• Title/Summary/Keyword: primary care

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Primary Care Physicians and Residency Training Programs in Korea (일차진료의사 양성과 전문의수련제도)

  • 김병익
    • Health Policy and Management
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    • v.9 no.2
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    • pp.139-156
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    • 1999
  • Recent changes in the health care environment have directed increasing attention to the number and specialty mix of practicing physicians. A major concern identified in Korean health care system is the serious oversupply of specialists and a relative lack of primary care physicians. Currently only 21% of Korean physicians are primary care physicians(general practitioners and family physicians), and less than 10% of recent medical school graduates are choosing to enter primary care. More primary care physicians are needed to deal with major problems in the current health care system, such as cost and access. The infrastructure that relies on primary care physicians is needed to deliver cost-effective and efficient care. To achieve a better balance of primary care to non-primary care physicians. more medical students need to choose careers in one of the primary care specialties(family medicine. internal medicine and pediatrics). This paper suggests the necessity of reforming the Korean graduate medical education system, that is, establishing the path of training primary care physicians in internal medicine and pediatrics residency training programs.

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Reform of the Primary Health Care Delivery System in Rural Areas (농어촌보건기관 일차보건의료 서비스 전달체계 개편안 논의의 문제와 대안)

  • Na, Baeg-Ju
    • Journal of Korean Academy of Rural Health Nursing
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    • v.1 no.1
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    • pp.5-10
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    • 2006
  • Purpose: This study was done to identify strategies for the reform of the primary health care delivery system in rural areas. Methods: Official documents on changes in the rural health care environment were reviewed along with previous articles on reform of the health care delivery system in rural areas. Results: The primary health care system in rural areas of South Korea has not been well developed by the government. The government has mainly invested in hardware like facilities and equipment but, not in software like the delivery system or personnel. Nowadays every country is confronted with an aging society, which means an increase in the prevalence of chronic disease. Thus they have again become interested in primary health care delivery system. Further, characteristics of the primary health care system have changed to be more comprehensive and to focus on chronic disease. The primary health care system in rural areas should have basic health care functions and a visiting medical officer(doctor) connected with basic health care. Conclusions: The primary health care delivery system is the best strategy when adjusted to the characteristic of the chronic diseases that are prevalent today. Cooperation of the central government and local government is important if these changes are to be realized.

Trend and Implication of Primary Care Evaluation in U.S. (미국의 일차의료 평가 동향 및 시사점: 미국의 리얼월드 평가 안내서를 중심으로)

  • Suh, Youshin;Kim, Hee-Sun;Yoo, Bit-Na;Kim, Jin-Hee;Park, Chong Yon
    • The Journal of Health Technology Assessment
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    • v.6 no.2
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    • pp.88-94
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    • 2018
  • This review aims to provide implications for relevant domestic policies and researches from Patient-Centered Medical Home (PCMH), a reinforcement model for primary care and its evaluations in the United States. As chronic diseases became dominant, changes in the health care delivery system in which primary care is central was required. The United States initiated primary care-reinforcing policies based on the PCMH following the increased demand for evidence-based health care policies. The current activities of the United States such as sharing research tools used to evaluate primary care interventions and circulating evaluation findings provide examples to Korea. Systematic evaluations for primary care interventions are required and appropriate methods using various types of data to reflect the real-world settings should be prepared. It is necessary to conduct policy assessment studies of public interests considering regional context. Support for the researches to make and advance from the existing environment must be examined.

Defining the Concept of Primary Care in South Korea Using a Delphi Method: Secondary Publication (델파이법을 이용한 일차의료 개념정의: 이차출판)

  • Lee, Jae Ho;Choi, Yong-Jun;Volk, Robert J.;Kim, Soo Young;Kim, Yong Sik;Park, Hoon Ki;Jeon, Tae-Hee;Hong, Seung Kwon;Spann, Stephen J.
    • Health Policy and Management
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    • v.24 no.1
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    • pp.100-106
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    • 2014
  • Background: There is no consensus on the definition of primary care in South Korea. This study's objective was to define the concept of primary care using a Delphi method. Methods: Three expert panels were formed, consisting of 16 primary care policy researchers, 45 stakeholders, and 16 primary care physicians. Three rounds of voting, using 9-point appropriateness scales, were conducted. The first round involved rating the appropriateness of 20 previously established attributes of primary care. In the second round, panelists received a summary of the first-round results and were asked to once again vote on the 10 undetermined attributes and the provisional definition. The final round involved voting on the appropriateness of the revised definition. The Korean Language Society reviewed the revised definition. Results: Four core (first-contact care, comprehensiveness, coordination, and longitudinality) and three ancillary (personalized care, family and community context, and community base) attributes were selected. The Korean definition of primary care was accomplished with all three panel groups arriving at a 'very good' level of consensus. Conclusion: The Korean definition of primary care will provide a framework for evaluating performance of primary care in South Korea. It will also contribute to resolving confusion about the concept of primary care.

The Primary Care Performance of Three Types of Medical Institutions: A Public Survey using the Korean Primary Care Assessment Tool

  • Jung, Hye-Min;Jo, Min-Woo;Kim, Hyun-Joo;Jang, Won-Mo;Lee, Jin-Yong;Eun, Sang-Jun
    • Quality Improvement in Health Care
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    • v.25 no.2
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    • pp.16-25
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    • 2019
  • Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

Effects of Outpatient Continuity of Primary Care on Hospitalization in Patients with Diabetes Mellitus: Focused on New Patients in 2012 (당뇨병 환자의 일차의료 외래 지속성이 입원에 미치는 영향: 2012년도 신규 당뇨병 환자를 중심으로)

  • Shin, Yang-jun;Woo, Kyung-sook;Shin, Young-jeon
    • Health Policy and Management
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    • v.29 no.3
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    • pp.262-276
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    • 2019
  • Background: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. Methods: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011-2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. Results: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72-4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55-4.25). Conclusion: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.

Chracteristics of Primary Health Practice and Diagnosis-Cluster Pattern in Health Insurance (의원의 특성에 따른 상병진단군의 분포에 대한 연구)

  • Yoon, Jong-Ryool;Moon, Ok-Ryun;Huh, Jung;Kim, Chang-Yup
    • Health Policy and Management
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    • v.3 no.2
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    • pp.100-129
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    • 1993
  • This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

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Need for and Supply of Primary Care in Rural Areas (농촌지역의 의료요구와 의료공급에 관한 연구)

  • 송건용
    • Korea journal of population studies
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    • v.4 no.1
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    • pp.23-35
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    • 1981
  • Health policy is directed to equity in the provision of primary care for rural people before the year of 2, 000. This study aimed to define and identify the need for physician's care by using empirical data, and suggested an alternative of the primary care delivery system in rural areas to the government. 1. Twenty percent of the study population wanted to obtain any form of medical care services. : 9.3 percent of the population was in need for physician's care; 15 percent of the need was met by physicians, while 85 percent remained unmet at the time of survey in 1979. 2. For meeting all the need for physician's primary care, 2.9 annual physician visits per capita are demanded. An alternative, which was devised in some favourable way at reasonable cost in rural settings, was suggested. It was to deploy the physician extender such as community health practitioner in the infrastructure of the health care delivery system, whose supervision is provided by physician, based on experience of the KHDI health demonstration project. 3. One physician, two community health practitioners and two community health aides should be assigned in distant locations for meeting all the estimated need for physician's primary care for 10, 000 rural underserved residents.

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A Study on Changes in Trends of Disease of Residents Who Received Treatment at Nam Jeju County Primary Health Care Post(1997~2003) (남제주군 보건진료소 이용 주민의 상병양상변화 고찰(1997년~2003년))

  • Kang, Na-Yon
    • Journal of Korean Academy of Rural Health Nursing
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    • v.2 no.2
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    • pp.133-144
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    • 2007
  • Purpose: The purpose of this study was to examine the trends of disease of residents who had treatment in primary health care posts in N-county over the past seven years (1997-2003). The data will assist in planning responses to changes in the health care environment and in planning health promotion programs. Method: A retrospective descriptive survey was conducted of the computerized records of primary health care done by community health practitioners over the last seven years. Cross analysis was conducted among the data using SAS, and the results were displayed in frequencies and percentages. The data were collected from May to September 2004. Results: The results of the study are as follows: 1. The six most frequent diseases were ranked as follows: diseases of the 1) respiratory system, 2) musculoskeletal system and connective tissue, 3) digestive system, 4) skin and subcutaneous tissue, 5) circulatory system, and 6) symptoms, signs and abnormal clinical and laboratory findings. Especially in 2002, circulatory system related disease rose two steps in the ranking and digestive system related disease went a step down. 2. The patients' use of primary health care posts over the past seven years continued to increase on the whole. Conclusions: According to these results, each primary health care post should carry out special health promotion programs that fit the local society of N- county and are in accordance with changes in health care needs.

Colorectal Cancer Screening Practices of Primary Care Providers: Results of a National Survey in Malaysia

  • Norwati, Daud;Harmy, Mohamed Yusoff;Norhayati, Mohd Noor;Amry, Abdul Rahim
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.6
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    • pp.2901-2904
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    • 2014
  • The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.