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의약분업 시행 후 피부과 외래 환자의 의료이용 행태에 관한 후향적 임상역학 연구
김재왕 ( Jae Wang Kim ),이일환 ( Il Hwan Lee ),김순택 ( Soon Taek Kim ),김충철 ( Choong Chul Kim ),송동훈 ( Dong Hoon Song ),김경진 ( Kyung Jin Kim ),전인기 ( Inn Ki Chun ),김준협 ( Jun Hyeob Kim ),양준성 ( Joon Seong Yang ),이민 대한피부과학회 2003 대한피부과학회지 Vol.41 No.6
N/A Background : Despite 2 years` separation of dispensary from medical prartice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegalpractices of pharmacists such as medical examination have contributed to the recent problematic situation. Objective : We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. Methods : The clinico-epidemiologic analysis of 17 months` data of 18,230 outpatients was conducted through the available medical records and serial questionnaires. Results : 1. The medical or non-medical institutions that 18,230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17,223) of the new patients did not select a dermatologic institution for the care of their skin diseases. 2. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. 3. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). 4. The patients utilizing non-dermatology measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3% , respectively). 5. Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). 6. In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. Conclusion : In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients. (Korean J Dermatol 2003;41(6) : 740~753)
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