• Journal of agricultural medicine and community health
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• v.27 no.2
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• pp.107-126
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• 2002

Health sub-centers(HSCs) have played an important role in primary health care in rural area in Korea. The unification of neighboring HSCs was a strategy to improve the role of HSCs. This study was conducted to reveal the efficacy of the unified HSC established in Yangbuk-myeon, Gyeongju-si in1997. The utilization patterns of HSC and its related factors, and satisfaction of consumer on HSC were compared before and after unification of two HSCs in Gampo-eup, Yangnam-myeon using questionnaire survey, and also the statistics of medical care services and public health services were compared. Four hundred forty nine subjects were questioned in survey, 156 from Gampo-eup, 147 from Yangbuk-myeon, and 146 from Yangnam-myeon. Following unification, the utilization rates and the frequency of visits in Gampo-eup declined. In all three areas, chronic illness was the common factor influencing the utilization and change in frequency of visits to the unified HSC. Following unification, aspects of consumer satisfaction, for example; accessibility and affordability decreased in Gampo-eup, but increased in both Yangbuk-myeon and Yangnam-myeon. The statistics relating to medical care, X-ray examination, home visiting service, vaccination, and health education showed an increase for the unified HSC when compared to the sum of the statistics for the previous two. The execution rates for other public health services were the same, or a little decreased. Clinical laboratory examinations and the issuing of civil affair documents were new services offered by the unified HSC. It is concluded, the overall consumer satisfaction with the unified HSC was improved. In Gampo-eup, where after unification there was no HSC, it seemed to be a barrier to accessing the unified HSC. The effect of the unified HSC, in the respect of medical care and public health services, was not as significant as expected at the time of being established. Therefore, the strategies to reenforce the unified HSC should be developed to provide all residents with comprehensive primary health care services.

• Journal of agricultural medicine and community health
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• v.13 no.1
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• pp.97-103
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• 1988

산간 농촌지역 19개 행정리 1,151세대, 인구 4,591명, 농가비율 78.4%인 경기도 남양주군 수동면에서 면지역사회 표본추출 세대주 284명의 보건지소 이용에 미치는 요인에 대한 설문조사 자료와 1976년부터 1987년까지 보건지소를 이용한 외래 초진 환자의 진료실적을 분석한 결과 다음과 같은 결과를 얻었다. 1) 농촌지역 주민의 보건지소 이용율은 인구 1,000명당 1987년이 900으로 최고율을 보이다가 1979년 846, 1981년 708, 1985년 618, 1983년 594, 1987년 341로 해가 거듭할수록 감소하는 경향을 보였다. 2) 농촌지역 주민의 연령별 보건지소 이용율은 인구 1,000명당 0~4세군이 1976년 1981년, 1986년 공히 2,067.4, 2,402.7, 2,308.2로 최고율을 보였으며 다른 연령군에서는 별차이가 없었다. 3) 조사대상 세대주의 1차진료기관 선정은 보건지소가 43.3%로 가장 높았고 다음이 병원 29.6%, 일반과의원 15.5%, 전문과 의원 11.6% 순이었다. 4) 조사대상 세대주의 92.6%가 보건지소를 가끔 또는 자주 이용한 적이 있으며 보건지소가 좋다고 생각하는 주민은 21.1%에 불과하였다. 5) 조사대상 세대주의 보건지소나 일반과의원 선정기준은 성실하고 친절한 차이 57.8%로 가장 높고 다음이 가까운 곳(24.6%), 시설이 좋은 곳(9.2%), 치료비가 싼곳(8.4%)순이었다. 6) 농촌지역주민의 보건지소 이용율은 보건지소와의 거리가 가까운 마을 주민일수록 자주 이용하고 있는 경향을 보였다. 7) 조사대상 세대주의 59.8%가 일상농사일이 일차진료에 영향을 미친다고 하였다. 8) 조사대상 세대주의 보건지소 발전 방안을 위해 보건지소에 바라는 소망을 보건지소 직원의 좋은 태도가 28.5%로 가장 높았고 다음이 근무시간 준수나 연장개선(10.9%), 시설 및 장비개선(9.5%), 기타(7.1%) 순이었다.

• 학교보건
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• s.3
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• pp.32-32
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• 1976

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.67-77
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• 2003

Objectives: This study is designed to suggest the health service goals necessary for providing the more efficient services relevant to the requests of the community, through the evaluation on the operating status of the unified health subcenters. Methods: We visited total 5 unified health subcenters comprising 3 ones located in Gyeongsangbuk-do and 2 ones located in Gyeongsangnam-do from December 2000 to January 2001, and interviewed about the pre- and post-unified status related to manpower, facilities, equipment, medical service and health service quality, and the problems and improvement plans of the unified management. Results: According to the evaluation on the manpower before and after the unification of the health subcenters, the total employees increased by 2.8 persons on average from 6.8 to 9.6 persons in the investigated subjects. The numbers of doctors, dentists and nurses were almost the same as before. There were no clinical pathologic technician and radiological technician before but they were appointed to duty in 3 unified health subcenters later. The unification of the health subcenters has produced slight increases in the frequency of the medical service and dental treatment and considerable increases in that of the physical therapy and laboratory tests. In relating to the changes of the health service, the cases of visiting health care and ambulatory medical service, and the total number of health education participants were greatly increased after the unification. The number of cases undergoing the vaccination and cervical cancer screening was similar to that of the pre-unification while the patient number of the registration to hypertension or diabetes showed a tendency to increase a little. Since the unification of the health subcenters, the frequency of laboratory tests has been increased, but the quality of health service has not been improved yet. Nevertheless, the unification seems to be positive according to the result of the great improvement in visiting health care, ambulatory medical service and health education service. The problems of the unification of the health subcenters were indicated in indefiniteness of the service details between the workers; excessively large building hard to be effectively managed; insufficient medical instruments, inappropriation of working expenses, lack of professional training for the health education, etc. Conclusions: For further active functions of the unified health subcenters, the minimal allocation basis to appoint doctors, nurses and administrative workers to do the duty should be differentiated from the basis for a health subcenter, and the fundamental instruments needs to be expanded to improve the quality of the medical service and visiting health care service. Moreover, the unified health subcenter needs to have definite service details between the workers, and should improve the working efficiency through the development of service-related guidelines.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.53-66
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• 2003

Objectives: To investigate the state of medical care around health sub-centers, public health doctors' participation and opinion in the process of district public health programs. Methods: The study included 1,036 public health doctors who worked at health sub-center all over the country. The data were collected for Feb, 2002 using self-administered questionnaire by mail. Results: One or two doctors were working at health sub-center and 33.5% of health sub-centers was located in the region of the separation of prescription and dispensing. There were another medical facilities in 45.9% of the administrative district(eup or myon) where health sub-centers were located. The count of medical utilization went down to 14.8${\pm}$14.8 per a day in Nov, 2001 from 18.0${\pm}$15.6 in May, 2000, and the decline was much more in the region of the separation of prescription and dispensing. Among public health programs in health sub-centers, public health doctors participated mostly in preliminary medical examination for vaccination and least in health education. They participated in implementation rather than planning or evaluation of health program. Over a half of public health doctors were found to be positive that health programs implemented in their health sub-centers would promote the level of health in community people and they were willing to participate in district public health program if community people were in need. Conclusions: Recently health sub-centers are required to turn into health promotion facilities rather than medical practice facilities. Health program in health sub-centers will be advanced in both quality and quantity by turning the role of public health doctors who have provided medical services mainly into managing health program. Persistent education about managing health program and the policy to motivate participation in health program should be provided for public health doctors.

• Journal of agricultural medicine and community health
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• v.25 no.2
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• pp.427-440
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• 2000

A comparative study was made about health resources, medical care service statistics and public health service statistics by health subcenters at Jangdong and Jangpyung townships, Jangheung County, Chollanamdo before and after the unification of two health subcenter to improve their function. 1. While two general physicians, one dentist, 4 nurse aids arid one oral hygienist were working at two health subcenters with simple facility with examination room and public health office in 1997 prior to the unification, in 1999 after the unification of two health subcenters 14 staff including a specialist physician, a general physician, a dentist, a herb hygienist, a radiology technician and a physical therapist were working in the new health subcenters equipped with appropriate facilities in two storey building. 2. In 1997 before the unification the yearly total income of two health subcenters was 78,815 thousand won(about 14,000 won per capita) and the amount was 140,376 thousand won(about 25,000 won per capita) in 1999 after the unification. And the income was used for operation of health subcenters excluding personnel expense. 3. While 90.5% of visitors to the health subcenters came for general medical care, and 91.6% came for the revisit before the unification, after the unification 71.2% came for general medical care, 10.8% for dental care, 16.5% for oriental physician's care, 29.7% for the first visit and 70.3% for revisit. Most common problem cared for was musculoskeletal disorder like arthralgia. Average treatment cost per person per month was 9,363 won before the unification and 8,309 won after the unification. 4. Through the comparison of execution rate of public health services before and after the unification. the practice rate of most health service among target population including visiting service for chronic illness, maternal and child health service and immunization service increased after the unification. The practice rate of tuberculosis control service, hypertension control and diabetes management was a little decreased. In conclusion, continuous effort to satisfy all persons in two townships and evaluation are necessary to coincide with the spirit of unification of two health subcenters.

• Journal of agricultural medicine and community health
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• v.35 no.4
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• pp.350-360
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• 2010

Objectives: This study was conducted to identify factors that affect medical service performance in rural health sub-centers and to develop a method to improve health sub-center performance that takes advantage of these insights. Methods: This study included 1,242 South Korean health sub-centers that had been in operation at least since December 31, 2009 as units of analysis. After adjusting for population differences between areas, the performance of medical service among health sub-centers was analyzed according to medical services performed per person. We performed t-tests, ANOVA, Scheffe's tests and multiple regression analyses. Results: The following were significant variables affecting the medical service performance of rural health sub-centers: number of hospitals and clinics, presence of community health practitioner posts, distance from health sub-centers to main public health centers, distance from health sub-centers to the nearest emergency medical facilities, and proportion of the local population aged 65 and over. In contrast, the proportion of the local population between ages 0-4 and the placement of public health doctors that had already completed their internship were not significant variables. Conclusions: The medical service performance of health sub-centers located in rural areas is significantly affected by local population and health care environment characteristics, and therefore, it is imperative to develop strategies to provide differentiated service based on these factors.

• Journal of agricultural medicine and community health
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• v.24 no.1
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• pp.65-77
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• 1999

In order to estimate the utilization pattern of a rural health subcenter, and to identify the recognition for it among the farmhouse members in a suburban area, a questionnaire survey was carried out for objects of 696 population. The results observed were as follows: The annual utilization rate of rural health subcenter for a basic health service unit was 25.0 per 100 persons, and annual mean visiting times was 0.22 times. And the most frequent disease by annual health subcenter utilization illness was musculoskeletal disease(30.6%), and the next was respiratory disease(14.1%), gastrointestinal disease(13.9%) by order. Favorite reason for community health subcenter utilization were near distance from living place(49.6%), lower disease severity(18.9%) and lower medical cost(18.1%) by order. But disfavoring reasons for it were absence of specialist(20.2%), non effective treatment(19.2%) and insufficient equipment(14.7%) by order. And insufficient items about community health subcenter utilization were restriction of treatment limit(40.7%), lower reliance(22.5%) and difficulty in traffic(13.4%) by order. The results of logistic regression analysis suggested that statistically significant factors in health subcenter utilization was educational level. The desirable works for the health subcenter in a suburban area were disease control of elderly and disease preventing service. These results suggested that to increase the utilization of rural health subcenter in a suburban area and to promote the accessibility of rural residents to primary health care, there must be considered public relation about health subcenter, improvement of medical quality and change of priority about health subcenter's works.

• Proceedings of the Korean Society of Health Policy and Administration Conference
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• 2006.11a
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• pp.195-210
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• 2006

• Journal of agricultural medicine and community health
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• v.36 no.1
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• pp.36-46
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• 2011

Objectives: To investigate the experience and competence of physicians providing emergency medical services at public health sub-centers on remote Korean islands. Methods: This study enrolled 79 doctors who work at public health sub-centers on remote Korean islands. Data were collected in December 2009 via self-administered e-mail questionnaires. The response rate was 44.3%. Results: Emergent situations occurred at most (58.68%) of the public health sub-centers that were surveyed in December 2009. An average of 1.92 cases required treatment by public health physicians. Only 20.25% of the physicians were specialists in emergency medicine, while the remainder were general practitioners (GPs) without clinical experience as emergency doctors. We also found that the physicians we surveyed had insufficient knowledge of emergency medical care. At some health centers only one doctor was available, and there was no medical team in holiday, although most of the physicians indicated that the ideal number of doctors per center was two or three. In cases of emergency, patients were often sent to the mainland by ship without receiving first-aid treatment. The public health sub-centers lacked the necessary medical equipment to save lives in emergencies and lacked escort systems for emergency patients. Conclusions: The Korean government should address the importance of providing emergency care in remote areas. Health administrators should provide suitable manpower, medical equipment, guidelines for emergency medicine, and education for public health physicians on remote islands.