• 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 Preventive Medicine and Public Health
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• v.26 no.4 s.44
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• pp.614-627
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• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• Journal of agricultural medicine and community health
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• v.17 no.1
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• pp.34-45
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• 1992

In this county, the gap between the urban 'haves' and the rural 'have-nots' continues to be an increasing problem. WHO and UNICEF see primary health care(PHC) as the key to achieving an acceptable level of health throughout the world as a community development. PHC is essential health care made accessible to individuals and families in the community by means acceptable to them. It is the first level of contact of individual, the family, and community with the national health system. It includes at least education on health system. It includes at least education on health problems, promotion of food supply, MCH including family planning, immunization against infectious diseases, control of endemic diseases, treatment of common diseases and injuries, promotion of mental health, and provision of essential drugs. However, of the aboves, education concerning of mental health problems and the methods to identify, prevent, and control them is the principal step of establishment. In Korea, the category of PHC worker includes the physician as public doctor and nurse as primary health care practitioner and community health leader as village health worker. PHC workers of the aboves will thus function best if they are appropriately trained to respond to the health needs of the community. However in this country, since the national PHC service project launched in 1980, the government has not developed and performed appropriate and enough education and training activities. In light of above reasons, several categories of health education activities had been planned and performed being aimed at above specific target groups and the main focus was on the village health workers for about one year from July 1991 to July 1992 in Yeoju Kun of Kyonki Province. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. The totals of 80 village health workers, 13 public health practitioners and 9 public docters took in the course of health education for a few hours at every month and the evaluation works of educational effect were taken. The results the study were as follows. 1) Number of persons who realized the maxim "health care of the people is a duty of the government" increased after the education course, On the other hand, the rate of satisfaction on the effort of government for health promotion of the people decreased. 2) Public doctors and primary health care practitioners(nurses) liked and enjoyed the education schedule as a meeting of peer group. It provided chances of communication with staffs of Korea University Hospital. It was said that lectures covered great deal of knowledge and technic they urgently needed in the field. 3) After finishing the education course, more of village health workers(VHW) thought they adapted themselves to their roles and functions showing increased number of home visit and contact with primary health care practitioners by month. 4) In case of patient refer, VHW preferred primary health care practitioners to public doctors. 5) Capability of VHWs in most of their functions increased dramatically after when the education course finished except tuberculosis control.

• Journal of Preventive Medicine and Public Health
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• v.30 no.4 s.59
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• pp.708-718
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• 1997

The author surveyed overall obesity indicies and factors concerned with obesity such as dietary intake, physical activity, stress and life style with the subject of doctors. The number of subjects was total 508 with 396 men and 112 women. They were subgrouped into surgical part, medical part and service and basic part by speciality. And also subgrouped into intern and resident, pay doctor, and practitioner by working type. The results were as follows. 1) Obesity indices: BMI of total doctor was $23.1{\pm}2.8$, and WHR was $0.87{\pm}0.08$ and overweight prevalence(BMI>25.0) was 23.6%. It was within normal limit but slightly over the Korean standard. The degree of obesity indices of subgroups by speciality was 'surgical part > medical part > service and basic part', and by working type was 'practitioner > pay doctor > intern and resident'. 2) Dietary intake and Physical activity: Average dietary intake was $2148{\pm}451kcal/day$. The degree of dietary intake by speciality was 'surgical part > medical part > service and basic part'. By working type it was 'practitioner > pay doctor > intern and resident'. Average physical activity was $29{\pm}5$ METs/day. The degree of physical activity also showed similiar pattern. But there was no significant difference among each groups. 3) Comparision between over-weight and non-over-weight group: The items that showed significant difference between two groups were dietary intake, skip breakfast, regular exercise, smoking, heavy drinking, chronic disease etc.

• Korean Journal of Acupuncture
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• v.30 no.1
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• pp.9-15
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• 2013

Objectives : Definition of Life has led an identity and advancement in the knowledge system of science including biomedicine. The world welcomes the new paradigm about the integrative medicine throughout Western Medicine and Traditional Medicine co-exists so far. Methods : Thus this study has comprised how Life was interpreted in Korean Medical history. To reach the purpose, various data and documents about Life subjected to the medical field was collected from medical textbooks and chapters presented in ancient Korean Medicine. Results : Most of important issue is Life as the key even though there are many opinions and conflicts in the view of Life between Western and Korean medical culture. As a result it is not different in the concept of Life each other except for speaking differently same as using the different languages. Integrative Medicine has accepted that it emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. Integrative Medicine declares to be a kind of medicine if vary medical system can focus on human being. Conclusions : Since Korean Medicine was early therapeutic medical categories developed based on Dao, Korean Medicine have to focus on mind and body interactive relationship and attribute to the public health care system in the future.

• Restorative Dentistry and Endodontics
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• v.43 no.4
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• pp.38.1-38.9
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• 2018

The restoration of endodontically treated teeth (ETT) with more than one cusp missing and thin remaining walls is challenging for the general practitioner. The use of posts combined with full coverage restorations is a well-established approach, yet not following the minimal invasive principles of adhesive dentistry. Endocrowns are indirect monoblock restorations that use the pulp chamber of the ETT for retention. In this study the fabrication of 4 endocrowns and their clinical performance will be discussed. Two clinical cases include computer-aided design/computer-aided manufacturing manufactured molar endocrowns (one feldspathic ceramic and one hybrid composite-ceramic restoration) and the other two are dental laboratory manufactured resin composite premolar endocrown restorations. The modified United States Public Health Service criteria were used to assess the clinical behavior of the restorations at different follow up periods. Endocrown restorations present a satisfactory clinical alternative, either by the use of resin composite or glass ceramic and hybrid materials. Specific guidelines with minimal alterations should be followed for an endocrown restoration to be successful. Due to limited evidence regarding the long term evaluation of this restorative technique, a careful selection of cases should be applied.

• Journal of agricultural medicine and community health
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• v.19 no.2
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• pp.141-158
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• 1994

To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

• The Journal of Internal Korean Medicine
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• v.37 no.6
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• pp.1022-1029
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• 2016

Objectives: This study surveyed doctors of Korean medicine on how they treat hypertension in their Korean clinical practices. Methods: An invitation to take an Internet-based questionnaire was sent to doctors who were registered in the Association of Korean Medicine in September 2016. Participants were first asked general profile questions, which included age, gender, work experience as a practitioner, and specialties. Second, they were asked whether they had experience with hypertension treatment and additional questions related to hypertension. Results: A total of 991 replies were received to the questionnaire. Most of the Korean medical doctors (95%) had blood pressure units and had monitored blood pressure. A majority of the Korean medicine doctors (55%) had provided hypertension treatment. Acupuncture and herbal medicine were commonly used for the treatment of hypertensive patients. In addition, bloodletting, moxibustion, pharmacopuncture, cupping, Chuna, Qigong exercise, meditation, and Tai Chi were used. Many doctors also recommended lifestyle modification. The respondents said that Korean medicine improves general health conditions (42.6%) and has low adverse effects (29.9%). One of the most common opinions about the revitalization measures of Korean medicine was expanding health insurance benefits (20.8%). Conclusions: Through this survey, we found out information about the present situation of hypertension treatment in Korean medicine. In the future, it is possible that hypertension treatment using Korean medicine will be demanded and used by practitioners if it is covered by public health insurance.

• Research in Community and Public Health Nursing
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• v.8 no.1
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• pp.116-132
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• 1997

The purpose of the study is to find out how laws related to the nursing profession can be improved by analyzing the rules and regulations concerning nursing. Furthermore, to help settle legal matters in the process of doing nursing work. The data used for the study are the Health and Medical Act, the Maternal and Child Health Act, the School Health Act, the Special Act for Health and Medical Service in Rural Areas, the Industrial Health & Safety Act and the Notice on Nursing Professional Courses analyzed by age and content. The results of the study are as follows : First, basic nursing practice includes 'nursing care for recuperation and assistance in medical treatment and in special areas including the pre-vention of disease, maintenance of health, control of environment, and other therapeutic activities. It is suggested that the phrase 'assistance in medical treatment' should be eliminated as it limits the basic nursing practice to the assistance of the medical treatment. Second, Article 56 of the Health & Medical Act prescribes a special nurse but it does not prescribe a specific job. Accordingly, the new provison concerning the specific jobs of a special nurse should be added or a job guide should be inseated. Third, it is prescribed that those who have completed the training course after obtaining a license are qualified to be a midwife, a special nurse and a nurse practitioner working in special areas. However, school nurses, occupational health nurses and maternal and health workers are required to obtain a nurse license, but not to take an additional training course. Nurses working in special areas should be legally recognized as nurse specialists. The regulations to control various qualification standards consistently should be established. Fourth, the qualifications and types of nurses by area prescribed by Article 54 of the Health and Medical Act are not consistent with those of special nurses as recognized by affiliated organizations of the Korean Nurse Association and some hospitals. Accordingly, the qualifications and types of special nurses should be adjusted in consideration of special nurses. Fifth, as Article 16, Paragraph 2 of the Health and Medical Act does not prescribe the type and scope of first - aid treatment that nurses can provide, the first-aid treatment of nurses might be considered as an unlicensed practice. The specific regulations regarding these matters should be established. Sixth, the contents of the nursing record, which are prescribed by Article 21 of the Health and Medical Act as a duty, include 1) matters concerning body temperature, pulse, breath and blood pressure 2) matters concerning drug prescription 3) matters concerning input and output 4) matters concerning the treatment and nursing care (Article 17 of the Enforcement Regulations, Health and Medical Act). However, these matters are limited to basic nursing care and assistance in medical treatment. The new recording methods on nursing process are suggested to be adopted legally. Seventh, the prescription right entrusted to nurses which are prescribed by the School Health Act, the Special Act on Health and Medical Service for Rural Areas, and the Industrial Health and Safety Act are not consistent with the rights of nurses as prescribed by the Health and Medical Act. New regulations prescribing the partial right for medical treatment entrusted to nurses in consideration of the restraint of time and place in emergency situations should be established.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.7-13
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• 2019

The aim of this study was to clarify the barriers of dental treatment for special needs patients felt by dentists and to determine the dentist-related factors contributing to the obstacles in treatment planning and decision making. Questionnaires were distributed and responded by dentists working at five public-based special care clinics in South Korea. Factors divided into three parts (dentist demographics, clinical factors, and educational and administrational factors) were assessed and analyzed for correlations between dentist-related factors and dentist-felt burdens for special care treatment. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 34 dentists responded to the questionnaires. Almost all dentists had obstacles in the treatment of special needs patients in terms of the patients' lack of cooperation (94.1%), proxy communication with caregivers (94.1%), payment reward system (63.6%), deficient workforce (67.7%), and others. The longer dentists had been practicing for special needs patients, the more they were dissatisfied with the reward system and a longer time was spent for communication with patients and their caregivers (p<0.05). For specialists, more obstacles were experienced in treatment planning due to a deficiency in the clinical information obtained from their patients compared to general practitioners (p<0.05). A total of 82.4% of the respondents approved of mandatory educational programs for special care dentists. There were practitioner-based factors related to the amount of obstacles felt by special care dentists. To overcome the treatment barrier of special needs patients, in-depth education and training are required in special care dentistry.