중독관리센터의 경제적 효과에 대한 체계적 고찰

한은아 ( Eunah Han ),황현아 ( Hyuna Hwang ),유지나 ( Gina Yu ),고동률 ( Dong Ryul Ko ),공태영 ( Taeyoung Kong ),유제성 ( Je Sung You ),좌민홍 ( Minhong Choa ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.1

Purpose: The purpose of this study was to conduct a systematic review to investigate the socio-economic benefits of the poison control center (PCC) and to assess whether telephone counseling at the poison control center affects the frequency of emergency room visits, hospitalization, and length of stay of patients with acute poisoning. Methods: The authors conducted a medical literature search of the PubMed, EMBASE, and Cochrane Library databases. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool. Key results such as the cost-benefit ratio, hospital stay days, unnecessary emergency room visits or hospitalizations, and reduced hospital charges were extracted from the studies. When meta-analysis was possible, it was performed using RevMan software (RevMan version 5.4). Results: Among 299 non-duplicated studies, 19 were relevant to the study questions. The cost-benefit ratios of PCC showed a wide range from 0.76 to 36 (average 6.8) according to the level of the medical expense of each country and whether the study included intentional poisoning. PCC reduced unnecessary visits to healthcare facilities. PCC consultation shortened the length of hospital stay by 1.82 (95% CI, 1.07-2.57) days. Conclusion: The systematic review and meta-analysis support the hypothesis that the PCC operation is cost-beneficial. However, when implementing the PCC concept in Korea in the future, it is necessary to prepare an institutional framework to ensure a cost-effective model.

응급실에서 의사소통 할 때 투명마스크의 사용 효과

노민형 ( Noh Minhyung ),한은아 ( Han Eunah ),조아라 ( Cho Ara ),조준호 ( Cho Junho ) 대한의료커뮤니케이션학회 2020 의료커뮤니케이션 Vol.15 No.2

Background: It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication. Methods : We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparent/non-transparent mask was randomly allocated to each participant. Results : In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001). Conclusions: This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.

장애인과 건강보험인구의 다빈도 상병과 진료비 비교: 시각, 청각, 지적장애를 중심으로

조유송 ( Yusong Cho ),한은아 ( Eunah Han ),전보영 ( Boyoung Jeon ),이혜재 ( Hyejae Lee ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.1

장애인은 비장애인에 비해 더 많은 건강문제를 갖는다. 장애인이 어떤 질환을 앓고 있으며, 이를 관리하기 위해 지출하는 의료비의 현황을 살펴보는 것은 장애인의 보건정책을 마련하는 데 중요한 기초자료이다. 본 연구는 장애인의 다빈도질환별 의료비 지출 현황을 일반인구와 비교하고 후속연구와 장애인 보건정책을 위한 기초근거를 제공함을 목적으로 한다. 자료원으로 국가승인통계인 ‘장애인건강보건통계’와 ‘건강보험통계’를 사용하였으며, 다빈도 상병별 의료비 지출에 대한 통계지표를 동일한 정의 하에 재구성하여 비교하였다. 특히 시각, 청각, 지적장애인들은 비장애인과 동일한 만성질환을 앓게 되어도 의사소통의 문제로 적절한 예방, 치료 및 재활에 어려움을 겪어 정책적 대상이 되는바, 전체 장애인에 대한 결과와 함께 이들 장애유형별 결과를 제시하였다. 그 결과 장애인구에서 건강보험인구에 비해 근골격계 상병과 치과계 상병을 앓고 있는 경우가 많았다. 반면 장애인은 건강보험인구에 비해 동일 상병에 대한 1인당 진료비 지출 수준이 낮았고, 본인부담 비율도 낮았다. 각 장애유형에 따라 다빈도 상병 및 지출은 다른 양상을 보였는데, 시각장애인에서는 녹내장과 기타 망막장애가, 청각장애인에서는 전음성 감각신경성 청력소실이, 지적장애인에서는 뇌전증으로 인한 의료이용과 이로 인한 의료비 지출 수준이 높은 것으로 나타났다. 이 연구에서는 기 구축된 국가승인통계를 재구성하여 장애인의 다빈도 상병과 의료비 지출에 대한 시사점을 도출하였으며, 이 결과로 향후 필요한 심층연구를 제안하였다는데 의미가 있다. People with disabilities have more health problems than people without disabilities, and it is important to look at the patterns of medical expenses of them. The purpose of this study is to compare the medical costs by diagnostic code between the people with disabilities and the general population, and to provide a basis for further research and policies for the disabled focusing on the visual, hearing, and intellectual disabilities. As data sources, the nationally approved statistics, ‘Healthcare Statistics of Persons with Disabilities’ and ‘National Health Insurance (NHI) Statistics’ were used, and the statistics for medical costs by diagnostic code were re-constructed under the same definition and compared. There were more cases of musculoskeletal morbidity and dental morbidity in the disabled people than in the health insurance population. Compared to the NHI population, the disabled had lower medical costs per capita for the same disease, and their out-of-pocket payments were also lower. Some diagnostic codes, which are closely related to the type of disability, such as ‘glaucoma(H40)’ for the visually disabled, ‘conductive and sensorineural hearing loss(H90)’ for the hearing disabled, and ‘epilepsy(G40)’ for the intellectually disabled, ranked higher than in the NHI population, and the expenditures of the diseases were large. In this study, the implications for the frequent morbidity and medical costs of the disabled were derived by re-constructing the previously developed statistics, and it is meaningful that further researches can be proposed.

급성 중독으로 응급실에 내원하여 사망한 환자의 원인물질 및 시간 분포

이현재 ( Hyeonjae Lee ),좌민홍 ( Minhong Choa ),한은아 ( Eunah Han ),고동률 ( Dong Ryul Ko ),고재욱 ( Jaiwoog Ko ),공태영 ( Taeyoung Kong ),조준호 ( Junho Cho ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.2

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (< 6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period ( >7 d) were 9.8%. Conclusion: This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.