Patients' Assessment of Community Primary and Non-primary Care Physicians in Seoul City of South Korea

정재욱,성낙진,박기흠,김선웅,이재호 대한가정의학회 2011 Korean Journal of Family Medicine Vol.32 No.4

Background: It is important to know the current level of primary care performance in order to evaluate and plan for desirable health policy. We tried to compare patient's assessment of primary (family physician, general practitioner,internist, pediatrician, and general surgeon) and non-primary (the other specialties) care physicians. Methods: Study subjects were physicians of primary care clinics in Seoul. The study subject evaluators were Seoul citizens who were selected by a list-assisted random digit dialing sampling method and who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. The modified version of the Korean Primary Care Assessment Tool was used for the evaluation of primary care performance. The data were collected with the aid of a computer-assisted telephone interview system from June 29 to July 22, 2009. Results: The data on 260 individuals were used for analysis. The mean scores of primary and non-primary care physician group were respectively 1.19 and 0.85 in the comprehensiveness domain, 1.00 and 0.83 in the coordination domain,1.54 and 1.31 in the family/community orientation, and 1.24 and 0.99 as an average of 3 domains above. The scores in the comprehensiveness domain and the average of 3 domains were significantly higher in the primary than in the nonprimary care physician group. Conclusion: Primary care physicians showed superior performance compared to non-primary care physicians in comprehensiveness domain and in the average of comprehensiveness, coordination, and family/community orientation domains.

일차의료 강화를 위한 교육수련제도 개편방안

김경우,박훈기,이승화 대한의사협회 2013 대한의사협회지 Vol.56 No.10

Primary care physicians who can deliver high quality primary care services are essential for strengthening the primary health care system. In Korea, primary care was regarded as substandard services practiced by any medical doctor without postgraduate education in primary care. The current and future health care systems are challenged by increasing complexity and co-morbidity and healthcare costs in medical care. The developed countries are preparing for the future by increasing support for basic, postgraduate, and continuing medical education in primary care. To strengthen the primary care in Korea, basic medical education programs should require experience in primary care clinics with a teaching and education function. Postgraduate primary care medical education must be enhanced to be qualified to practice in the community. The recognition of the importance of primary care and the need for changes in the current education and healthcare system among medical professionals and other stakeholders and support systems such as legislation and finance for primary care medical education.

일차의료의 개념과 가치, 그리고 한국의 현실과 과제

최용준,이재호,고병수,조경희 대한의사협회 2013 대한의사협회지 Vol.56 No.10

Primary care is an essential part of a whole health system. It is the first contact point for medical care in the community, where many people are likely to obtain their own impression of the health system. Primary care has its own attributes, such as first contact, continuity, comprehensiveness, and coordination, which are yardsticks for measuring its excellence. Regarding the value of primary care, many studies have reported extensive evidence of the advantages of primary care at individual and societal levels. Health systems with strong bases of primary care are better than those with weak ones in terms of cost, health outcomes, and quality of care. However, primary care in South Korea has continuously shrunk or been weakened for several decades. As people age and chronic illnesses become prevalent, more attention is being paid to primary care than ever before, and several policy options have been proposed. Therefore, if the medical community wishes to invigorate primary care, it should play a pivotal role in formulating and implementing primary care policies by envisioning primary care, establishing related data infrastructure, and continuing the discussion on long term goals like training primary care physicians.

의료생활협동조합 의원의 일차의료서비스 질 평가

최윤구,김경우,최용준,성낙진,김재용,박진하,홍승권,이재호,일차의료연구회 대한가정의학회 2010 Korean Journal of Family Medicine Vol.31 No.10

Background: In South Korea, major health care problems have been occurred under the structural background that medical services are mainly provided by private medical institutions. Primary health care, which is very crucial in public health, has been overlooked, and is disorganized and fragmented. In the mean time, health cooperative movement was initiated by local residents and medical doctors to overcome health care problems in 1987. We conducted this study to evaluate the role of health cooperative clinics and obtain lessons for the future primary care policy. Methods: During April to June in 2006, survey was performed by a trained interviewer at the waiting rooms of 3 health cooperative clinics, in the process of development of the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of 5 domains (21 items): first contact (5), coordination function (3), comprehensiveness (4), family/community orientation (4), and personalized care (5). Subjects were patients (or guardians) who had visited their health cooperative clinics on six or more occasions over a period of more than 6 months. We compared primary care scores of each domain between members and non-members of health cooperative clinics by student t-test. Effect of having a membership on each primary care domains was examined by multiple regression analysis. Results: Among the participants (N = 100), members of health cooperatives were 48, and non-members 52. Total average scores of 5 primary care domains of the KPCAT were 78.0 ± 13.5 on 100 point scale. (82.0 ± 13.1 in members, and 74.3± 13.0 in nonmembers; P = 0.004) Among primary care domains, personalized care was the highest (91.4 ± 11.0), and coordination function the lowest (61.0 ± 33.1) in score. Significant differences between members and nonmembers were noted in coordination function (68.9 vs. 53.7, P = 0.021) and comprehensiveness (78.4 vs. 67.2, P = 0.008). These differences were continued after adjusting by multiple regression analysis for socio-demographic variables including age,sex, income, education, number of disease, and duration since the first visit. Conclusion: In the health cooperative clinics whose primary care performance has been considered exemplary in the context of health care in South Korea, primary care scores assessed by members were higher than those by non-members. The significant differences of scores in coordination function and comprehensiveness between members and nonmembers suggest that the future primary care policy should be focused to strengthen these two domains of primary care. 연구배경: 우리나라 보건의료체계는 의료기관의 사적소유가지배적이며 공공성이 결여되어 있는 문제를 안고 있다. 국민건강증진과 질병예방에 기여하는 일차보건의료는 간과되어왔고, 조직화되어 있지 못하고 분절화되어 제공되고 있다. 이러한 보건의료 문제 상황을 극복하기 위하여 지역 주민과 의료인이 함께 운영하는 의료생활협동조합(의료생협) 운동이시작(1987)되었다. 의료생협은 일차의료의 바람직한 대안으로 평가되기도 한다. 본 연구는 의료생협이 수행하는 일차의료기관으로서의 역할에 대해 평가하여 향후 일차의료 정책을위한 교훈을 얻고자 시행하였다. 방법: 한국 일차의료 평가 도구(the Korean Primary Care Assessment Tool, KPCAT) 개발을 위하여 2006년 4월부터 6월까지 수집된 자료 중에서, 인천시, 안산시, 안성시에 위치한 의료생협세 곳의 자료를 분석하였다. 의료생협을 상용치료원으로 이용하는(방문한 지 6개월이 경과하고 6회 이상 방문한) 환자또는 보호자가 평가 주체로 참여하였다. KPCAT의 5개 영역즉, 최초 접촉, 포괄성, 조정 기능, 전인적 의료, 가족/지역사회지향성에 대해서, 영역별 점수를 구하고 의료생협 조합원 여부에 따라 영역별 점수를 비교하였으며, 인구사회학적인 변수를 통제한 후의 변화를 관찰하였다. 통계분석을 위해, 영역별 점수비교에는 t-검정을, 그리고 인구사회학적 변수의 통제에는 다중회귀분석을 이용하였다. 결과: 의료생협을 상용치료원으로 이용하는 지역주민 100명이 본 연구에 참여하였다. 의료생협 조합원은 48명, 비조합원은 52명이었다. KPCAT 일차의료 속성영역 5개 평균점수를 100점 척도로 나타내었을 때, 의료생협의원의 일차의료평균점수는 78.0±13.5 (조합원 82.0±13.1, 비조합원 74.3±13.0;P=0.004)이었다. 일차의료 영역들 중에서 점수가 높은 것은 전인적 의료(91.4±11.0), 최초접촉(89.3±11.5)이었으며, 점수가낮은 것은 조정기능(61.0±33.1), 포괄성(72.6±21.4)이었다. 조합원 여부에 따라 유의한 차이를 보인 영역은 조정기능(68.9vs. 53.7, P=0.021)과 포괄성(78.4 vs. 67.2, P=0.008)이었다. 이 같은 차이는 연령, 성, 소득, 교육수준, 질병의 수, 첫 방문 후 경과기간 등의 변수를 다중회귀분석으로 통제한 후에도 지속되었다. 결론: 우리나라 보건의료 맥락에서 모범적인 일차의료기관으로 평가되는 의료생협의원에서, 주치의 서비스를 받는 조합원이 평가한 의료생협의 일차의료서비스 질은 기존 방식의진료를 받는 비조합원이 평가 한 것보다 우수하였다. 특히 조정기능과 포괄성 영역에서의 유의한 차이가 있는 점은, 향후주치의제도 도입 등 일차의료 정책 수립 시에, 일차의료의 조정기능과 포괄성 영역을 강화시키는 데 역점을 두어야 한다는 점을 시사한다.

Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

김미자,정향인,안양희 한국간호과학회 2008 Asian Nursing Research Vol.2 No.1

Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34] Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34]

개원 가정의를 상용 치료원으로 이용하는 고혈압 환자의 건강행태와 일차의료 서비스 질

박진하,김경우,성낙진,최윤구,이재호,일차의료연구회 대한가정의학회 2011 Korean Journal of Family Medicine Vol.32 No.2

Background: Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care. Methods: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis. Results: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (<25 kg/m2) was 2.53 (P = 0.02), and odds ratio to have a habit drinking an adequate amount of alcohol was 4.32 (P = 0.02). Conclusion: The fact that high-quality primary care was associated with good health behaviors in this study suggests that improving quality of primary care by health care reform can make health behaviors more desirable in patients with essential hypertension. 연구배경: 일차의료에서 고혈압 환자의 관리가 많이 이루어지나 그 관리 수준은 만족스럽지 못하다. 개원 가정의를 상용치료원으로 이용하는 고혈압 환자들의 건강 행태와 일차의료서비스 질을 살펴봄으로써 건강증진 활동의 향상 방안을 찾아보고자 하였다. 방법: 한국 일차의료 평가도구(Korean Primary Care Assessment Tool, KPCAT) 개발과 타당도검증을 위한 조사(2007년4-6월) 기간 동안, 가정의학과 의원(총 9곳: 서울 3곳, 경기 3곳, 경주-포항 3곳)에서 수집된 602명의 자료 중, 고혈압 환자(134명) 자료를 분석하였다. 참가 자격은 해당 의료기관을 상용 치료원(처음 방문하고 6개월이 경과하고 6회 이상 방문 경험이 있는 의료 제공자)으로 이용하는 환자 또는 그 보호자에한정되었다. 환자의 연령, 성, 소득, 교육연한, 첫 방문 후 경과기간 등 인구사회학적 정보와, 흡연력, 음주력, 운동습관, 비만도, 그리고 KPCAT 5영역 평가점수를 분석하였다. 통계처리는SAS ver. 8.11 프로그램을 이용하여 T검정, 카이제곱 검정, 다중로지스틱 회귀분석을 이용하였다. 결과: 개원 가정의를 상용 치료원으로 이용하는 고혈압환자들은 KPCAT 5영역 중에서, 전인적 돌봄을 가장 높게(71.7/100), 그리고 조정기능을 가장 낮게(49.7/100) 평가하였다. 일차의료 서비스 질을 평균(69.2/100) 이상으로 높게 평가한 환자들은 환자-의사 관계의 지속기간이 유의하게 길었다(P=0.035). 인구사회학적 변수들을 통제한 상태에서 일차의료 서비스 질을 높게 평가한 환자들은 낮게 평가한 환자들에비하여 체질량 지수가 정상(BMI<25 kg/m2)일 경우의 교차비가 2.53배(P=0.02), 건강한 음주 습관을 가질 경우의 교차비는4.32배(P=0.02)로 나타나 건강행태가 양호한 것으로 나타났다. 결론: 고혈압 환자의 일차의료 서비스 질이 건강행태와 연관성이 있다는 사실은, 제도 개혁을 통한 일차의료 서비스 질 향상이 고혈압 환자의 혈압관리에 기여할 수 있음을 시사한다.

일차의료 표준모형과 질 평가체계

이재호,이상일,고병수,임종한 대한의사협회 2013 대한의사협회지 Vol.56 No.10

During the past several decades, population aging and chronic diseases have been common burdens to nearly all the world’s countries. To meet future health care needs, many coun-tries have tried to improve the efficiency and equity of the health care system by reforming pri-mary care. In the UK, which has already achieved a high level of strength in primary care, the Quality and Outcomes Framework (2004) was introduced and a great deal of the National Health Service (NHS)budget has been invested in primary care. In the US, a country with a low level of strength in primary care, to transform primary care practices to model practices, medical home movements such as the Patient-Centered Medical Home (PCMH) have been initiated after the development of the joint principles of the PCMH (2007) by 4 major societies of primary care. In Australia, despite having achieved high levels of health outcomes among the OECD countries, the Practice Incentives Program (PIP) has been introduced to respond to concerns about quality and coordination of care and prevention in 1998. In South Korea, a country with a very weak infrastructure in primary health care, where primary care has never been explicitly defined at the national level, the government is trying to improve quality in chronic care by using small financial incentives. The authors assert that a standard model and a quality appraisal framework for the organization of primary care are necessary to achieve the goals of primary care reform in this country.

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis

Koh Hyeonseok,Kwon Soonman,Cho Belong 대한가정의학회 2024 Korean Journal of Family Medicine Vol.45 No.2

Background: Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated.Methods: This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data.Results: Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983–0.9995). Simi-lar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract dis-eases, and traffic accidents.Conclusion: This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the signifi-cance of strengthening primary care in the South Korean healthcare system to improve the overall health and well-being.

일차의료 강화를 위한 지불제도 개편방안

정현진,이태진,이희영,이재호 대한의사협회 2013 대한의사협회지 Vol.56 No.10

Strengthening primary care has always been a major policy issue in most developed countries to achieve the health care system's goals, and policy makers continuously try to use payment system as an effective tool to improve overall performance of primary care. In this paper, we examined the various payment methods and growing trends in primary care payment system in some developed countries. Overall, a common form of payment for primary care doctors is a blend of fee-for-service (FFS), capitation, and pay-for-performance (P4P). In addition, many countries are still in the way of many new trials to find the right way to provide primary care service effectively, to meet the complex health care needs of populations. In Korea, primary care system is not well-established, and other institutional arrangements are not in good conditions for primary care, either. FFS, which is a dominant payment method in Korea, is not favorable for achieving good attributes of primary care. Mixing various payment components, like capitation, P4P to current FFS is essential to provide the optimal incentive structures for primary care physicians. Also, new models to encourage doctor-patient relationships with appropriate P4P mechanisms could be used as an early step in reforming primary care payment system gradually.

상용치료원 보유가 예방 가능한 입원에 미치는 영향

송연재,권순만 한국보건경제정책학회 2020 보건경제와 정책연구 Vol.26 No.3

Preventable hospitalization is the admission that could be prevented through effective chronic disease management and proper use of primary care services, thus closely related to the lack of primary care. This study considered the role of a usual source of care as a quality primary care provider. Quality primary care attributes include longitudinality, comprehensiveness, and coordination. This study explored how preventable hospitalization is affected by not only having a usual source of care but also having it with quality primary care attributes. With 2012, 2013, and 2016 Korean Health Panel, this study used random-effects logistic panel model and pooled logistic model to examine the effects of having a usual source of care with primary care attributes on preventable hospitalization. The results show that having a usual source of care and quality primary care attributes had no significant impact on preventable hospitalization, which seem to result from the perverse incentive and payment systems for health providers, e.g., fee-for-service, or lack of the community and primary care based integrated health care services in Korea.