2) inappropriate antibiotic dosage or duration. Multiple logistic regression was conducted to estimate the impact of various factors on inappropriate antibiotic prescribing. Results: Of 1,210 patients, 80.83% received potentially inappropriate ARS antibiotic prescriptions. Inappropriate antibiotic selection accounted for 43.55%, and inappropriate antibiotic dosage and duration contributed to 37.28%. Otolaryngologists had higher odds ratio (OR) of potentially inappropriate antibiotic prescribing compared to internal medicine practitioners, while dentists had lower OR. Patients aged 20 to 29 years had a higher OR than other age groups, and those who visited primary care clinics had a higher OR than those who visited hospitals. Conclusion: Potentially inappropriate antibiotic prescribing for ARS is prevalent in South Korea. This study identified physician specialty, patient age group, and the level of healthcare facility as factors influencing potentially inappropriate antibiotic prescriptions. Addressing this issue through targeted interventions, such as improved guidelines adherence and patient education, is imperative to mitigate the risks associated with antibiotic misuse and antibiotic resistance.

• Health Policy and Management
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• v.16 no.2
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.