保健診療員의 正規職化 前과 後의 保健診療員 活動 및 保健診療所 管理運營體系의 比較 分析

尹石玉,朴正漢,鄭文淑 대한보건협회 1994 대한보건연구 Vol.20 No.1

본 연구는 보건진료원의 정규직화가 보건진료원의 활동과 보건진료소 관리운영체계에 미친 영향을 알아 보기 위해 정규직화 이전(1992.1.1-3.31)과 정규직화 이후(1993.1.1-3.31)에 경상남북도의 보건진료소 중에서 50개소를 뽑아 보건진료원을 직접 면담하고 각종 기록과 보고서에서 필요한 자료를 발췌하였다. 조사대상자의 96%가 신분보장과 보수향상의 이유에서 정규직화를 원하였다. 정규직화 후에 신분보장과 봉급, 직분에 재한 만족도와 업무의 계획, 수행, 평가 및 보건진료소 관리(재점)운영에 대한 자율성 인지도가 증가했다. 그러나 보건진료원의 역할, 기능 등의 업무활동에는 큰 변화가 없었다. 보건소의 보건진료소에 대한 지원은 약간 늘었으나 업무추진 목적의 행정적, 기술적 지도는 거의 없었다. 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 job was increased from 24.0% to 46.0% after officialization. Those CHPs who felt insecure for their job decreased from 30.0% to 10.0%. Monthly salary was increased by 34.0% from 802,600 Won to 1,076,000 Won and 90.0% 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 increasd 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 20.0% to 38.0% 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 78.0% to 62.0%, and from 86.0% to 74.0%, respectively. The proportion of CHPs who maintained a coorperative relationship with Myun Health Workers was reduced from 84.0% to 72.0%. The proportition of CHPs who maintained a good cooperative relationship with the director of health center from 46.0% to 24.0%, that with the chief of public health administration section from 56.0% to 36.0%, and that with the chairman of PHP management council from 62.0% to 38.0%. Most of the CHPs (92.0% before and 82.0% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecesssary increased from 4.0% to 16.0%(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.

보건진료원 업무활동의 변화과정 : 문헌사료를 중심으로

김옥 한국농촌간호학회 2013 한국농촌간호학회지 Vol.8 No.1

우리나라의 보건진료소는 1940년 전라북도 옥구군에서 일본인 지주 웅본(雄本)에 의해 최초로 개소되었다. 개소 된 보건진료소 인력으로는 의사 리영춘이 유일하였으며 지역 내의 소작인을 대상으로 방문 및 내소진료, 질병예 방, 보건교육 등의 업무활동을 하였다(동아일보, 1940년5 월23일). 이러한 업무활동은 보건진료소의 기능과 역할을 인식시키는 계기가 되었다. 보건진료소는 해방과 한국전쟁을 겪으면서 간간히 유 지되어 오다가 경제와 인력수급의 문제로 폐쇄 위기에 놓이게 되었다. 이에 정부는 국제사회의 도움을 받아 무 의촌 보건의료문제를 우선 해결하고자 간호사, 조산사를 활용한 보건진료원을 양성하여 의료취약지역에 시범적으 로 배치하였다(김진순, 2000). 보건진료원은 1977년 마을 건강시범사업에서 최초로 업무활동을 시작하였고(간협신 보, 1977년6월23일) 1980년 ‘농어촌 보건의료를 위한 특별 조치법(이하 ‘농특법’)’의 시행으로 법적?행정적 지위를 갖게 되었다(데일리팜, 2012년1월1일). 보건진료원의 업무활동과 관련한 연구에서 보건진료원 은 일차진료와 보건, 건강증진이 주요업무라고 하였으며 (고일선 등, 2005) 투약, 보건교육, 상담, 방문진료, 건강 검진 등의 업무활동이 주로 이루어지고 있다(홍예경, 2007)고 하여 보건진료원의 업무활동의 근거인 ‘농특법’의 업무내용과 일치하고 있음을 알 수 있었다.

벽지로 간 간호사: 보건진료원의 탄생과 1970-80년대 보건의료체계의 젠더질서

정다혜 의료역사연구회 2022 의료사회사연구 Vol.9 No.1

The introduction and development of the Community Health Practitioner (CHP) system reveals that nurses were involved in reorganizing the health care system through the assumption of a new role and reflects gendered perceptions and practices of nursing in the 1970-1980s. At this time, the status and treatment of public health nurses in the public health system continued to worsen despite the increasing presence and need for public health nurses in public health administration and public health works. To resolve this, nurses actively participated in establishing an alternative public health system to secure the position of nurses and enhance nurses' stature in healthcare. Key figures in the nursing profession viewed the debate over the administration of primary medical practice by CHPs to be symbolic/representative/reflective of the solidarity among males with vested interests and the struggle to promote rights of nurses against them. Beginning in 1981, CHPs were officially dispatched to remote areas and were permitted to serve as primary healthcare providers, offering primary treatment for their communities. Although the societal gender norms were a double-edged sword, the CHPs attempted to use their commitment to the community and gender identities as an adaptation strategy. 보건진료원 제도의 도입과 초기 전개과정은 1970-80년대 보건의료체계 재편을 둘러싼 간호계의 입장을 보여주며, 당시 간호 및 간호사에 대한 젠더화된 인식이 보건의료제도에 어떻게 반영되고 수행되었는지를 드러낸다. 간호계는 1970년대 중반 정부가 새로운 보건체계를 수립하려는 국면에서 지역사회건강사업을 중심으로 한 보건 체계를 제안하고 간호사가 주요한 행위자가 될 수 있도록 정책 수립에 적극적으로 관여하였다. 이는 기존의 보건행정과 보건사업에서 간호사들의 역할이 증대되고 있음에도 오히려 입지가 축소되는 상황을 벗어나 독자적인 간호 영역을 확보하고 보건사업에서 간호사들의 주도성을 확보하기 위한 것이었다. 간호계는 보건진료원의 일차진료권 부여를 둘러싼 논쟁을 기득권 남성들의 연대와 이에 맞서는 간호사의 권리신장 과정으로 보았다. 간호계의 적극적인 정책 참여와 정치활동으로 보건진료원은 벽⋅오지 지역에서 일차적인 진료행위를 포함하여 지역사회의 건강 관리를 전담하는 직역으로 제도화될 수 있었다. 1981년부터 파견된 보건진료원들에게 여성간호사에 대한 성별화된 인식과 규범은 양날의 검으로 작용했다. 그들은 여성 간호사의 전문성에 대한 지역사회의 의심을 헌신성과 돌봄의 실천으로 극복하며 주민들에게 인정받고자 했다. 동시에 지역사회의 성별화된 역할구조와 관계에 순응하며 젠더 규범을 충실히 수행함으로써 지역사회에 적응하고 건강사업을 수행해나갔다. 보건진료원의 지역사회 건강관리자로서의 자긍심은 당시의 성별화된 규범과 실천에서 자유로울 수 없었으며 보건의료체계의 안정성에 따라 흔들리고 있었다.

보건진료원 관련 국내 연구논문 분석

장희정,박경민,강영미 한국농촌간호학회 2007 한국농촌간호학회지 Vol.2 No.1

본 연구는 1980년 1월부터 2006년 6월까지 발표된 국내의 보건진료원 관련 연구를 분석함으로써 국내 보건 진료원 관련 연구의 경향을 파악하고 보건진료원의 건강 관리 중재연구의 방향을 탐색하고자 시도되었으며 연구 의 구체적 목적을 다음과 같다. 1) 보건진료원 관련 연구의 발표연도를 분석한다. 2) 보건진료원 관련 연구의 연구출처를 분석한다. 3) 보건진료원 관련 연구의 연구 유형을 분석한다. 4) 보건진료원 관련 연구의 연구대상을 파악한다. 5) 보건진료원 관련 연구의 주요개념을 파악한다.

지역보건의료 활성화를 위한 법제 : 토론문

조형원 ( Hyong Won Cho ),이석구 한국법정책학회 2004 법과 정책연구 Vol.4 No.1

보건진료원의 은퇴에 영향을 미치는 요인 -도서 및 오벽지를 중심으로-

조유향 ( Yoo Hyang Cho ),정영해 ( Youn Ghae Chung ) 한국도서학회 2014 韓國島嶼硏究 Vol.26 No.3

This study was conducted to illuminate the related factors of preparedness and satisfaction concerning the retirement of CHPs. Secondary data from 467 CHPs was analyzed. The used data is same to the one collected by Cho and Chung(2013). Chi-squared tests, Fisher`s exact tests, t-tests, and logistic regression were analyzed using SPSS 14.0. version. The results of this study are the following. Age, economic status, eligious gathering activity, duration of work turned out to be statistically significant on the retirement preparedness of CHPs. Satisfaction on their retirement preparedness was related to age, current living area, presence of spouse, economic status, attendance of friendly meeting and duration of work. Factors related to the retirement preparedness of the CHPs were age, duration until retirement, intention to retire early, intention to participate in social activities after retirement. In addition, factors related to the satisfaction of retirement preparedness of CHPs were wanted retire ager, intention to participate in social activities after retirement. Given that all other factors are equal, younger age, higher economic status, longer duration of work, necessity of CHP post were positively linked with the CHPs` satisfaction towards their retirement preparedness.

보건진료원의 직무만족에 영향을 미치는 요인

정귀임,윤석옥,신현주,신동수 한국농촌간호학회 2009 한국농촌간호학회지 Vol.4 No.2

보건진료원 업무현황 및 업무향상활동

고일선,이태화,이경자,조원정,김진순,송은경 대한간호행정학회 2005 간호행정학회지 Vol.11 No.4

Purpose: The purpose of the study was to analyze the present status of community health practitioner activities and efforts to improve the job performance. Method: This study employed descriptive exploratory design. The sample consisted of 1,892 community health practitioners which was 90% of population of community health practitioners. The data was analyzed by using SPSS Windows 10.0. Result: The most popular activities of community health practitioners were women's health, chronic degenerative disease management, elderly health, and outpatient care of primary health care. The activities that community health practitioners want to strengthen were outpatient care, disease prevention, rehabilitation, health promotion, and counseling. The efforts to improve the job performance were consult to other health care professionals, discussion with patient and families to choose effective treatment options, Community health practitioners knew that they were exposed to malpractice and hould try to make many efforts to improve their performance. Conclusion: The roles and activities of community health practitioners should be changed to the shift of health care environment and systems.

보건진료원의 자아상태 및 대인태도가 우울에 미치는 영향

이숙,Lee Sook 한국간호과학회 2006 Journal of Korean Academy of Nursing Vol.36 No.3

Purpose: Community health practitioners (CHP) in Korea have a responsibility for delivering primary health care to remote or isolated communities. The aim of this paper is to analyze CHPs' level of depression and impacts of their Ego state and interpersonal attitude in transactional analysis on depression. This paper gives fundamental data for developing a the program for mental health promotion of CHPs. Method: The subjects Of this Study consisted of 459 Korean CHP who were conveniently selected from the target population. The data was collected through interviews using self-administered questionnaires, including the Korean Ego gram and life position inventory and depression scale. Results: The CHP's Ego gram showed the N type with the top point of NP. The type of interpersonal attitude was I'M OK - YOU'RE OK (I+U++). The level of depression was 35.4, normal range. There was a significant difference in depression according to the duration of the career. There was a significant negative correlation among NP, A, FC ego states, interpersonal OK and depression, and a significant positive correlation between interpersonal Not-OK and depression. The NP, A, FC ego states and interpersonal Not-OK were significant predictors (47.1%) of depression. Conclusion: This study showed that a program for CHPs to should include increasing the function of ego states and positive interpersonal attitude.

보건진료원의 직무 만족도에 관한 조사연구 : 전남지방을 중심으로

박정애,정영 朝鮮大學校 附設 醫學硏究所 1988 The Medical Journal of Chosun University Vol.13 No.1

In any profession, the utmost precedent condition for doing one's job most effectively, is the satisfaction with one's job and one can act to the best of one's ability and can promote the professional development. So the authors tried to make a survey of the C.H.P's satisfaction with their job who were working for more than 1 year in Chunnam area, distributed after finishing the training course for C.H.P., The total subjects were 86 and the authors tried to find out their general characteristics and the degree of the satisfaction with their job and it's working condition with presentation of the basic data for establishing the direction, seeking promotion of their quality and quantity at the same same time and seeking development of nursing eventually and obtained the following results : 1. The mean score of satisfaction was 18.2 on the basis of 35. (52.0/100) 2. The groups who were older, less educated, married, catholics, living with family, have clinical experience, have varied exprience, have longer C.H.P. experience were more satisfied with their job and among these only education(x² = 12.93 P<0.05) and marital status(x² = 5.52 P<0.05) have significant relationship with the degree of job satisfaction. 3. The job satisfaction related factors were : professional pride(80.0), interrelationship with the inhabitants(68.0), physical safety(56.0) job amount(48.0), administrative supervision(44.0), paper work(42.0), pay(22.0). 4. The group who have varied experience keep good interrelationship with the inhabitants and it was significant by statics. (x² = 14.55 P<0.05) 5. The group who have lower educational background showed positive attitude toward administrative supervision and the group who have higher education showed negative attitude toward it, and it was significant by the statistics. (x² = 20.54 P<0.05)