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An Analysis on the Factors Affecting Revisit and Defection of Long-term Outpatients in Neighboring Pharmacy of General Hospital (종합병원 장기처방환자의 인근 약국 재방문 및 이탈 요인 분석)

  • Oh, Chang-Kyun;Choi, Byung-Chul;Sohn, Uy-Dong
    • YAKHAK HOEJI
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    • v.49 no.6
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    • pp.449-458
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    • 2005
  • There have been rapid changes in the pharmaceutical environment after the separation of Dispensing and Prescribing practice. In the early stage of this system, outpatients had few options to choose their pharmacies due to various obstacles. Under these circumstances, this study on the defection tendency of long-term care patients was performed through the analysis of outpatients who quit visiting a pharmacy nearby general hospital. PowerBuilder ver 9.0 program was used to extract significant data, and SPSS package was employed for statistic analysis. 3,308 outpatients who visited a pharmacy nearby hospital for a month (in January, 2004) were studied. Patients' sex, age and location of residence, the class of medical insurance, the characteristic type of medication (powder, split form, medication for external use/injection), waiting time, disease (department) were considered as variable factors. It turned out that the patient revisit ratio was 80.8$\%$ and the patient defection ratio was 32.4$\%$. As was expected, those factors mentioned above influenced on the revisit and defection ratio considerably. In terms of patient factors, it proved that there was no relationship among sex, location of residence, the class of medical insurance and revisit (defection) ratio. Only age factor influenced the ratio; the older, the higher revisit ratio and the less defection ratio. In respect of dispensing factors, there were obvious relationships among the factors and the ratio: bill (money they had to pay individually), waiting time, number of medications, splitting of tablets, unit price of drug and revisit (defection) ratio showed significant relationship. The result of this study revealed an aspect of outpatients' behavior and it could be used as a reference for better patient service and customer relationship management.

A Study on the Perception of the Importance and Performance of Patient Education of the Clinical Nurses (종합병원 간호사가 인식하는 환자교육 중요도와 수행도의 관계연구)

  • Yoo, Eun-Kyung;Suh, Moon-Ja
    • The Journal of Korean Academic Society of Nursing Education
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    • v.6 no.2
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    • pp.287-302
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    • 2000
  • The purpose of the study are to examine the perception of the importance and performance of patient education of the clinical nurse and find out the interfering factors in practicing patient education. The data were collected from convenient sample of 256 clinical nurses working in the nursing units of adult patients except the psychiatric unit, obstetric unit, dental surgical unit and intensive care unit of one University Hospital in Seoul from September 29 to October 2, 1998. Three measurement tools of self-report- questionnaires developed by researcher used. For the content validity of the questionnaires, two sessions of panel discussion and a pilot test were done and finally factor analysis was done with Varimax method. Analysis of data was done with SAS program using frequency, percentage, means, standard deviation, Pearson's Correlation Coefficients, t-test and ANOVA. The obtained results were as follows : 1. The surveyed nurses perceived the importance of patient education at higher level with mean score of 4.08 among 5 point than their perception of practice( mean score : 3.42). 2. There was positive significant correlation(r=.29, p=0.0001)between nurses' perception of the importance of patient education and it's practice 3. Among the teaching contents for patients, 'information of diagnostic procedure and operation' and 'orientation of hospitalization' were perceived most important. And 'preparation for discharge' and 'understanding of disease and health promotion' were perceived least important 4. Among the teaching contents for patients, 'orientation of hospitalization' and 'information of diagnostic procedure and operation' were perceived highly performable. And 'understanding of disease and health promotion' and 'preparation for discharge' were perceived least performable. 5. Three types of interfering factors were identified as patient-factor, situational factor, nurse-factor. The mean degree of impediment with the interfering factors was at average level(3.09 among 5). The patient and situational factors of impediments were more interfering than nurse- factor for teaching patients. 6. In older age(p<.05), married state (p<.05), higher educational status (p<.01), higher clinical experience (p<.01) and higher position(p<.01), the score of perceived importance of patients education was more high. 7. In older age(p<.01), higher clinical experience(p<.001) and surgical unit (p<.01), the score of perceived performance of patients education was more high. In conclusion, in order to activate patient education practice in the clinical setting, the continuing education for patients education should be more emphasized and the effective teaching methods and materials should be developed to help patient teaching. And an organizational support such as budgeting for patient education and reimbursement system should be administrated.

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Satisfaction Gaps among Physicians, Nurses, and Patient Family in the Emergency Department (응급실 서비스 만족도에 대한 환자 가족의 평가와 의료진의 인식 차이)

  • Kang, Kyunghee
    • Health Policy and Management
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    • v.23 no.2
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    • pp.145-151
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    • 2013
  • Background: The objective of this study was to explore patient family's evaluation of emergency department (ED) service satisfaction and to compare these with ED staff perception of patient family's evaluation. Methods: Based on two surveys of the National Emergency Medical Center: the 2008 National Survey for Recognition and Satisfaction towards Emergency Medical Services and the 2008 Opinion Survey of Emergency Medical Service Providers, satisfaction gaps among physicians, nurses, and patient family were evaluated by Kruskal-Wallis tests and Wilcoxon-Mann-Whitney tests. Furthermore, the factors associated with satisfaction of emergency medical service were identified by ordinal logistic regression models. Results: There were statistically significant gaps among physicians, nurses, and patient family in overall satisfaction with ED visit, length of stay in ED, enough explanation, physicians/nurses kindness, and ED facilities. Age and income in the patient family model, the number of beds in hospital, job satisfaction and year of service in the physicians model, and the number of beds in hospital, job satisfaction and the number of patients per duty hour in the nurses model were statistically significant factors associated with evaluation/ perception of ED service satisfaction. Conclusion: Patient satisfaction is an important indicator of the quality of care and service delivery in the ED. To improve and understand satisfaction in ED service, a dyadic view of the evaluation of service quality and satisfaction-that is, from the perspectives of both the patient and the emergency medical service providers-should be concerned.

Influence of perceived patient safety culture on patient safety management activity in the dental hygienists (치과위생사의 환자안전문화 인식이 환자안전관리활동에 미치는 영향)

  • Lee, Da-Jung;Han, Su-Jin
    • Journal of Korean society of Dental Hygiene
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    • v.16 no.6
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    • pp.863-877
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    • 2016
  • The study aimed to investigate the influence of perceived patient safety culture on patient safety management activity in the dental hygienists. Methods: A self-reported questionnaire was completed by 292 dental hygienists in Seoul, Incheon and Gyeonggido from March 1 to April 8, 2016. The questionnaire consisted of general characteristics of the subjects (9 items), patient safety culture (44 items), and patient safety management activity (25 items) by Likert 5 point scale. Data were analyzed by t test, one way ANOVA, stepwise multiple regression test, and post-hoc Tukey test using SPSS 18.0 program. Results: The perceived patient safety culture was 3.50 on average. Entire organization was the highest score (3.68) and followed the communication process (3.55), the environment of work unit (3.47), the attitude of supervisor/manager (3.45), and the frequency of events reported (2.98). The average of patient safety management activity was 3.71. As for the factors of patient safety culture on patient safety management activity, communication process was the most influential factor (${\beta}=0.268$), and followed the entire organization (${\beta}=0.265$), the environment of work unit (${\beta} =0.166$), the frequency of events reported (${\beta}=0.104$), and among the control variables. Work place proved to be the only significant variable. Conclusions: In order to promote patient safety management activity of dental institutions, the patient safety culture should be created and established. The influence of communication process and patient safety culture at entire organization level was huge. So the environment of work unit and the perceived patient safety culture in the process of reported events were influencing factors. The strategy for patient safety management activity should be considered because of low level of perceived patient safety culture.

Perceived Level and Associated Factors of Patient Safety Culture among Health Care Providers in an Operating Room (수술실의료진의 환자안전문화 인식수준 및 관련요인)

  • Kim, Suk Kyoung;Lee, Hyejung;Oh, Eui Geum
    • Journal of Korean Clinical Nursing Research
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    • v.16 no.2
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    • pp.57-67
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    • 2010
  • Purpose: The purposes of this study were to compare the level of perception and to identify factors associated with perception on patient safety culture among health care providers working in an operating room(OR). Methods: A cross-sectional survey design was used. Data were collected conveniently from 154 RNs and 116 physicians working in a tertiary hospital in Seoul. Patient safety culture was measured using "The Hospital Survey on Patient Safety Culture" developed by the Agency for Healthcare Research and Quality (AHRQ). Descriptive statistics, t-test, ANOVA, and Spearman rank correlation coefficients were used for statistical analysis with the SPSS version 17.0. Results: The perception level of nurses and physicians on patient safety culture was "moderate" (3.14). Compared to physicians, nurses showed a significantly lower perception on the items of "teamwork within units" (t=-6.904, p<.001) and "overall perception of patient safety" (t=-4.327, p<.001), but had a higher perception about "frequency of events reported" (t=2.769, p=.006). The physicians' professional positions, years of working experience, age, and working hour per week were identified as factors associated with patient safety culture. Conclusion: Level of perception on patient safety culture may vary among health care providers working in the OR. The study finding suggests that a tailored education and training strategies should be considered to develop an effective safety culture for healthcare professionals working in OR.

A Predictive Model on Patient-Centered Care of Hospital Nurses in Korea (상급종합병원 간호사의 환자중심간호 예측모형)

  • Jeong, Hyun;Park, Myonghwa
    • Journal of Korean Academy of Nursing
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    • v.49 no.2
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    • pp.191-202
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    • 2019
  • Purpose: Patient-centered care is a widely utilized concept in nursing and health care. However, the key components of patient-centered nursing have not yet been reported. Moreover, previous studies on patient-centered care have mostly focused on components of nursing rather than organizational factors. Therefore, a comprehensive understanding of influential factors of patient-centered care is required. Methods: The purpose of this study was to develop a theoretical model based on person-centered care theory, and the relevant literature and to test the developed model with covariance structure analysis in order to determine the causal paths among the variables. Results: The model fit indices for the hypothetical model were suitable for the recommended level (goodness of fit index=.87, standardized root mean residual=.01, root mean square error of approximation=.06, Tucker-Lewis index=.90, comparative fit index=.92, parsimonious normed fit index=.75). In this study, five of the six paths established in the initial hypothetical model were supported. The variables of teamwork, self-leadership, and empathy accounted for 56.4% of hospital nurses' patient-centered care. Among these, empathy was the strongest predictor of patient-centered care. Conclusion: These results suggest that it is necessary to use strategies to improve self-leadership and empathy. In addition to enhancing the personal factors of nurses, nursing organizations should strive for effective multidisciplinary cooperation with active support for patient-centered care and openness to change.

The Impact of Health Service Quality Factors on Patient's Satisfaction According to Duration of Hospitalization (입원기간에 따른 의료서비스 품질요인이 고객만족에 미치는 영향에 관한 연구)

  • Lee, Hoon-Young;Jung, Kee-Taig;Shine, Eun-Kyu;Han, Yong-Jun
    • Korea Journal of Hospital Management
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    • v.13 no.3
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    • pp.44-68
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    • 2008
  • The purpose of this study is to identify which factors of medical service quality were considered important by patients based on survey on eight hospitals located in Seoul. We analyzed the difference in impact of health service quality factors between the two groups with short and long inpatient days. In addition, we analyzed which service factors affected the customer satisfaction more differently across the inpatient groups. We found that patient satisfaction was not different between the two groups with short and long inpatient days. But the two groups showed different priority orders of medical service factors that affect patient satisfaction. In the group with long inpatient days, the order of medical service factors are cleanness, speciality, process. In the group with short stay, important factors are speciality, cleanness and convenience of facilities. These findings imply that hospitals should set up different marketing strategies across the different inpatients groups.

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Risk Factors Affecting the Graft and Patient Survival in Kidney Transplant Patients (신이식환자에서 이식과 환자의 생존에 영향을 끼치는 위험요인 분석)

  • Kim, Joo-Young;Han, Duck-Jong;Shin, Hae-Young;Shin, Whan-Gyun;Oh, Jung-Mi
    • Korean Journal of Clinical Pharmacy
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    • v.16 no.1
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    • pp.14-22
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    • 2006
  • Purpose: To determine the short (1 year of transplant) and long-term (1-5 years of transplantation) risk factors affecting the graft and patient survival in kidney transplantation recipients. Methods: Records of 149 patients who received kidney transplantation in 1996 from Asan Medical Center were followed for 5 years retrospectively. Results: All patients initiated triple immunosuppressive therapy with cyclosporine, prednisone and azathioprine. One, two, three, four, five year patient and graft survival rates were 98.7%, 98.0%, 98.0%, 97.3%, 97.3%, and 96.6%, 95.2%, 94.6%, 92.5%, 91.8%, respectively. There were 30 cases of acute rejection (AR) and 6 cases of chronic rejection (CR) within $2.1{\pm}3.2$ months and $42.1{\pm}13.2$ months of transplantation, respectively. The risk factors for AR were donor's age older than 30 years (p=0.02) and cardiovascular disease (p=0.05). The risk factors for CR were AR (p=0.0169) and episode of complications (p=0.0330). Increasing period of dialysis (p=0.0473), episodes of AR (p<0.0001) and complication (p=0.0317) were significant factors for graft loss. Seven grafts were lost from noncompliance during 1-5 year period. The most com- mon cause of the graft loss for both periods was the graft rejection. The graft survival rate was significantly lower in patients with than without rejection episodes (77.4% vs. 90.0%, p=0.002). Conclusions: Survival rate of the graft with rejection was significantly lower. The risk factors affecting AR were donor's age older than 30years and CVD. AR and episode of complications within 1year were the risk factors for CR and graft loss.

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Patient Safety Education for Medical Students: Global Trends and Korea's Status (의과대학생을 위한 환자안전 교육의 국제적 동향 및 국내 현황)

  • Roh, HyeRin
    • Korean Medical Education Review
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    • v.21 no.1
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    • pp.1-12
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    • 2019
  • This study is a narrative review introducing global trends in patient safety education within medical schools and exploring the status of Korean education. Core competences for patient safety include patient centeredness, teamwork, evidence- and information-based practice, quality improvement, addressing medical errors, managing human factors and system complexity, and patient safety knowledge and responsibility. According to a Korean report addressing the role of doctors, patient safety was described as a subcategory of clinical care. Doctors' roles in patient safety included taking precautions, educating patients about the side effects of drugs, and implementing rapid treatment and appropriate follow-up when patient safety is compromised. The Korean Association of Medical Colleges suggested patient safety competence as one of eight essential human and society-centered learning outcomes. They included appropriate attitude and knowledge, human factors, a systematic approach, teamwork skills, engaging with patients and carers, and dealing with common errors. Four Korean medical schools reported integration of a patient safety course in their preclinical curriculum. Studies have shown that students experience difficulty in reporting medical errors because of hierarchical culture. It seems that patient safety is considered in a narrow sense and its education is limited in Korea. Patient safety is not a topic for dealing with only adverse events, but a science to prevent and detect early system failure. Patient safety emphasizes patient perspectives, so it has a different paradigm of medical ethics and professionalism, which have doctor-centered perspectives. Medical educators in Korea should understand patient safety concepts to implement patient safety curriculum. Further research should be done on communication in hierarchical culture and patient safety education during clerkship.

A Case of Heel Reconstruction with a Reverse Sural Artery Flap in a Hemophilia B Patient

  • Lee, Byung-Kwon;Shim, Jeong-Su
    • Archives of Plastic Surgery
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    • v.39 no.2
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    • pp.150-153
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    • 2012
  • Hemophilia B is a rare blood coagulation disorder. Complications such as bleeding and hematoma can cause necrosis of flaps, wound disruption, and the disturbance of wound healing. In particular, guidelines for flap operations in hemophilia B patients have still not been defined, and case reports are rare. We reconstructed the heel of a 41-year-old male hemophilia B patient using a reverse sural artery flap operation. The patient presented with mild hemophilia, having 27% of the normal value of coagulation factor IX. Coagulation and the changing value of the coagulation factor were regularly measured, and 70% of the normal value of coagulation factor IX was maintained through the injection of recombinant coagulation factors and antihemorrhagics. Hematoma developed twice (postoperative day [POD] 5 and POD 7) and in each case the hematoma was removed. Injections of recombinant coagulation factors and antihemorrhagics were continuously administered until postoperative week 2. When the coagulation factors were within normal ranges. In this article, a hemophilia B patient underwent reverse sural artery flap surgery and the healing progress was analyzed. We conclude that higher than baseline levels of coagulation factors are needed for successful healing in reverse sural artery flap surgery.