환자중심 구강건강관리 모형 개발 = Development of patient-centered oral health care model

다국어 초록 (Multilingual Abstract)

Objectives: The purpose of this study is, first, to develop a theoretical model of patient-centered oral health care; and second, to develop a more effective and practical model for dental practice, based on the opinions of dentists through in-depth interviews after the pilot application.

Methods: A patient-centered oral health care model was developed through literature review, group discussion and open discussion of Core Development Group and Professional Clinical Advisory Group. In addition, five dental clinics were recruited who agreed with the purpose and content of the pilot application and voluntarily expressed their intention to participate. Operational tools were produced via two-way communication with the participating dentists. During the period of participation, a total of 4 dental clinic visits were conducted to confirm the pilot status of the model, and the dental team and rapport of the participating dentists were formed. Six months after the trial implementation, each of the pilot dentists conducted face-to-face in-depth interviews at the time and place they wanted. The data were analyzed using qualitative research, and transcribed, coded, and derived.

Results: A patient-centered oral health care model involving oral health assessment, clinical care pathway, customized health coaching, and recall interval decision was theoretically developed. The model was named 'DentalSignal' and used for pilot application. The medical records (questionnaires, oral examination results, and consent forms) were first developed in written form, modified and supplemented, and finally, the algorithms were created and developed electronically. The electronic records section classified the results of the questionnaire and the oral examination table as health signals (green, yellow, red and black). Based on the results, customized health coaching and recall interval were suggested. In addition to the medical records, we have developed banners, posters, leaflets, educational materials. Dentists understood the model in various ways. Although the clinical philosophy of each dentist reflected the patient-centeredness pursued by the DentalSignal, the level of implementation varied according to the level of the dentist's own preventive management system and dental team. In addition, we stated that patients experienced increased participation through the DentalSignal, and appreciated its importance in each process. However, only a handful of dentist’s thought that this extension of participation was linked to the 'patient-centered' concept. The evaluation of the DentalSignal is necessary for the dentist’s evaluation of the patient’s response, the operational process, and so forth. It takes time to establish it in the current oral health care system and requires institutional support.

Conclusions: DentalSignal, a 'patient-centered oral health care model' for dental practice, which was developed only theoretically in this study, is feasible for practical application. In the future, it will be necessary to study the compensation system and dental leadership to evaluate and institutionalize clinical efficacy by extensive application in the Primary Dental Care.

목차 (Table of Contents)

• Ⅰ. 서 론 1
• 1. 연구의 필요성 1
• 2. 연구목적 5
• Ⅱ. 연구대상 및 방법 6
• 1. 연구설계 6
• 2. 연구방법 7
• 1) 모형 개발 연구집단 구성 및 운영 7
• 2) 모형 초안 개발 11
• 3) 연구윤리승인 11
• 4) 연구의 신뢰성 확보 12
• 5) 시범적용 참여치과 모집 12
• 6) 운영도구 개발 13
• 7) 시범적용 14
• 8) 시범적용 평가 15
• Ⅲ. 연구결과 21
• 1. 모형 초안 개발 결과 21
• 2. 운영도구 개발 결과 22
• 1) 문진표 22
• 2) 구강검사표 25
• 3) 전자기록부 27
• 4) 환자용 홍보·교육자료 및 진료실 지침서 31
• 3. 시범적용 평가 결과 33
• 1) 참여치과와 치과의사의 일반적인 특성 33
• 2) 치과의사 심층면담조사 결과 34
• Ⅳ. 고 안 41
• 1. 환자중심 구강건강관리 모형의 의미와 시범적용의 필요성 41
• 2. 모형의 시범적용을 위한 운영도구 개발의 의미 43
• 3. 환자중심 구강건강관리 모형 시범적용의 시사점 44
• 4. 제도적 측면의 향후 과제 46
• 5. 본 연구의 한계점과 제안사항 47
• Ⅴ. 결 론 49
• Ⅵ. 참고문헌 51
• Ⅶ. 각주 참고문헌 56
• Abstract 59

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