환자의 치료 의사결정 참여와 건강수준

윤난희,Yoon, Nan-He 한국의료질향상학회 2018 한국의료질향상학회지 Vol.24 No.1

Purpose: This study aimed to identify the factors influencing on patients' participation in their treatment decision making, and influences of patients' experience on their health status. Methods: Data from the 2015 Korea National Health and Nutrition Examination Survey were used for the analysis. Multivariate logistic regression analysis was conducted to identify the factors influencing on patients' participation in their treatment decision making. The influences of patients' experience on their health status were analyzed using multiple linear regression analysis. Results: Of the 4,497 respondents, 3,698 (82.2%) respondents mostly participated in their treatment decision making. Those who experienced enough visit duration, physicians' explanation easy enough to understand, or more opportunities to ask were more likely to participate in their treatment decision making. After controlling for their sociodemographic factors and health status, those who had better experience during the outpatient visits were more likely to have better self-rated health or quality of life. Conclusion: To improve patients' health outcomes and satisfaction of health care uses, it is necessary to provide better experiences and expand the opportunities for participation in treatment decision making during their hospital visits.

비만이 의료이용과 의료비용에 미치는 영향

윤난희 ( Nan He Yoon ),권순만 ( Soon Man Kwon ) 한국보건경제정책학회(구 한국보건경제학회) 2013 보건경제와 정책연구 Vol.19 No.2

본 연구는 비만이 개인의 의료이용과 의료비 지출에 미치는 영향을 확인해 보고 비만으로 인해 개인에게 발생하는 추가 의료비 부담을 예측 해 보고자 하였다. 본 연구에서는 한국의료패널 2008-2010년 자료를 이용하여 2009년 한국의료패널 부가조사에 응답한 연구대상자 11,792명을 BMI 25 이상인 비만군과 BMI 25 미만인 정상군으로 구분하고 2009년과 2010년, 2년 간비만과 관련된 의료이용 및 의료비 지출의 현황을 비교하였다. 연구 결과, 개인의 인구사회학적 특성과 건강행태 실천 여부, 건강상태 등을 모두 통제한 후에도 BMI 25 이상인 비만군이 정상군에 비해 의료이용을 할 확률이 유의하게 높고, 의료비 지출도 유의하게 더 많이 하는 것으로 확인되었다. 의료이용을 유형에 따라 외래와 입원으로 분류하여 동일한 분석을 실시한 결과에 따르면, 외래 이용의 경우 개인의 인구사회학적 특성과 건강행태 실천 여부, 건강상태 등을 통제한 후에도 비만군이 정상군에 비해 외래 이용확률이 유의하게 높고 의료비 지출도 유의하게 더 많이 하는 것으로 나타났으나 입원 이용에는 비만이 통계적으로 유의한 영향을 미치지는 않았다. 전체 의료이용과 외래 의료이용에 대하여 Two-Part Model 분석 결과를 이용하여 비만군과 정상군의 의료이용 추정확률을 계산하고, 그를 적용한 1인 당 연 평균 추정 의료비 지출금액을 산출한 결과, 비만군의 비만 관련 의료이용 추정 확률은 약 38.23%로 정상군(32.48%)에 비해 유의하게 높았고, 비만 관련 연 평균 추정 의료비는 약 92,099원으로 정상군(약 83,378원)에 비해 유의하게 많았으며( p<.0001), 이는 외래이용에 대해서도 동일한 결과를 보였다. 이에 따라 비만인 경우 비만으로 인해 추가로 부담하는 관련 의료비가 약 9.5-11.9%를 차지하고 있는 것으로 나타났다. Obesity has been a worldwide health concern because it is associated with substantially increased morbidity and mortality from chronic diseases and leads to higher socioeconomic costs. This study investigated the impact of obesity on health care expenditure in Korean adults, using a nationally representative sample of Korean adults. We conducted a Two-Part Model analysis of 11,792 adults from the 2008-2010 Korea Health Panel Survey. Comparing with the normal-weight adults (BMI<25), obese adults (BMI≥25) are more likely to use health care services(OR=2.266; [95% CI=2.011-2.553]) resulting in greater health care expenditure(b=0.214; SE=0.047), after controlling for the socio-demographic factors, health behaviors, and health status. It is consistent with the result from the analysis of outpatient use, but the impact of obesity on inpatient use was not significant. Predicted probability of health care utilization among the obese adults was 38.23% which was significantly higher than that of the normal-weight adults(32.48%), and predicted per capita health care expenditures among the obese adults was about 83 US dollars, significantly greater than that of the normal-weight adults(75 US dollars). Therefore, the additional health care expenditure of the obese adults was about 9.47%.

아동의 비만과 부모의 영향요인

윤난희 ( Nan-he Yoon ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적: 본 연구는 아동의 비만과 그에 영향을 미치는 부모의 요인을 확인하고, 부모의 비만 여부에 따른 아동의 비만 발생 추정 확률을 비교하고자 수행되었다. 연구방법: 본 연구는 제6기(2013-2015년) 국민건강영양조사 자료를 활용하였으며, 조사 응답 가구 중 부모 모두의 정보가 수집된 만 3세 이상 13세 미만 아동 1,064명을 대상으로 분석을 실시하였다. 아동의 성별과 연령, 거주지역, 가구소득, 부모의 교육수준 등의 일반적 특성과 부모의 식생활 및 신체활동 실천 요인들에 따른 비만율의 분포를 확인하고 카이제곱 검정을 통해 비교하였다. 그리고 로지스틱회귀분석을 활용하여 이러한 잠재적 영향요인들을 통제한 후 부모의 비만이 아동의 비만에 미치는 영향을 확인하였으며, 학령기와 학령전기 아동을 구분하여 층화분석을 실시하였다. 로지스틱회귀분석 결과를 통해 아동의 비만 발생 추정 확률을 산출하였고, 부모의 비만 여부에 따른 차이를 일원배치분산분석을 통해 확인하고 Tukey 사후검정 방법을 적용하여 비교하였다. 연구결과: 전체 연구대상자 1,064명 중 64명의 아동(6.0%)이 비만이었다. 이들의 인구사회학적 특성과 부모의 건강행태 요인 등을 통제한 로지스틱회귀분석 결과, 부모가 비만인 아동에게서 비만이 유의하게 많은 것으로 확인되었으며, 층화분석 결과에 따르면 특히 학령전기 아동에게서 이러한 경향이 더 강하게 나타났다. 한편 아동과 부모의 잠재적 영향요인들을 보정하여 산출한 아동의 비만 발생 추정 확률을 살펴보면, 부모가 모두 비만인 경우에 아동이 비만일 확률이 가장 높았다. 이러한 경향은 학령기와 학령전기를 구분해도 동일하게 나타났으나 어머니가 비만인 학령기 아동의 비만 발생 추정 확률은 아버지가 비만인 경우에 비해 유의하게 높은 것으로 확인되었다. 결론: 전 세계적으로 급증하는 아동 비만을 효과적으로 예방하고 관리하기 위하여 부모의 비만 여부에 따라 아동 비만 관리의 고위험군 대상 집단을 선정하고 부모와 가족들이 함께 참여하는 전략의 마련이 필요하다. Objective: This study aimed to identify the influences of parental factors on childhood obesity in Korea. Methods: Data from 2013-2015 Korea National Health and Nutrition Examination Survey were used for the analysis. Multivariate logistic regression analysis was conducted to analyze effects of the parental factors on childhood obesity. Stratified analysis was also conducted to compare the effects between preschool-aged and school-aged children. Predicted probabilities of childhood obesity were calculated after adjusting for covariates including sociodemographic characteristics, parents’ dietary behaviors, and physical activity. The probabilities were compared according to the obesity of parents using one-way ANOVA and Tukey's honestly significant difference (HSD) post-hoc test. Results: Of the 1,064 respondents, 64 (6.0%) were obese. After controlling for their sociodemographic factors and parents’ health behaviors, the children with obese parents were more likely to be obese than their counterparts. According to the stratified analysis, the effects of parental factors on childhood obesity were more significant among preschool-aged children. The predicted probability of obesity was highest among children whose both parents were obese, and the predicted probability among school-aged children whose mothers were obese were higher than those whose fathers were obese. Conclusion: To prevent and manage childhood obesity effectively, it is necessary to involve their parents and family targeting high risk group from those whose both parents’ are obese.

생애말기 노인의 장기요양서비스 이용 특성과 영향요인

윤난희 ( Nan-he Yoon ),김홍수 ( Hongsoo Kim ),권순만 ( Soonman Kwon ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.4

Background: The purpose of this study is to examine the characteristics of and factors associated with long-term care (LTC) utilization under public long-term care insurance (LTCI) among end-of-life older adults in Korea. Methods: Using a 5% sample of older people aged 65 or older and their health and LTC insurance data, two-part model analyses were conducted. We compared LTC uses and their determinants during the last year of life among decedents in the year 2010 with those of survivors. We also compared the medical uses of the same sample with their LTC uses. Results: The end-of-life elderly were more likely to use LTC, and their expenditure on LTC was higher than their counterparts. Whether or not older people used LTC during their last year of life was significantly affected by age, sex, health insurance, household income, and living alone; however, LTC costs of the decedents were only affected by functional status, which may have been due to the reimbursement scheme of the current LTCI, which is mainly based on functional dependency level. For the survivors, having chronic diseases significantly increased the likelihood of LTC use, which was not the case for the decedents. End-of-life elderly with relatively low social economic status were more likely to use the LTC other than medical services, while the health conditions affected their medical uses most significantly. Conclusion: The study findings provide key information for predicting demand related to the increasing LTC needs of Korean older people at the end of life.

국가암조기검진 수검자 만족도에 영향을 미치는 요인

윤난희 ( Nan He Yoon ),권순만 ( Soon Man Kwon ),이후연 ( Hoo Yeon Lee ),박은철 ( Eun Cheol Park ),최귀선 ( Kui Son Choi ),곽민선 ( Min Son Kwak ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.1

The objectives of this study were to evaluate the satisfaction of participants in the National Cancer Screening Program(NCSP) and to identify factors affecting the satisfaction. The telephone survey was conducted in July 2007 for the participants who were screened by the NCSP from January through May 2007. Student`s t-tests and analysis of variance were performed first to determine if the mean satisfaction score differed by the characteristics of study objects, followed by multiple linear regression analyses to examine the factors affecting satisfaction. Dependent variable was general satisfaction for the screening service, and three dimensions of independent variables - ``sociodemographic characteristics``, ``screening characteristics``, and ``perceived service quality`` - were used for the empirical analyses. Female, old-aged, less educated, Medicaid recipients, rural residents and the participants with normal results were more likely to be satisfied with the NCSP. The results of multiple regression analyses show that gender, age, location of residence, type of screening units, and perceived quality of screening services were significantly related to satisfaction. This study is meaningful as the first attempt to measure participant satisfaction with the NCSP, and to identify factors affecting the satisfaction. Among the identified factors, the NCSP needs to pay attention to perceived quality of service, in particular, to improve the satisfaction. This study is expected to contribute to raising the compliance rate and to improve the quality of the NCSP.

건강보험 급여 한약제제와 양방 처방의약품의 병용투여 현황

이혜재,윤난희,박소현,신승원,박민정,Lee, Hye-Jae,Yoon, Nan-He,Park, So Hyun,Shin, Seungwon,Park, Minjung 대한예방한의학회 2021 대한예방한의학회지 Vol.25 No.2

Objective : The purpose of this study is to analyze Korean patients' characteristics, who were concurrently treated with both Korean herbal medicines and Western chemical medicines using nation-wide database. Method : Using the patients sample data (HIRA-NPS 2018) provided by Health Insurance Review and Assessment Service, a group of patients who co-administered Korean herbal and Western medicines was selected, and their basic characteristics, diagnosis, and prescribed chemical medicines were analyzed. Results : Out of the 1,481,921 sample population, 17,629 patients (1.2%) were selected as a concurrent medication group. Compared to the whole sample, the concurrent medication group was composed of more women (65.8% vs. 51.1%), the more elderly people (65 or older years old) (44.5% vs. 14.6%), and the higher prevalence of chronic diseases (49.1% vs. 22.2%). The most frequent diagnosis treated with Western medicines was mental and behavioral disorders, musculoskeletal and circulatory disorders. Frequently used drugs among concurrent medication group were anti-anxiety drugs, gastric ulcer treatment drugs, and senile diseases treatment drugs. Conclusion : The evidence reported in this study is expected to provide herb-drug interaction researchers with important reference to set the priorities of research topics in the future.

한국과 일본 장기요양시설 공급과 이용의 지역 간 변이

김홍수 ( Hongsoo Kim ),윤난희 ( Nan-he Yoon ),이세윤 ( Seyune Lee ),( Hideki Hashimoto ) 한국보건행정학회 2020 보건행정학회지 Vol.30 No.1

Background: Few studies have examined the performance of the public long-term care insurance (LTCI) from the perspective of geographic equity. This study investigated regional variations and associated factors in the supply and utilization of nursing home care within and also between Japan and Korea. Methods: A comparative dataset was developed by extracting data from 2013-2015 LTCI statistics yearbooks and Organization for Economic Cooperation and Development regional statistics, as well as other comparable data in Japan and Korea. The unit of analysis was the prefecture in Japan and the province in Korea. We computed variation indices and conducted regression analyses for regional variations within each country and decomposition analyses to examine the variations between the countries. Results: The overall regional supply and use of nursing home care were higher in Japan, but the regional variations in Korea were larger than in Japan. In both countries, the nursing home supply was negatively associated with the proportion of older people with independent living. Nursing home use was also negatively associated with the supply of hospital beds and home care agencies in Korea; the relationship was the opposite in Japan, however. The country-based differences were more likely to be explained by differences in the distributions of the variables included in the analytical model than country-specific characteristics. Conclusion: Regional-level nursing home supply and use were unequal in both countries, and the contributing factors were not the same. Policy efforts are needed to advance regional equality in long-term care (LTC) and collaboration between health and LTC institutions for frail older people, especially in Korea.

정신건강복지법 개정에 따른 입원적합성심사와 관련된 이해관계자의 경험

신소연 ( Shin Soyoun ),조윤민 ( Cho Yoon-min ),윤난희 ( Yoon Nan-he ),황서은 ( Hwang Seo Eun ),황종남 ( Hwang Jongnam ),최정원 ( Choi Jung Won ),김잔디 ( Kim Jandi ),허종호 ( Heo Jongho ),이선구 ( Lee Sun Goo ) 한국보건사회연구원 2021 保健社會硏究 Vol.41 No.2

2016년, 구 정신보건법이 「정신건강증진 및 정신질환자 복지서비스 지원에 관한 법률」로 개정되면서, 입원적합성심사위원회(이하 입적심) 제도가 신설되고 비자의입원 절차가 강화되었다. 본 연구는 입적심의 목표인 정신질환자의 인권증진 여부를 평가하기 위해 이해관계자들의 참여경험을 질적으로 분석하고, 향후 나아갈 방안을 모색하였다. 이에 전국 5개 국립정신병원에서 입적심과 관련된 총 27명의 전문의, 법조인, 정신건강전문요원, 가족, 당사자, 조사원, 정신질환자를 심층 면담하였다. 주제분석 결과, 4개의 주제와 16개의 하위주제가 도출되었다. 입적심 제도는 부당한 비자의입원 및 강압 이송행위에 대한 안전장치를 마련하여 인권을 향상시켰지만, 대면조사보다 서류심사가 주를 이루고 의사결정지원이 미흡하여 자기결정권이 제한된다는 한계를 드러냈다. 추후 자기결정권을 보장하기 위한 대면조사와 절차보조사업을 확충하고, 의료기관과 지역사회서비스를 연결하는 협력시스템이 구축되어야 한다. The revision of the “Mental Health Act” into the “Act on the Improvement of Mental Health and the Support for Welfare Services for Mental Patients” in 2016 led to the tightening of procedures for involuntary hospitalization through the implementation of the “Committee for Review as to Legitimacy of Admission” (hereinafter “Admission Review Committee”). This study evaluated whether the Admission Review Committee has achieved its goal to promote the human rights of people with a mental illness through qualitative analysis of stakeholder experiences. The evaluation is based on interviews with a total of 27 subcommittee members from all the five national psychiatric hospitals which have an Admission Review Committee in place. Those interviewed were psychiatrists, lawyers, mental health professionals, patients and their families, and investigators. As a result, a total of four categories and 16 themes emerged from the thematic analysis. Our study shows that the Admission Review Committee has promoted human rights by functioning as a minimum safeguard to prevent unjust involuntary hospitalization and forced transfer to psychiatric hospitals. However, insufficient procedural assistance has limited the right to self-determination, and the committee heavily relied on paper review rather than the face-to-face investigation with people with a mental illness. For a better supportive committee for the human rights of people with a mental illness, we suggest that the committee adopt the face-to-face review process, procedural assistance services, and a governance system closely connecting medical facilities with local communities.

우리나라 일차의료 만성질환 관리 이용자의 경험 분석: 포커스 그룹 인터뷰에 기초하여

황정해(Jeong Hae Hwang),최윤경(Yun-Kyoung Choi),이연경(Yeon Kyung Lee),윤난희(Nan-He Yoon) 한국보건교육건강증진학회 2020 보건교육건강증진학회지 Vol.37 No.5