일개 종합병원의 처방전달시스템 도입전후 직원의 직무스트레스 변화

감신,박기수,김성아,김정미,이채용,정상재,정재진,Kam, Sin,Park, Ki Soo,Kim, Seong Ah,Kim, Jung Mi,Lee, Chae Yong,Jung, Sang Jae,Jung, Jae Jin 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.1

Background : This study was carried out to examine the changes of job stress after adoption of order communication system(OCS) and its related factors. Methods : Two hundreds and twenty one employees in a university hospital were surveyed 4 months before and 1 year after the OCS had been adopted. Author used Korean version of Karasek's job content questionnaire(K-JCQ) to evaluate job stress. The questionnaire developed by Doll's was used to assess the satisfaction for the OCS. Result : With the adoption of OCS, the scores of skill discretion increased significantly from 29.9 to 30.8 that meant job stress was decreased. In use of OCS, direct user group showed significant increase of skill discretion, whereas the indirect user group showed significant increase in psychological job demand, and it was statistically significant when compared to direct user group(p<0.05). Among the changes in job stress, skill discretion score change was significantly different by age(p<0.05). This study revealed that there was statistically significant relationship between the change of skill discretion score and time computer use, level of satisfaction for content of provided information(p<0.05). And psychological job demand score change was significantly different by time of computer use(p<0.05). Conclusion : Adoption of OCS into hospital may increase job stress, but when it is adopted wisely and appropriately, it may enhance skill discretion of each individual, and decision authority while reducing psychological job demand.

폐암환자의 치료순응도와 관련요인

감신,박재용,채상철,배문섭,신무철,예민해,남시현,Kam, Sin,Park, Jae-Yong,Chae, Sang-Chul,Bae, Moon-Seob,Shin, Moo-Chul,Yeh, Min-Hae,Nam, Si-Hyun 대한예방의학회 2002 예방의학회지 Vol.35 No.1

Objectives : To investigate the therapeutic compliance and its related factors in lung cancer patients. Methods : The subjects of this study comprised 277 patients first diagnosed with lung cancer at Kyungpook National University Hospital between Jan 1999 and Sept 1999. Of these, 141(50.9%) participated in the study by properly replying to structured questionnaires. The data was analyzed using a simplified Health Decision Model. This model includes categories of variables covering therapeutic compliance, health beliefs, patient preferences, knowledge and experience, social interaction, sociodemographic and clinical characteristics. Results : The therapeutic compliance rate of the 141 study subjects was 78.0%. An analysis of health beliefs and patient preferences revealed health concern (p<0.05), dependency on medicine (p<0.05), perceived susceptibility and severity (p<0.05) as well as preferred treatment (p<0.01) as factors related to therapeutic compliance. Factors from the sociodemographic characteristics and clinical factors that were related to therapeutic compliance were age (p<0.01), monthly income (p<0.05), histological type (p<0.05) and clinical stage (p<0.05) of cancer. Conclusions : In order to improve therapeutic compliance in lung cancer patients it is necessary to educate the aged, low-income patients, or patients who have small cell lung cancer or lune cancer of an advanced stage for which surgery is not indicated. Additionally, it is essential for medical personnel to have a deep concern about patients who have poor lifestyles, a low dependency on medicine, or a high perceived susceptibility and severity. Practically, early diagnosis of lung cancer and thoughtful considerations of low-income patients are important. By means of population-based education in a community, we may promote attention to health and enhance the early diagnosis of lung cancer.

성인코호트에서 고혈압 발생률

감신,오희숙,이상원,우극현,안문영,천병렬,Kam, Sin,Oh, Hee-Sook,Lee, Sang-Won,Woo, Kook-Hyeun,Ahn, Moon-Young,Chun, Byung-Yeol 대한예방의학회 2002 예방의학회지 Vol.35 No.2

Objectives : This study was peformed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. Methods : The study cohen comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmMg,2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. Results : The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. Conclusions : The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea. 고혈압 발생률을 조사하기 위하여 1996년 경상북도 청송군의 20세 이상의 지역주민 중 정상 혈압자 2,580명(남자 1,107명, 여자 1,473명)을 연구대상자로 선정하였다. 매년 혈압을 측정하였으며 2년간 추적하였다. 2년 동안 중도탈락률은 남자가 24.7% 여자가 19.6%이었다. 이 연구에서 사용한 고혈압의 정의는 수축기혈압이 140-159 mmHg 이거나, 이완기혈압이 90-99 mmHg 이상이면 경증 이상(above mild) 고혈압, 수축기혈압이 160 mmHg 이상이거나 이완기혈압이 100 mmHg 이상이 면 중등도 이상(above moderate) 고혈압으로 하였으며, 항고혈압 약물치료를 받고 있는 경우 측정 혈압 치에 관계없이 모두 중등도 이상 고혈압으로 하였다. 남자에서 경증 이상 고혈압과 중증 이상 고혈압의 연령표준화 발생률(rate)은 각 각 100인년 당 6.0과 1.2였다. 여자는 각 각 5.7과 1.5였다. 그런데 이를 연간발생률(risk)로 환산하면 남자가 4.8%와 1.0%, 여자가 4.6%와 1.2%이었다. 남녀 모두 연령은 고혈압 발생률과 유의한 관련성이 있었다. 즉, 남자에서 중증 이상 고혈압 발생률은 20-39세가 100인년 당 0.5, 40-49세 0.7, 50-59세 1.7, 60-69세 3.6, 70세 이상 5.8로 연령이 증가할수록 유의하게 증가하였다. 여자에서도 중증 이상 고혈압 발생률은 20-39세가 100인년 당 0.6, 40-49세 1.8, 50-59세 1.3, 60-69세 3.3, 70세 이상 5.6으로 연령이 증가할수록 유의하게 증가하였다. 그리고 연령별 고혈압 발생률은 남녀 모두에서 60세 이후가 되면 급격하게 증가하였다. 이 연구결과 얻어진 고혈압 발생률은 지역사회의 고혈압 일차예방을 위한 보건사업의 영향을 평가하는 기초자료가 될 것이다.코발트에서 거의 비슷한 부화특성을 보이나, 크롬에서는 남해지역보다 화개지역에서 보다 큰 부화특성을 보인다. 납은 연구지역 모두에서 상당히 부화되어 있었지만, 토양 및 퇴적물의 환경오염 허용 한계치(tolerable level)을 이용하여 살펴본 결과에서는 환경유해원소의 오염에 특별히 노출되지 않는 것으로 판단된다. 이루었고 그가 남긴 시대정신의 이념과 가치를 Miesianism이라고 부른다. 실용성과 도덕성을 근본으로 하는 Miesianism은 대중에 호소하는 미적 표현주의를 부정하고 지역정서를 중시하는 문맥적 접근방식을 경시함으로써 보편화라는 현상을 불러일으킨 국제주의 양식의 한 부류로 비판을 받아왔다. 즉, Miesianism의 단순하고 강렬한 외형적 요소는 그것이 내포하는 기술적 합리성이나 공간적 완결성을 무시한 채 전 세계에 영향을 미쳤고 동시에 지역적 저항을 받게 되었다. 시카고 및 전 세계의 Miesian들, 즉 Mies van der Rohe의 제자들이나 그로부터 영향을 받은 수많은 건축가들은 이러한 저항과 비판에 직면하게 되며 새로운 사고의 시대적 요구 앞에 고뇌하게 된다. 한국에서는 1978년 Mies van der Rohe의 제자인 김종성이 미국에서 서울로 돌아와 '서울건축컨설탄트'를 설립하며 본격적으로 Miesianism의 규범적 건축론을 설파하기 시작하였다. 이른바 시카고 국제주의학파의 건축전수라고 할 수 있는데 '서울건축컨설탄트'를 통하여 배출된 김종성의 제자들은 명쾌하고도 간결한 건축해법의 경험을 토대름대로의 정체성을 갖고자 노력하였으나 결국 다원적 가치를 요구하는 시대적 흐름 속에 혼란을 겪고 있는 것 또한 사실이다. 본 연구는 Miesianism의 기원을 밝히고 그것의 실수와 오류를 밝힘과 동시에 현대의 여러 가지 건축유형들과 비교하여 봄으로써 Post-Miesianism의 실체와 그

지역의료보험(地域醫療保險) 재정지출(財政支出)의 결정요인(決定要因)

감신,박재용,예민해,Kam, Sin,Park, Jae-Yong,Yeh, Min-Hae 대한예방의학회 1995 Journal of Preventive Medicine and Public Health Vol.28 No.1

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

영리법인 의료기관 설립 허용의 문제점

감신,Kam, Sin 대한예방의학회 2004 예방의학회지 Vol.37 No.2

일부 의사들의 직무스트레스와 관련 요인

감신,이상원,천병렬,예민해,강윤식,Kam, Sin,Lee, Sang-Won,Chun, Byung-Yeol,Yeh, Min-Hae,Kang, Yune-Sik 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.2

Objective : To investigate the sources, extent and related factors in South Korean doctors. Methods : The study subjects were 934 doctors in Taegu, Kyungpook Province, Korea(540 independent practitioners, 105 employed at hospitals and 289 residents in training). Information concerning job stress was obtained using a 9-item questionnaire. Information regarding related factors such as demographic characteristics(age, sex, marital status), perceptions on the socioeconomic status of doctors and working conditions(work time, on-call days per week) was also obtained by self-administered questionnaire during April and May, 2000. Results : Major sources of job stress included clnical responsibility/judgement factor, patient factor and work loading factor. The job stress score of residents was the highest among three groups. The score was lower in older doctors. The score was low among those who thought doctors' socioeconomic status was not good. The longer the work time, the higher the job stress score was. Multiple regression analysis was conducted to control for the mutual influence of independent variables. In regression analysis, the score of residents was higher than practitioners. Work time and socioeconomic status perception had negative effects on job stress score. Conclusion : The average job stress score of the doctors was high. Age, work type, working conditions and perceptions of socioeconomic status were found to besignificantly related to job stress score. Although the job stress of doctors is somewhat inevitable due to the nature of the doctor's job, control of work time, development of coping tools and other intervention methods are needed to reduce job stress of doctors. Further studies are required to understand the characteristics of iob stress and reduce the job stress of doctors.

고혈압의 위험요인에 대한 환자-대조군 연구

감신,예민해,이성국,천병렬,Kam, Sin,Yeh, Min-Hae,Lee, Sung-Kook,Chun, Byung-Yeol 대한예방의학회 1991 예방의학회지 Vol.24 No.2

고혈압과 관련된 위험요인을 조사하기 위하여 1908년 5월 1일부터 11월 30일까지 대추시내 일반근로자들 가운데 고혈압환자 330명(남자 247명, 여자 83명)과 정상인 1,336명(남자 887명, 여자 449명)을 대상으로 환자-대조군 연구를 실시하였다 성, 연령을 제한요인으로 하여 조사한 위험요인들은 근무부서, 비만도, 음주력, 흡연력, 우유섭취빈도, 식염섭취정도, 고혈압가족력이었다. 다변량분석기법가운데 지수형회귀분석 (logistic regression analysis)에 의해 분석한 결과 남자에서는 음주(odds ratio=3.23), 비만도(odds ratio=2.31), 그리고 식염(odds ratio=1.75)이 고혈압의 위험을 증가시키는데 비해 여자에서는 음주(odds ratio=16.49), 고혈압가족력 (odds ratio=3.70). 비만도(odds ratio=1.74), 그리고 식염(odds ratio=1.73)이 고혈압의 위험을 증가시켰다(p<0.05). 그리고 남녀 모두에서 우유가 고혈압의 위험을 감소시키는 유의한 변수이며(남자 odds ratio=0.69, 여자 odds ratio=0.65) 용량-반응 관계가 있음으로 보아 (p<0.05) 고혈압의 예방요인으로 생각된다. 남녀 모두에서 흡연은 고혈압과 관련이 없었다. 그런데 단순분석결과 여자에서 근무부서가 고협압과 유의한 관련이 있었는데 다변량분석에서는 유의한 관련성이 없었다. A case-control study was conducted to investigate the risk factors (Part of job, Obesity, Alcohol, Smoking, Milk, Salt. and Family history) for hypertension. We selected 330 hypertension cases (male;247, female;83) and 1,336 controls (male;887, female;449) from employees in Taegu city from 1 May to 30 November, 1908. Data was analysed using a logistic regression model. Statistically significant elevated odds ratio were noted for alcohol (odds ratio=3.23), obesity (odds ratio=2.31), salt(odds ratio=1.75) in male (p<0.05) and those in female were noted for alcohol (odds ratio=16.49), family history(odds ratio=3.70), obesity (odds ratio=1.74) and salt (odds ratio=1.73) (p<0.05). Statistically significant reduced odds ratio was noted for milk in both sexes (odds ratio=0.69 for male and 0.65 for female)(p<0.05) and the dose-response relationship between milk intake and hypertension was confirmed (p<0.05). Therefore, milk seems to be preventive factor for hypertension. Smoking was not significantly associated with hypertension in both sexes. The part of job was significantly associated with hypertension in female by simple analysis (P<0.05) but the relationship was disappeared when multivariate analysis (logistic regression analysis) was done.

지역사회 보건사업에서 발견된 고혈압환자의 치료실태와 관련요인

감신(Sin Kam),김인기(In-Ki Kim),천병렬(Byung-Yeol Chun),이상원(Sang-Won Lee),이경은(Kyung-Eun Lee),안순기(Soon-Ki Ahn),진대구(Dae-Gu Jin),이경수(Kyeong-Soo Lee) 한국농촌의학 지역보건학회 2001 농촌의학·지역보건 Vol.26 No.2

일개 시지역 저소득 골관절염 환자의 보완대체요법 이용실태 및 비용

감신(Sin Kam),박기수(Ki-Soo Park) 한국농촌의학 지역보건학회 2008 농촌의학·지역보건 Vol.33 No.2

이 연구는 일개시지역의 건강보험하위 20%에 해당하는 자들의 골관절염으로 인한 보완대체요법 이용실태를 조사한 것이다. 최근 6개월 동안 이용한 보완대체요법은 91.6%가 1개 이상 보완대체요법을 이용하고 있었으며, 평균 2.5개의 보완대체요법을 이용하고 있었다. 성별로는 여자가 92.3%, 2.7개로 유의하게 많이 이용하고 있었으며, 연령대별로는 6,70대가 유의하게 많이 이용하고 있었으며, 의료보장 유형별로는 건강보험대상자가 3.2개로 많이 이용하고 있었으며, 교육수준에서는 초등학교이하 졸업자가 이용여부와 이용 갯수 모두에서 유의하게 많았다. 항목별로는 한증탕, 사우나, 핫팩, 찜질 등 이용이 34.7%로 가장 많았다. 보완대체요법 이용으로 인한 비용은 6개월 동안 1인당 12만원이 지출되었으며, 인구사회학적 변수에 따른 유의한 차이점은 없었다. 항목별로는 한증탕, 자석 옥 매트 등에서 일인당 지출비용이 많았다. 또한 성별에 따른 항목별 비용은 침이용에 대한 비용이 여성에게서 유의하게 많았다. 골관절염으로 보완대체요법을 이용한 사람들의 만족점수는 100점 만점으로 환산하였을 경우 대부분 60-70점 사이에 분포하여 만족도가 보통수준으로 높지 않았다. 만족도 점수가 통계적으로 유의하게 의미가 있는 것은 성별 간에는 여성에게서 침이용에서 남자에 비하여 높게 응답하였으며, 의료보장유형에서는 사골, 우족 등 이용이 급여 1종에서 유의하게 높게 응답하였다. 외국의 연구결과와 우리나라의 기존의 연구결과들을 종합하여 볼 때 관절염에 대한 보완대체요법의 이용에 대한 과학적 근거 평가와 함께 이용에 대한 보건교육 등이 필요할 것이다. Objective: The use of complementary and alternative medicine (CAM) is common especially among patients with osteoarthritis The aim of this study was to investigate the utilization rate and expenditures of patients who use CAM. Method: Two hundred seventy four patients with osteoarthritis were interviewed by a telephone survey. A structured questionnaire about sociodemographic features and type, cost, satisfaction and reason of CAM utilization was used Results: Among 274 patients with osteoarthritis, 251 patients(91.6%) had used at least one type of CAM during six months. There was a significant difference in sex (female), age (70 years), medical security (insurance), educational level between the user and non-user of CAM. Hyperthermia was the most use. The average cost for CAM utilization was 120 thousands won/person during six months and there was no difference in sociodemographic features among the out-of-pocket cost of users. The scores of satisfaction for CAM use were ranged between 60-70. Conclusions: CAM became a popular source of health care because of elderly and lay referral system. And Korean spent a substantial amount of out-of-pocket money on CAM without benefit. Health care system and professionals should pay more attention to CAM, make a evidence for CAM.

상병 · 수술별 진료비 정보공개에 대한 의료소비자와 공급자의 견해

감신(Kam, Sin),홍남수(Hong, Nam-Soo),이경수(Lee, Kyeong-Soo),이중정(Lee, Jung-Jeong),황태윤(Hwang, Tae-Yoon),김건엽(Kim, Keon-Yeop),류동희(Ryu, Dong-Hee),이선화(Lee, Seon-Hwa),두영택(Doo, Young-Taek),서강석(Seo, Kang-Suk) 비판과 대안을 위한 사회복지학회 2016 비판사회정책 Vol.- No.51

이 연구는 소비자에게 실질적인 도움을 줄 수 있는 상병 · 수술별 비급여를 포함한 진료비 정보공개체계 구축의 필요성이 제기되고 있는 상황에서 진료비 정보공개에 대한 의료소비자와 공급자의 견해를 파악하여 공개의 필요성과 방법, 항목 등 구체적인 정보공개 관리체계 개발을 위한 자료로 활용하는 것을 목적으로 수행되었다. 의료소비자의 인식과 견해를 확인하기 위하여 전국의 일반시민 500명을 대상으로 전화설문조사를 시행하였고, 대구시의 3개 시민단체 활동가를 대상으로 인터뷰와 서면조사를 진행하였다. 의료공급자의 의견은 병의원경영 관련자(의사) 인터뷰를 통해서 확인하였다. 일반인을 대상으로 한 전화설문조사 결과 응답자의 85.1%가 비급여를 포함한 진료비 정보제공에 대해서 필요하다고 응답하였으며, 공개해야 할 우선순위 질환은 암, 치과질환, 뇌혈관질환 순이었다. 시민단체 활동가들은 의료기관별 진료비 공개를 제도화해야 하고, 진료비 공개는 궁극적으로 의료기관 경영의 투명성과 합리성을 제고하고 의료서비스 질을 개선하는 계기로 작용할 것이라고 하였다. 반면에 의료공급자는 의료소비자가 진료비를 제대로 이해하기 어려운 상황에서 진료비 공개는 의료소비자의 공급자에 대한 불신을 키우는 결과를 초래할 것이며, 의료서비스의 하향평준화, 특정병원 환자쏠림 등 부정적인 영향이 클 것이라고 생각하였다. 의료소비자의 알권리를 충족시키고 의료기관 선택에 도움이 되며, 병원 이용 전에 진료비를 예측 가능하게 하고 이용 후에 진료비 내역의 적정성에 대한 올바른 판단을 위해서는 비급여를 포함한 진료비를 공개하는 것이 바람직하겠지만 진료비 공개제도에 따른 파급효과, 부작용에 대한 충분한 논의와 검토를 거친 후에 진료비 정보공개의 구체적인 방안을 마련해야 할 것이다. Objective: The purpose of this study was to investigate opinions of consumers and providers on an establishment of a public access system to medical costs including payment for uncovered services which would help consumers make wiser decisions on medical service utilization. The study results are expected to be used as fundamental data for specifying contents and determining means to go on public regarding the system. Method: A total of 500 general population underwent telephone interviews. Document investigations as well as in-person interviews were conducted for three activists from civil organizations. The opinions of physicians on an establishment of a public access system to medical cost were also examined. Results: The telephone survey results revealed 85.1% of respondents agreed on the necessity of the information access system. Cancers, odontopathies, and cerebrovascular diseases were selected as ones whose total medical costs should be revealed with priority. The civil organization activists addressed that an establishment of a legal policy enforcing each medical facility to reveal their total medical costs is required, and it would, therefore, be an opportunity to examine transparency and rationality of hospital managements and to improve service quality. The medical service providers, on the other hands, worried that the information access system would deteriorate the relationship in between consumers and physicians since medical consumers are not capable of fully understanding provided information regarding medical costs due to difficult medical terms and lack of related knowledge. Moreover, they also mentioned that the system would have negative influences on the market by causing problems such as downward equalization of medical services and patient- flock to certain hospitals. Conclusion: It is required to reveal information regarding total medical costs including out-of-pocket expenses since it would satisfy consumers" right to know and help them to make right decisions when choosing hospitals and to predict medical costs in advance. They could also make appropriate judgements about medical costs afterwards. However, as pointed out by the physicians, there could be unexpected negative effects regarding the system. Therefore, relevant investigations and sufficient discussions with involved must precede the system establishment.