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오현종,박정식,박아련,편석원,김양균 대한의사협회 2011 대한의사협회지 Vol.54 No.2
Primary care lays the foundation of national healthcare systems, but it has been weak in playing its role correctly because of legal and environmental attributes surrounding the healthcare industry in Korea. This study is conducted to concretize the definition and scope of primary care and to deduce its standard functions to contribute to establishing the healthcare delivery system and appropriate healthcare systems embracing socio-environmental leverage. The term primary healthcare institution was adopted based on literature review to achieve the research goal. The principle diseases appropriate for the primary healthcare institution based on ambulatory care sensitive conditions were analyzed, and the standard functions were deduced by matching these diseases with current procedural terminologies using CrossCoder package. Based on the analysis,the primary healthcare institution-specific diseases were 53 specific diseases under 23 broad disease groups. The standard functions were deduced in three categories of the standard functions of the entire primary healthcare institutions with 100% frequency, common standard functions with 70% frequency, and peculiar standard functions specific to diseases or body systems. These functions included outpatient evaluation and measurement, various factor tests through blood collection, and X-ray. Establishing the standard functions for the primary healthcare institution can promote patient reliability on primary care, alleviate health demand congestion toward large-sized advanced healthcare institutions. Furthermore, it contributes to establishing and reinforcing other healthcare policies related to the healthcare reimbursement system and referral system, and fosters primary care physician education. Most importantly, it reduces the national health expenditures by realizing efficient and effective healthcare delivery.
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1차 의료 기관에서 발달성 고관절 이형성으로 의뢰된 예에 대한 분석
차수민(Soo-Min Cha),신현대(Hyun-Dae Shin),이승현(Seung-Hyun Lee),김보건(Bo-Kun Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.6
목적: 발달성 고관절 이형성증(developmental dysplasia of hip, DDH) 추정 진단으로 전원 의뢰된 환아들에 대해서 전향적으로 역학 조사를 시행하였다. 대상 및 방법: 2006년 l월부터 2007년 12월까지 1차 의료 기관에서 DDH 추정 진단으로 전원된 121예중, 2년의 추시가 가능했던 82예를 대상으로 하였다. 문진, 이학적 검사, 단순 방사선 촬영, 초음파 검사 등으로 확진하였고 의뢰된 총 82예와 확진된 예를 대상으로 역학 조사를 하였고 최소 2년의 추시를 시행하였다. 결과: 82예 중 56예(68.3%)에서 정상, 15예(18.29%)에서 DDH, 11예(13%)에서 기타 질환으로 진단되었다. 전체 82예에 비해 DDH로 진단된 예에서 여아의 비율, 가족력의 존재가 통계학적으로 많았으며, 둔위의 비율은 통계학적 차이가 없었다. 소아과 전문의로부터 61예, 정형외과 전문의로부터 21예가 의뢰되었고, 정형외과 전문의가 의뢰한 환아들에서 DDH 진단율이 통계학적으로 높게 나왔다(p<0.05). 결론: 1차 의료 기관에서 적용할 수 있는 이학적 검사나 방사선 소견에 대한 지침 설정 및 체계적 연수 교육 등을 통해 보다 DDH 추정 진단에 대한 확진율을 높일 수 있을 것으로 기대된다. Purpose: A prospective, epidemiological investigation was performed in the patients referred to our hospital with suspected developmental dysplasia of the hip (DDH). Materials and Methods: Of the 121 patients referred from the primary healthcare institutions, with suspected DDH from January 2006 to December 2007, 82 patients who were able to be followed up for at least 2 years were enrolled in this study. Confirmation of the diagnosis was determined by patient history, physical examination, simple radiographs, and ultrasonography. Epidemiological investigation was performed in the total 82 cases which were referred from the primary healthcare institution and were confirmed as having DDH, and at least a 2-year follow up was performed in all these cases. Results: Of the 82 cases, 56 cases (68.3%) were within normal limits (W.N.L), 15 cases (1829%) were confirmed as having DDH, and 11 cases (13%) were diagnosed with several different diseases other than DDH. Compared to the total 82 cases, the percentage of females, presence of family history was statistically higher in the cases confirmed as having DDH. However, the incidence of breech presentation was not statistically different between all cases. 61 cases were referred by pediatricians and 21 cases were referred by orthopedic surgeons to the primary healthcare institution, and the diagnostic rate of DDH was statistically higher in the cases referred by orthopedic surgeons (p>0.05). Conclusion: The rate of confirmation of the suspected diagnosis of DDH would hopefully increase through the establishment of physical examination protocols or radiologic study and systematic training programs that could be applied in the primary healthcare institution.
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