• Safety and Health at Work
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• 제7권1호
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• pp.18-31
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• 2016

Background: A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. Methods: Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. Results: Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. Conclusion: The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

• Safety and Health at Work
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• 제9권4호
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• pp.381-387
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• 2018

Background: Physician behaviors that undermine a culture of safety have gained increasing attention as health-care organizations strive to create a culture of safety and reduce medical errors. We developed, implemented, and assessed a course to teach physicians skills regarding effective coping and interpersonal communication skills and present our results regarding outcomes. Methods: We examined a professional development program specifically designed to address unprofessional or distressed behaviors of physicians, and we evaluated the impact on burnout, quality of life, and emotional flooding scores of the physicians. Assessments of burnout, quality of life, and emotional flooding were assessed preintervention and postintervention. Results: Results demonstrated statistically significant reductions over time in physicians' emotional flooding and emotional exhaustion (EE). Specifically, using a Wilcoxon Signed-Rank test, results revealed that flooding scores at follow-up were statistically significantly lower than at baseline, V = 590, p < 0.05, and EE and personal accomplishment distributions were found to significantly deviate from normal as indicated by Shapiroe-Wilks tests (p < 0.05). A Wilcoxon signed-rank test indicated that EE scores were significantly higher at baseline compared to follow-up 1, V = 285, p < 0.05. Conclusion: We conclude that the physician participants who enrolled in the educational skills training program improved scores on emotional flooding and EE and that this may be indicative of improved skills related to their experiences and learning in the program. These improved skills in physicians may have a positive impact on the overall culture of safety in the health system setting.

• 보건행정학회지
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• 제4권2호
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• pp.77-110
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• 1994

This study is an empiriacl analysis of effects of government intervention on the health care delivery system in Korea. The purposes of this study are to find out the effects of government intervention on the per capita national health expenditure(per capita NHE), crude mortality rate(CMR), and institutional efficiency. Here, the institutional efficiency is defined as a formula shown below: log$\frac{100-curde mortality rate }{per capita NHE}$$\times$100. The formula indicates that the instiutional efficiency increases if the CMR and/or per capita NHE goes down. In the meantime the government intervention is measured by six independent variables: I) the degree of social developments, ii) the numberr of physicians per 100, 000 population, iii) the proportion of specialists among the total physicians, iv) the proportion of public expenditure among the NHE, v) the proportion of public beds to the total number of beds, vi) the proportion of physicians working at the public sector to the total number of physicians. In the above six independent variables iv), v) and vi) are the ones that reflect the degree of government intervention. In actual calculation, the two independent variables v) and vi) are integrated into a new variable based on one to one correspondence. The materials used are the time-series data from 1970 through 1990 in Korea. A path analysis and the time-series regression analysis were adopted to estimate and examine the causal relationship between variables involved. And decomposition of the effect of causal relationship is made to find net effect, direct and indirect effect. The major findings are as follows; 1. The effect of public expenditure, number of physicians per 100, 000 population, the proportion of specialists among the total physicians and social development shows a positive relationship with per capita NHE. Only if the government intervention would be counted, the effects of the number of physicians and the proportion of specialists succeed in containing per capita NHE. 2. In additionn to the above four variables, one additional variable, per capita NHE, was also responsible for the reduction of CMR. The factor of social development found to be the most potent predictor of the CMR reduction. However, the CMR reduction due to government intervention was negligible. 3. Meanwhile, the above four variables were found to was have negative effects on the institutional efficiency. The reverse is true when the government intervention is counted. For example, the number of physicians and the proportion of specialists have played a positive role in raising institutional efficiency via goverment intervention. This comes from the factual effect that the increment of institutional efficiency via the reduction of per capita NHE is bigger than via the reduction of CMR.

• 가정∙방문간호학회지
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• 제8권2호
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• pp.148-158
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• 2001

Purpose: This study is to investigate the attitudes on the Home Health Care among the physicians and nurses in P University. Method: Data were gathered from 71 physicians and 264 nurses. working at P University Hospital. from May 1 to May 15, 2001 and analyzed using descriptive statistics and Fisher exact test. Results: 1) As to the previous information about home health care program, those who have been familiar to it were 100% of physicians, and 99.6% of nurses, and 39% of the physicians and 66.1% of the nurses. were found to have responded with right answers, 2) As to the acceptance of the home health care program, 87% of physicians and 98.5% of nurses were found to be positive and there showed a significant difference(p= .019), 3) The main reasons for accepting the system were: the alleviation of the family burden of time, the maintenance of continuity of care, and the reasons for opposing the system were incomplete legal assurance. the possibility of providing illegal medical services. 4) The physician's intention rate of patient referrals to home care program reveled 49.2%. 5) According to the services related to Home Health Care. the orders of acceptance rates were medical tests related services (77.8%, 92%); therapeutic nursing interventions(69.0%, 88.2%): and services for medication(68.3%, 82.5%) among physicians and nurses. respectively. Conclusion: For the stabilization and successful implementation of home health care system. it should be accompanied with education for physicians about home care. setting specific laws and regulations for home care. legal assurance of home care business. outcome research for home care recipients. and support systems of hospital administration.

• 농촌의학ㆍ지역보건
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• 제34권3호
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• pp.303-315
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• 2009

다양한 보건사업 수행과 서비스 질 보장을 위해서는 공공보건부문 지식을 비롯하여 행정력과 리더십을 갖춘 의사인력의 확대를 통한 인프라 구축이 중요하다. 본 연구는 공공의료계의 우수한 의사인력의 진출을 활성화하는 방안의 일환으로써 현재 보건소에서 근무하고 있는 의사들을 대상으로 공공보건부문 의사인력 양성과 개발에 대한 인식정도를 파악함으로써 향후 공공보건부문에 종사하는 의사인력의 확대 방안을 모색하기 위한 기초자료를 제공하기 위해 시행되었다. 본 설문조사는 126명이 응답 하였으며, 수집된 자료는 SPSS ver. 17.0K를 이용하여 빈도분석을 통해 분석하였다. 분석 결과 ‘의사조직 내에서의 공공의료부문 의사의 위상확보와 지원 필요성’에 대한 조사결과, 거의 모든 항목에 대해 응답자들이 필요성을 높게 인식하고 있었다. 특히, ‘의사들의 공공보건부문 진출의 장애요인’에 대해서는 ‘낮은 급여문제’와 ‘승진기회의 부족’ 등을 중요하게 꼽고 있었다. ‘의사들의 보건소 근무를 위하여 가장 필요한 교육 프로그램’으로는 ‘보건기획과 보건사업 수행 관련 프로그램’을 꼽고 있었는데, 사전 교육 및 보수 교육을 통해 공공보건부문 의사들의 역량을 강화해 나가는 것이 필요할 것이다. 공공의료계 의사인력의 원활한 확보와 역량강화를 위해서는 의사를 많이 충원하는 것도 중요 하겠지만 공공의료계에 의사들의 진입을 위한 방안과 함께 현재 근무 중인 의사인력에 대한 역량강화 방안도 중요하다. 후속연구를 통해 공공보건부문 인력양성과 개발에 기여할 수 있는 새로운 방안들을 마련하고 제도화 하여 공공보건부문 확충을 통한 국민보건향상에 기여할 수 있기를 기대한다.

• 정보관리학회지
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• 제33권1호
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• pp.161-180
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• 2016

의사들은 학술연구와 환자진료에 관한 정보요구를 가지고 있고, 전자정보원을 이용하여 해결하고 있으나 정보원의 선택이나 검색에서 어려움을 겪는다. 본 연구는 의사들의 연구와 진료정보요구를 지원할 수 있는 검색시스템을 설계하고 개발하는 것이 목적이다. 이를 위해 의사들의 정보요구에 적합한 정보원 개발을 위해서 정보이용행태에 관하여 심층인터뷰를 하였고, 그 결과를 바탕으로 검색 시스템인 MediSearching을 개발하였다. 개발된 시스템은 효용성 검증과 제안을 얻기 위해 추가 인터뷰와 테스트검색을 통하여 피드백을 받았다. 의사들의 정보이용행태에 관한 인터뷰 결과 소속병원의 종류나 진료 과목에 따라서 차이를 보였다. 대학병원 의사들은 연구와 관련된 정보요구가 컸으며 학술지 논문을 주로 이용하고 있었으나, 전문병원이나 개인병원 의사들은 진료와 관련된 정보요구가 대부분으로 동료와의 대화로 해결하는 형태를 보였다. MediSearching은 연구와 진료정보요구를 동시에 지원할 수 있는 검색시스템으로 개발되었고, 인터페이스와 검색효용성이 검증되었다. 기존의 한국 의학 정보 사이트에서는 제공 정보의 종류나 검색방법에 따라 서비스 범위가 모두 달라 의사들은 동일한 검색 과정을 반복하는 불편함이 있었으나 이를 해결한 것으로 파악되었다. 또한 파일 형태나 언어와 상관없이 정보원의 추가가 가능하도록 한 점에서 유용한 것으로 평가되었다.

• 보건행정학회지
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• 제3권2호
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• pp.100-129
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• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• Journal of Hospice and Palliative Care
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• 제20권1호
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• pp.18-25
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• 2017

목적: 돌발성 통증을 적절히 조절하는 것은 암환자에서 필수적이다. 돌발성 통증을 조절하는 것은 의료진이 돌발성 통증에 대해 잘 이해하고 적절한 구제 진통제를 사용하는 것에 달려있다. 본 연구는 한국 완화의료 전문의들의 돌발성 통증에 대한 견해와 진료 형태에 대해 알아보고자 하였다. 방법: 본 연구는 한국호스피스 완화의료학회에서 시행된 2014년 돌발성 통증 설문조사를 바탕으로 진행하였다. 100명의 의사가 온라인 설문조사에 참여하였다. 총 33개의 자가 기입식 설문 문항 중에서 12개의 항목이 분석에 사용되었다. 결과: 빠른 작용 발현은 구제 진통제를 선택함에 있어 가장 중요한 요소였다. 경구 옥시코돈(65%)과 모르핀 주사제(27%)는 흔히 사용되는 구제진통제였다. 소수의 의사들(3%)만이 점막 흡수형 펜타닐을 선호하였다. 빠른 작용 발현 때문에 경구 옥시코돈을 선택한다고 답변한 의사들은 21.5%였으며, 반면에 빠른 작용 발현 때문에 모르핀 주사제를 처방한 의사들은 81.5%였다. 전체 응답자의 약 66%는 돌발성 통증이 구제 진통제로 잘 조절되지 않는다고 답변했다. 결론: 돌발성 통증 조절에 의료진들은 어려움을 느끼고 있었고, 의료진들이 구제진통제를 선택함에 있어서 필요로 하는 중요한 요소와 실제 처방의 형태에는 차이가 있었다.

• 한국병원경영학회지
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• 제20권2호
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• pp.15-27
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• 2015

환자의 만족도는 더 나은 의료서비스 결과물을 위한 중요 요소이기에, 환자만족도와 관련 요인에 대한 연구는 그 필요성이 대두하고 있다. 따라서, 본 연구는 의사의 환자를 향한 공감적(empathetic) 태도와 같은 잠재적 요인이 환자만족도와 어떤 연관성을 가졌는지를 분석했다. 이를 위해, 편의표본추출법을 통한 환자설문조사 자료 중 총 273,994 개의 사례들을 분석한 단면연구가 수행되었다. 연구의 독립변수 및 종속변수들은 각각 의사의 태도 및 의사와 진료소(office setting or clinic) 관련 환자만족도로 정의되었다. 연구결과에 의하면, 의사와 진료소 관련 환자만족도는 각각 100점 만점에 평균 78.08과 78.62로 나타났고 상응하는 표준편차는 각각 0.14와 0.12였다. 또한, 의사의 태도가 의사와 진료소 관련 환자만족도와 유의한 관계에 있음을 확인하였다(p < 0.001). 의료에 대한 환자만족도를 높이기 위해서는, 의사의 공감적 의사소통 능력개발을 위한 지속적인 노력이 기울여져서 환자에 의한 의사의 공감적 태도가 인지되어 질 수 있기를 본 연구는 제언한다.

• 한국간호교육학회지
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• 제13권1호
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• pp.105-113
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• 2007

Background: Cancer genetics have gained public attention dramatically. Everyday physicians and nurses use the knowledge of cancer genetics in their practices. Despite the importance of the knowledge of the health care providers on cancer genetics, there is a paucity of literature investigating the levels of knowledge about cancer genetics among health care providers. Purpose: This study aimed to describe the Korean physicians' current knowledge level about hereditary breast and ovarian cancer (HBOC). Method: This nation-wide survey used a 15-item questionnaire which is modified from the Breast Cancer Genetic Counseling Knowledge Questionnaire originally developed by Erblich et al.(2005). One hundred and forty-four physicians participated in this survey from October 1, 2006 to March 31, 2007. Result: Physicians' knowledge level about hereditary breast cancer was 11.94 (S.D=2.46). Physicians with short-term careers (less than one year), the position of Intern, or who were involved in breast or ovarian cancer care demonstrated the highest knowledge about HBOC. Conclusion: Genetic courses in medical education seemed to contribute to the high level of physicians' genetic knowledge. Also, nursing discipline needs to incorporate genetics or genetic counseling courses into the formal educational curriculum in order to deliver up to date cancer care services which are sensitive to ever-changing cancer genetic information.