• 보건교육건강증진학회지
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• 제29권3호
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• pp.75-89
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• 2012

Objectives: This study was performed to identify the level of health literacy and to investigate the relationship between the health literacy and preventive health care use in middle-aged adults in Korea. Methods: A total of 315 adults aged 40 to 64 years living in Seoul participated in the study. Data were collected from December 15-24, 2010 from outpatient hospitals, clinics, workplaces and other locations in the community. Health literacy was measured using the Functional Health Literacy and Self-rated Health Literacy Questionnaires. Preventive health service use was defined as receiving screening (general health checkups, gastric and colorectal cancer, mammogram, and pap smear) and influenza vaccination. Descriptive analysis, t-test, and ANOVA were used. Results: The mean of functional health literacy was 3.87 (score range 0-6) and the self-rated health literacy was 60.08 (score range 16-80). The most difficult items of the self-rated questionnaires were patient educational materials provided by health care providers and medical forms. The most difficult items of functional health literacy were information-based, including nutritional facts and clinical schedules. Association between health literacy and preventive health service use was not found. Conclusions: Further study is necessary with larger samples and with considerations for their education level, age, and preventive health care use.

• 보건행정학회지
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• 제22권4호
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• pp.497-521
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• 2012

Objectives This study aimed to investigate the effect of social capital, health risk behavior and health status on medical care utilization by the elderly. The data and Research method Data were obtained from the 4th wave survey of the Korea Welfare Panel Study. 4,087 household members aged 65 years and over were subject to analysis. Descriptive statistics are used to describe the basic features of the data in a study. we performed a structural equation modeling(SEM) analysis to evaluate the effect of social capital and mediating effect of health risk behavior and health status. Results Results showed that factors related to medical care utilization of the elderly were different depending on types of service (inpatient and outpatient service) except health status. Age, higher social capital, more health-risk behavior and poorer health status were associated with increased use of inpatient service. Social capital was found to have a positive direct effect on it. Also, social capital had an indirect effect on reducing use of inpatient services by improving health status. On the other hand, lower age and higher household income tended to increase use of outpatient service, while higher social capital and higher health status were inversely related. Social capital had a direct effect and an indirect effect on reducing use of outpatient service and, at that time, health status played a mediating role. Conclusions Social capital may contribute to improve health status and indirectly reduce medical care utilization of the elderly by enhancing their health status. These results provide evidence that more policy and strategy considerations should be needed for the elderly to strengthen their social capital in order to enhance their levels of health and more efficient utilization of medical care.

• Journal of Preventive Medicine and Public Health
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• 제38권1호
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• pp.16-24
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• 2005

Objectives : To help develop strategies to cope with the changes arising from the rapid aging process by predicting the determining factors of intention to actual use of the charged long-term care services for elderly as perceived by the middle aged who play the major role of supports. Methods : Subjects were the parents (men 177, women 507) in their 40s of the students selected from a university of Busan city. A questionnaire survey was conducted for 4 weeks in October 2003 about the knowledge for long-term care service, the intention of actual use, and the preferences about the type of service suppliers. Data analysis was performed with frequency, chi-square test, and t-test using SPSS program (ver 10.0K), along with data mining using decision tree of Enterprise Miner V8.2 by SAS. Results : About half of the subjects (53.7%) had the actual experiences of elderly supports. Intentions to use the charged services were relatively high in home visiting nursing care service (40.1%) and long-term care facilities service (40.4%), and were influenced by previous knowledge about the services. The intentions were stronger in women, those with higher education, and those with greater income levels. Actual elderly supports were mostly (80%) done by women, and the perceived burdens for the supports were bigger in women and those of lower socioeconomic level. Desired charges were about 10,000 won for the bath service, 20,000 won for the rests services per day, and about 500,000 won for the long-term care facilities service per month. From the result of decision tree analysis, the job professionalism was the most important determining factor of intention to actual use of the services with validation as $63{\sim}71%$. Health and welfare mixed type facilities were preferred, and the most important consideration was the level of professionalism. Conclusions : Intention to actual use of the charged services was largely determined by the aspects of time and cost. Polices to increase the number of service suppliers and to decrease the burdens perceived by actual supporters were strongly recommended.

• Journal of Preventive Medicine and Public Health
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• 제19권1호
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• pp.56-64
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• 1986

This paper describes a GPSS-based, multi-server queueing model that was developed to simulate the patient flow, and to analyze the effectiveness of the patient scheduling system under various conditions. Unpredictable and unacceptably long waits to receive the service at the outpatient department of a general hospital necessitated the study. Arrival and service time distribution needed for the simulation model were generated from actual arrival and service patterns observed during the peak hours. The simulation results show that a change in patient scheduling system (i.e. time interval between appointments, starting time. and the number of physicians) from a current system would significantly reduce the patient wait time. This study provides the hospital administrator with an analysis of patient scheduling system under several conditions, and will be used to plan future scheduling system and staffing. Studies such as this can demonstrate the value of simulation in providing information for use in future planning.

• Journal of Preventive Medicine and Public Health
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• 제53권6호
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• pp.476-486
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• 2020

Objectives: The objective of this study was to estimate the risk of lung cancer in relation to angiotensin II receptor blocker (ARB) use among patients with hypertension from the Korean National Health Insurance Service-National Health Screening Cohort. Methods: We conducted a retrospective cohort study of patients with hypertension who started to take antihypertensive medications and had a treatment period of at least 6 months. We calculated the weighted hazard ratios (HRs) and their 95% confidence intervals (CIs) of lung cancer associated with ARB use compared with calcium channel blocker (CCB) use using inverse probability treatment weighting. Results: Among a total of 60 469 subjects with a median follow-up time of 7.8 years, 476 cases of lung cancer were identified. ARB use had a protective effect on lung cancer compared with CCB use (HR, 0.75; 95% CI, 0.59 to 0.96). Consistent findings were found in analyses considering patients who changed or discontinued their medication (HR, 0.50; 95% CI, 0.32 to 0.77), as well as for women (HR, 0.56; 95% CI, 0.34 to 0.93), patients without chronic obstructive pulmonary disease (HR, 0.75; 95% CI, 0.56 to 1.00), never-smokers (HR, 0.64; 95% CI, 0.42 to 0.99), and non-drinkers (HR, 0.69; 95% CI, 0.49 to 0.97). In analyses with different comparison antihypertensive medications, the overall protective effects of ARBs on lung cancer risk remained consistent. Conclusions: The results of the present study suggest that ARBs could decrease the risk of lung cancer. More evidence is needed to establish the causal effect of ARBs on the incidence of lung cancer.

• 한국병원경영학회지
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• 제26권3호
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• pp.28-42
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• 2021

Purposes: The objective of this study is to analyze service design process of dental clinic preventive service by using 'Double Diamond Design Process' which is user-centered for improving dental clinic management efficiency. Methodology: We examine case study that dental clinic preventive service of local dental clinic. Following the double diamond design four steps(①discover, ②define, ③develop, ④deliver), we use suitable analytic tools in each steps. In discover step, we perform observation and desk research. Next, in define step, affinity diagram, user persona, and user journey map are performed. We then make service blueprint in develop step. Finally, in deliver step, virtual scenario and confirm some outputs which are based on results of former steps are suggested. Findings: As a result of this study, waiting and consulting phases turn out that these phases are in the most trouble than others. Users(patients) have lots of complain and dissatisfaction in these phases. These touch-points will have to be modified Practical Implication: After checking this study result, it could suggest improvement schemes. To apply these, we try to make some scenarios, and finally realize some outputs. Service design has arisen to strengthen the competitiveness by reflecting user's experience and needs. Especially, service design is not typical, it is so flexible that can apply to various situation and objects. We hope that result of this study is made good use for dental clinics in need.

• Journal of Preventive Medicine and Public Health
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• 제43권3호
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• pp.235-244
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• 2010

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

• 한국치위생학회지
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• 제20권6호
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• pp.819-829
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• 2020

Objectives: This study aimed to assess the relationship between dental care needs and dental service use in Korean elderly. Methods: Using the sixth Korea National Health and Nutrition Examination Survey, from 22,948 individuals, 1,572 (male 701, female 871) elderly individuals aged above 65 years were included in the study. All analyses were stratified by sex. Results: In males, the group with subjective needs was 3.74 (95% confidence interval [CI]: 2.58-5.41) times more likely to use dental services than the group without subjective needs. For females, the group with subjective needs was 2.17 (95% CI: 1.57-2.98 ) times more likely to use dental services than the group without subjective needs. Conclusions: To conclude, the elderly with symptoms, used the dental services for pain relief and functional recovery. Fundamental efforts to improve oral health are needed, such as providing treatment, prevention and educational services, besides efforts to provide treatment-oriented dental services. Further research is needed for the middle and elderly individuals who are in the blind spot of the existing policy.

• Journal of Preventive Medicine and Public Health
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• 제43권5호
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• pp.445-450
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• 2010

Objectives: Emotional support and a stress management program should be simultaneously provided to clients as effective preventive services for healthy behavioral change. This study was conducted to review various relaxation and meditation intervention methods and their applicability for a preventive service program. Methods and results: The author of this paper tried to find various relaxation and meditation programs through a literature review and program searching and to introduce them. The 'Relaxation Response' and 'Mindfulness Based Stress Reduction (MBSR)' are the most the widely used meditative programs in mainstream medical systems. Abdominal breathing, Progressive Musclular Relaxation (PMR), Relaxative Imagery, Autogenic Training (AT) and Biofeedback are other well-known techniques for relaxation and stress management. I have developed and implemented some programs using these methods. Relaxation and meditation classes for cancer patients and a meditation based stress coping workshop are examples of this program. Conclusions: Relaxation and meditation seem to be good and effective methods for primary, secondary and tertiary preventive service programs. Program development and standardization and further study are needed for more and wider use of the mindbody approach in the preventive service area of medicine.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.148-155
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• 2012

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.