• 지역사회간호학회지
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• 제23권4호
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• pp.438-445
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• 2012

Purpose: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. Methods: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. Results: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. Conclusion: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.

• Journal of Yeungnam Medical Science
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• 제40권2호
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• pp.218-222
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• 2023

A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients' emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient's perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient's emotional state. Tailoring the level of advice and diabetes targets based on a patient's personal and contextual factors requires mindfulness by clinicians.

• Clinical Endoscopy
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• 제55권4호
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• pp.489-495
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• 2022

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

• 대한조현병학회지
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• 제20권2호
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• pp.55-60
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• 2017

Objectives : Severe mental illness is a major risk factor for suicide. This study aimed to identify characteristics of patients who died by suicide among subjects who had been received service from a community mental health center. Methods : We searched individuals who had committed suicide in Gwangju Bukgu Community Mental Health Center since 2006. Sociodemographic and clinical data were gathered from medical records and their case managers and they were compared with those of general members in the center. Characteristics of schizophrenia patients who died by suicide were particularly summarized. Results : Twelve person committed suicide between 2006 and 2016. The characteristics of those who died by suicide were male (67%), diagnosis of schizophrenia (75%), aged below 50 (83%), unemployed (92%), past history of psychiatric hospitalization (100%), recent admission within 3 months (67%), past history of suicidal attempt (78%), family history of schizophrenia (58%), poor adherence to medication (58%), and use of daily rehabilitation program (42%). Ten out of twelve (83%) showed warning sign for suicide. All identified method of suicide in patients with schizophrenia was jumping from high building. Many patients with schizophrenia, who committed suicide, suffered from comorbid depressive symptoms (67%) and auditory hallucination (78%). Conclusion : Case managers should pay attention to and carefully manage individuals who showed suicidal warning, particularly with risk factors for suicide, such as unemployment, admission state or recent discharge from psychiatric hospital, poor adherence to medication, family history of schizophrenia, and a history of suicidal attempt.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.91-98
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• 2018

When it comes to the use in inhalers in the management of chronic obstructive pulmonary diseases, there are many options, considerations and challenges, which health care professionals need to address. Considerations for prescribing and dispensing, administering and following up, education, and adherence; all of these factors impact on treatment success and all are intrinsically linked to the device selected. This review brings together relevant evidence, real-life data and practice tools to assist health care professionals in making decisions about the use of inhalers in the management of chronic obstructive pulmonary diseases. It covers some of the key technical device issues to be considered, the evidence behind the role of inhalers in disease control, population studies which link behaviors and adherence to inhaler devices as well as practice advice on inhaler technique education and the advantages and disadvantages in selecting different inhaler devices. Finally, a list of key considerations to aid health care providers in successfully managing the use of inhaler devices are summarized.

• 한국산학기술학회논문지
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• 제21권7호
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• pp.656-666
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• 2020

본 연구는 주기적으로 혈액투석을 시행하고 있는 환자를 대상으로 사회적 지지와 건강정보이해능력의 정도를 파악하고 치료순응도에 미치는 영향을 조사하기 위해 시도된 서술적 연구이다. 연구대상자는 지방 Y시에 소재한 2개 종합병원 인공신장실에 등록된 혈액투석 치료를 받은 지 1년이 경과 한, 만 40세 이상 투석환자 140명이며, 자료수집기간은 2019년 11월 1일부터 12월 31까지이다. 수집된 자료는 SPSS/WIN 26.0 프로그램을 이용하여 빈도와 백분율, 평균과 표준편차, t-test, one-way ANOVA, Scheffe test, Pearson의 상관계수, 다중회귀분석을 실시하였다. 연구 결과, 사회적 지지 하위영역인 가족 지지는 친구 지지와 의료인 지지에 비해 치료순응도에 더 유의한 영향을 주는 것으로 나타났다. 건강정보이해능력에 있어 세 가지 하위영역인 기능적, 의사소통, 위기 건강정보이해능력 모두가 치료순응도와 매우 높은 상관관계를 보여 건강정보이해능력이 높을수록 치료순응도가 높은 것으로 나타났다. 사회적 지지와 건강정보이해능력은 치료순응도에 유의한 영향을 미치는 변수로 나타났고 69.6%의 높은 설명력을 보였다. 따라서 혈액투석환자의 치료순응도를 증진시키기 위해서는 사회적 지지를 기반으로 건강정보이해능력을 향상시키는 교육을 제공하는 프로그램 개발이 필요하다.

• 디지털융복합연구
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• 제16권7호
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• pp.419-428
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• 2018

본 연구는 만성질환노인의 건강정보이해능력, 사회적지지 및 약물복용이행 간의 관계를 확인하고 약물복용이행에 영향을 주는 요인을 파악하는 서술적 상관관계 연구이다. 연구대상은 J도 H군에 소재한 2곳의 중소병원을 내원한 만성질환노인 100명이며, 자료수집은 2017년 7월 14일부터 2017년 8월 14일까지 구조화된 설문지를 사용하여 일대일 면접방법으로 실시하였다. 수집된 자료는 SPSS/WIN 18.0프로그램을 이용하여 분석하였다. 약물복용이행은 건강정보이해능력(r=.398, p<.001)과 사회적지지(r=.453, p<.001)에 모두 유의미한 정적 상관관계를 보였고 건강정보이해능력과 사회적지지도 유의한 정적 상관관계(r=.731, p<.001)를 나타냈다. 약물복용이행에 영향을 미치는 요인은 약물부작용경험 유무였으며 약물복용이행을 25.9%로 설명하는 것으로 나타났다(F=3.91, p<.001). 이상의 연구결과에서 만성질환노인에게 건강정보이해능력과 사회적지지가 높을수록, 약물부작용경험이 없을수록 약물복용이행이 높은 것으로 파악되었다. 만성질환노인의 약물복용이행을 증진시키기 위해서는 보건의료인의 사회적 지지와 정확한 약물복용방법 등이 포함된 맞춤형 의료정보 교육 프로그램이 필요하다.

• 문화기술의 융합
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• 제6권4호
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• pp.231-244
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• 2020

본 연구는 관상동맥중재술을 받은 지역사회 거주 노인의 건강행위 이행에 영향을 미치는 심리사회적 요인을 분석하기 위해 수행된 서술적 조사연구이다. 경상남도 J시 G대학교병원에서 관상동맥중재술을 받고 외래를 내원한 환자 126명을 대상으로 2018년 7월 15일부터 10월 2일까지 구조화된 설문지를 사용하여 자료수집 후 SPSS/WIN 21.0으로 통계 분석하였다. 분석결과 대상자 특성에 따른 건강행위 이행은 배우자 유무, 교육수준, 주관적 건강상태, 주관적 삶 만족도에 따라 차이가 있었으며, 의료인 지지, 회복탄력성에서는 정적 상관관계가 있었고, 지각된 스트레스, 지각된 스트레스의 하위영역인 가족관계, 불안과 위축, 빈곤과 재정, 우울과는 부적 상관관계가 있었다. 다중회귀분석 결과 회복탄력성, 지각된 스트레스의 하위영역인 빈곤과 재정, 교육수준, 주관적 삶 만족도가 관상동맥중재술을 받은 노인의 건강행위 이행을 27.9% 설명하는 것으로 나타났다. 이러한 결과를 기반으로 관상동맥중재술을 받은 지역사회 거주 노인의 건강행위 이행을 향상시키기 위한 간호중재 프로그램 개발과 적용이 필요하다.

• Nutrition Research and Practice
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• 제7권1호
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• pp.49-58
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• 2013

The most critical point in the assessment of adherence to dietary guidelines is the development of a practical definition for adherence, such as a dietary pattern score. The purpose of this study was to develop the Korean Diet Score (KDS) based on the Korean Food Balance Wheel and to examine the association of KDS with various lifestyle characteristics and biochemical factors. The dietary data of 5,320 subjects from the 4th Korean National Health and Nutritional Examination Survey were used for the final analysis. The food guide was composed of six food group categories; 'grain dishes', 'fish and meat dishes', 'vegetable dishes', 'fruits', 'milk' and 'oils and sugars'. Based on the recommended serving numbers for each group, the scores measuring adherence to this food guide were calculated from the dietary information from the 24-hour dietary recall questionnaire, and then its correlation with various characteristics was assessed. KDS was significantly associated with several clinical, lifestyle and socioeconomic factors as well as diagnosed disease history. The higher quintile group of KDS showed a significantly lower level in fasting blood glucose, systolic blood pressure, triglycerides, current smoking and drinking as well as higher leisure time activity, house income and education. Furthermore, the KDS quintile group of women was inversely associated with hypertension, osteoporosis and diabetes. A higher KDS quintile was characterized with a higher intake of several critical nutrients, such as Ca, Fe and vitamins as well as a desirable nutrition balance such as the ratio of macronutrients. Our results demonstrate that KDS is a beneficial tool in assessing the adherence to a healthy diet based on the Korean dietary guidelines. We suggest that KDS could be a useful indicator for evaluating the dietary balance of the Korean population.

• 한국콘텐츠학회논문지
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• 제21권9호
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• pp.609-621
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• 2021

본 연구는 고령자의 상용치료원 유형이 복약순응에 미치는 영향을 분석하였다. 한국의료패널 2017년 자료를 사용하였으며, 만성질환의 치료를 위해 처방약을 복용중인 65세 이상 고령자 3,623명을 대상으로 하였다. 상용치료원 유형은 상용치료원 보유여부, 상용치료의사 보유여부, 상용치료원 규모 등 세 가지 측면으로 세분화하여 분석을 실시하였다. 전체 응답자의 79.8%는 복약순응군에 속하였는데, 그 비율은 상용치료원 보유자가 81.8%, 미보유자가 75.8%로 차이가 있었다. 로지스틱 회귀분석 결과, 상용치료원 보유자는 미보유자에 비해 복약순응군에 속할 확률이 약 1.6배 높은 것으로 나타났다. 의료기관만을 보유한 경우, 미보유자에 비해 그 확률이 약 1.4배, 의사까지 보유한 경우에는 1.8배 높아졌다. 또한 보건소/의원 또는 병원을 상용치료원으로 보유한 경우 미보유자에 비해 복약순응군에 속할 확률이 약 1.7배 높아졌으나, 종합병원/대학병원을 보유한 경우에는 그 확률이 1.5배 정도로 다소 낮아졌다. 본 연구는 우리나라 고령자에 대해 대표성을 가지는 표본을 사용하여 상용치료원 보유가 고령자의 복약순응을 높이는데 긍정적 역할을 하고 있음을 검증하였다. 본 연구결과는 효과적인 고령자 만성질환 관리 및 의료자원의 효율적 사용을 위한 정책의 근거자료로 활용될 수 있을 것이다.