환자와 의사의 의료에 대한 태도 차이 -한 중소도시의 대학병원과 한의과대학 부속 한방병원을 중심으로-

강명근,박종구,김한중,손명세,김달래,Kang, Myung-Guen,Park, Jong-Ku,Kim, Han-Joong,Sohn, Myong-Sei,Kim, Dal-Rae 대한예방의학회 1998 예방의학회지 Vol.31 No.3

The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilzers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's $\alpha$ coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care-preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a univisity hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demanad side such as the developement and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be neccessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.

일부 지역 의사들의 흡연실태와 금연지도활동에 대한 조사연구

김기순,강명근,박형철,김진선,류소연,Kim, Ki-Soon,Kang, Myung-Gun,Park, Hyung-Cheol,Kim, Jin Sun,Ryu, So-Yeon 대한예방의학회 2003 예방의학회지 Vol.36 No.3

Objectives : The purposes of this study were to assess the smoking status, knowledge and attitude related to smoking and smoking cessation activity of the physicians in a community, and to identify their predictors of smoking cessation activity. Method : All physicians employed by various health facilities in a community were surveyed using a structured questionnaire. Of the physicians surveyed,523 (69.6%) returned completed questionnaires. Results : The smoking rate of physicians was 29.3% (34.2% in males, 3.6% in females) and the knowledge and attitude scores to smoking were $22.5{\pm}2.4\;and\;65.4{\pm}0.9$, respectively. The self-efficacy score was $3.4{\pm}1.0$ and the smoking cessation activity score was $65.4{\pm}6.9$. The smoking cessation activity was statistically significant with working place, specialty, knowledge and attitude to smoking and self-efficacy. In stepwise multiple regression, smoking cessation activity was predicted by doctors' working place, specialty, attitudes related to smoking issues, and self-efficacy of counseling knowledge and stills. Conclusion : Physicians need to participate routinely and actively in smoking cessation activity. For doctors to effectively counsel and intervene in patients regarding smoking cessation, it is essential to integrate education un smoking cessation intervention into curricula in formal education and to offer continuing education including smoking cessation intervention.

한국인 뇌혈관질환의 위험요인에 관한 메타분석

박종구,강명근,김춘배,김기순,지선하,Park, Jong-Ku,Kang, Myung-Guen,Kim, Chun-Bae,Kim, Ki-Soon,Jee, Sun-Ha 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.1

This study was conducted to integrate the results of studies which evaluated or identified the risk factors of CVD(cerebrovascular disorders) for Koreans. We retrieved the literature published in Korean by manual search and the English literature by Medline database to identify studies on the relationship between reported risk factors and CVD conducted for the Korean from 1980 to August, 1997. Hypertension and total serum cholesterol were selected as subjects of quantitative meta-analysis on risk factors of CVD in Koreans. The overall effect sizes of the risk of CVD due to hypertension and total serum cholesterol were calculated by common odds ratio(OR) and average standardized mean difference, retrospectively. Before the integration of each effect sizes into common effect sizes, the heterogeneity tests were conducted. Also, sensitivity tests were conducted for the estimated common effect sizes. Regarding hypertension and CVD, a total of 9 epidemiologic studies were identified with a total of 2,271 cases of CVD. The overall OR of hypertension associated CVD was 4.10(95% confidence interval[CI] 3.56 to 4.71). The OR of hypertension associated with hemorrhagic CVD and ischemic CVD were 6.56(95% CI : 4.92 to 8.80) and 3.28 (95% CI : 2.77 to 3.90), retrospectively. The OR of hypertension in relation to hemorrhagic CVD was significantly higher than that of hypertension in relation to overall CVD or ischemic CVD. Regarding total serum cholesterol and ischemic CVD, total 9 epidemiologic studies were identified with a total of 843 cases of ischemic CVD. Average mean difference as an effect size was 0.76, which was judged an important value according to Cohen's criteria. Our data suggested that hypertension was an important risk factor of overall CVD and its subtypes, and that the total serum cholesterol was associated with ischemic CVD in Koreans. For the lack of reliable prospective studies, however, we concluded that further research designed longitudinally would be required in this area.

병원건강증진서비스에 대한 의료소비자의 이용의도

함명일,강명근,박춘선,조우현,Hahm, Myung-Il,Kang, Myung-Geun,Park, Choon-Sun,Cho, Woo-Hyun 대한예방의학회 2003 예방의학회지 Vol.36 No.2

Objective : To determine the relationships between customer's attitude, the subjective norm and the intention to use hospital-based health promotion services. Methods : This study was based on the theory of reasoned action, suggested by Fishbein and Ajzen. The subjects of this study were 501 residents of Seoul, Bun-dang, Il-san and Pyung-chon city, under 65 years, who were stratified by sex and age. A covariance structural analysis was used to identify the structural relationships between attitude towards health promotion programs or services, their subjective norm and their intention to use the aforementioned services. Results : The subjective norm for using the health promotion programs or services provided by hospitals was a significant predictor of the intention to use, but the attitude towards the services was not significant Conclusions : Our results suggest that a customer's reference group affects their use of the hospital-based health promotion services. Because the subjects of this study were restricted to specific urban areas, there are limitations to generalizing the study results. Despite the limitations of these results, they can serve as baseline information for the understanding of consumers behavior toward hospital-based health promotion services.

우리나라 직장인 피로의 역학적 특성

장세진,강명근,현숙정,차봉석,박종구,박준호,김성아,강동묵,장성실,이경재,하은희,하미나,고상백,Chang, Sei-Jin,Kang, Myung-Gun,Hyun, Sook-Jung,Cha, Bong-Suk,Park, Jong-Ku,Park, Jun-Ho,Kim, Seong-Ah,Kang, Dong-Mug,Chang, Seong-Sil,Lee, Kyung-Jae 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objective : To elucidate the correlates of self-rated fatigue in Korean employees. Methods : The data for 10,176 (men, 7,984; women, 2,192; mean age, 34.2; SD: 8.8) employees recruited from a nationwide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS). Results : According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (<1,000 employees). Conclusions : These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.

일부 한.양방병원 뇌혈관질환 환자의 진료결과 및 만족도의 비교연구 -한양방협진 진료프로토콜의 적용을 중심으로-

박종구,강명근,이성수,김달래,최서영,한창호,유준상,김민기,김춘배,Park, Jong-Ku,Kang, Myung-Guen,Lee, Seong-Soo,Kim, Dal-Rae,Choi, Seo-Young,Han, Chang-Ho,Yoo, Jun-Sang,Kim, Min-Gi,Kim, Chun-Bae 대한한방내과학회 2001 大韓韓方內科學會誌 Vol.22 No.4

Objectives : This study was done to assess the effects of the clinical interchange between the Western Medicine and the Oriental Medicine for ischemic stroke patients. The patient outcomes include changes in neurologic function by modified NIH stoke scale, stroke pattern identification scale, and patient satisfaction, Methods : For the assessment of effects, this study was performed with 178 inpatients who had undergone the stroke care at three hospitals (W Hospital adopted western therapy, S Oriental Hospital adopted Sasang constitution medicine therapy, and H Oriental Hospital adopted mixed therapy according to a joint protocol on Western Oriental medical care) from November 1997 to December 1998. Patients were interviewed or written with self-entered questionnaire forms, and clinical data were obtained, Physicians or oriental doctors wrote clinical questionnaire forms according to the care process. Results : The patient outcomes within three hospitals at 2 stages (at admission and discharge in the modified NIH stroke scale. at admission and second weeks during admission in the stroke pattern identification scale) were found to be decreased, Especially in the results of hierarchical multiple regression analysis, the degree of improvement of modified NIH stroke scale of the stroke patients at W Hospital was significant large than it at S Oriental Hospital. Also, the degree of improvement of stroke pattern identification scale at W Hospital was significantly large than it at other two hospitals. However, the patient's satisfaction score at three hospitals wasn't significantly different. Conclusions : The result of this study suggested that the joint clinical research of Western & Oriental medical practitioners was possible even if there was a conflict between Western Medicine and Oriental Medicine. Therefore Western & Oriental medical practitioners share a mutual responsibility to apply evidence-based practice, to seek scientific empirical proof through randomized clinical trials between the multicenter.

우리나라 직장인 스트레스의 역학적 특성

장세진,강명근,차봉석,박종구,현숙정,박준호,김성아,강동묵,장성실,이경재,하은희,하미나,고상백,Chang, Sei-Jin,Kang, Myung-Gun,Cha, Bong-Suk,Park, Jong-Ku,Hyun, Sook-Jung,Park, Jun-Ho,Kim, Seong-Ah,Kang, Dong-Mug,Chang, Seong-Sil,Lee, Kyung-Jae 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objective : To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample. Methods : A total of 6,977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress. Results : The results showed that 23 % of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand. Conclusions : The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e. g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.

일부 농촌지역 주민의 High Sensitivity C-reactive Protein(hsCRP)과 고혈압의 관련성

이영선,박종,강명근,김기순,류소연,Lee, Young-Seon,Park, Jong,Kang, Myeong-Guen,Kim, Ki-Soon,Ryu, So-Yeon 대한예방의학회 2005 예방의학회지 Vol.38 No.3

Objectives : This study was performed to assess the association between high sensitivity C-Reactive Protein (hsCRP) and hypertension. Methods : We evaluated the relationship between hsCRP with hypertension and other cardiovascular risk factors, using a cross-sectional survey of 202 people over the age of 50, living in a rural area. A logistic regression analysis was used to study the association between hsCRP and hypertension. The hsCRP levels were divided in quartiles, and the odds ratios (OR), with 95% confidence intervals (95% CI), calculated, using the lowest quartile as a reference. Results : The subjects consisted of 37.1% men and 62.9% women, with a mean (SD) hsCRP level of $1.9({\pm}3.0mg/{\ell})$ . The overall prevalence of hypertension was 61.4%. The prevalence of hypertension according to the hsCRP quartile was not statistically significant. After adjustment for confounding variables, the prevalence of hypertension according to the subjects in the 2nd, 3rd and 4th hsCRP quartiles were 1.418 (95% CI=0.554-3.628), 1.124 (95% CI=0.392-3.214) and 0.892 (95% CI=0.312-2.547) times higher, respectively, compared to those in the 1st quartile. Conclusions : The results showed that the level of hsCRP was not a risk factor for hypertension among adults aged over 50 years, living in a rural area. A further study should be performed to find the association between hsCRP and hypertension.

직장인들의 건강수준 평가를 위한 측정도구의 신뢰도와 타당도 분석

고상백,장세진,강명근,차봉석,박종구,Koh, Sang-Baek,Chang, Sei-Jin,Kang, Myung-Guen,Cha, Bong-Suk,Park, Jong-Ku 대한예방의학회 1997 예방의학회지 Vol.30 No.2

In order to test scaling assumption, and to assess the validity, reliability, and acceptability of the Short form 36(SF-36) health survey questionnaire, we conducted a survey. Samples were 296 workers who had been employed in small sized companies. All scale passed for item internal consistency(100% sucess rate) and item discriminant validity(100% success .ate). Reliability coefficients were ranged from the lowest 0.51 to the highest of 0.85. For 87.5% of the total workers, inconsistent responses were not observed. Only 3.0% of the total workers failed two or more checks. Factor analysis was performed using principal axis factor method and quartimax rotation. In this survey, the SF-36 retained available psychometric properties even when used in a generally healthy worker group. But further study with some consideration to develope health status measurement is expected : first, the definition of health status should be rationalized. Second, the measurement of outcome is an important consideration in evaluations of quality of care. But ambiguities hinder understanding of this important topic. Third, internal consistency should be interpreted with caution as an indication reliability because it ignores potentially important sources of variation that can occur over time.

병원 고객만족도 측정방법에 대한 비교분석

이선희,최귀선,강명근,조우현,Lee, Sun-Hee,Choi, Kui-Son,Kang, Myung-Guen,Cho, Woo-Hyun 대한예방의학회 2001 예방의학회지 Vol.34 No.1

Objectives : The SERVQUAL scale is based on gap theory, which suggests the difference between consumers' expectations and the quality of the medical service actually received. However, problems in the implementation of the SERVQUAL scale have been identified by several researchers. Some researchers have proposed a simple performance-based measure (SERVPERF) or au exportation-controlled performance-based measure(Non-Diff) as alternatives to the SERVQUAL scale. On the basis of the theoretical concerns discussed, we examined the capability of each of the three scales(SERVQUAL, Non-Diff, SERVPERF) to explain variations in consumer satisfaction. Methods : Data was gathered from a self-administered questionnaire in a 430 bed hospital. Questionnaires evaluating medical services were distributed to 180 ambulatory patients. A total of 167 usable questionnaires were gathered. The questionnaire was composed of 10 expectation, performance and expectation-controlled performance items. In addition, overall satisfaction and purchase intention were measured. Results : Compared with the SERVQUAL scale, the Non-Diff and SERVPERF scales better explained the observed variations in consumer satisfaction(SERVOQUAL, $R^2=0.29;\;Non-Diff,\;R^2=0.51;\;SERVPERF,\;R^2=0.48$) and purchase intention(SERVQUAL, $R^2=0.22;\;Non-Diff,\;R^2=0.33;\;SERVPERF,\;R^2=0.34$). Conclusion : The maier conclusion from our study is that the Non-Diff and SERVPERF scales are more efficient in assessing consumer satisfaction than the SERVQUAL scale. Therefore we suggest that consumer satisfaction he measured by the Non-Diff or SEVPERF scales.