Background : Due to the limited medical resources, effectiveness, efficiency, and equity has become the main issue of health care system reform in the developed countries, which has lead to the focusing on strengthening of primary care. The study was performed to assess the primary care level and health indicators in Korea utilizing objective criteria used in other developed countries, so as to evaluate its current status compared to the developed countries.
Methods : Starfield's primary care scoring criteria of the system and practice characteristics was used to evaluate the primary care level in Korea and 13 members of the OECD countries. According to the primary care score, the countries were grouped into 3 groups (highest, middle, lowest) and were compared the health indicators, health care expenditure, and satisfaction with health care system.
Results : Korea ranked the lowest in both primary care level and health indicators. The amount of health care expenditure and satisfaction with health care system were also low. Health indicators were worst in the lowest primary score gorup. But unexpectedly, middle group had better health indicators than highest group in most items.
Conclusion : Primary care level in Korea is very low compared to the developed countries. Middle primary care level countries having better health indicators may be due to the overemphasis of efficiency and equal distribution in highest level countries leading to low quality service. Korea should consider modelling the middle group countries in the course of establishing primary care system with equal balancing in quantity and quality.
BACKGROUND Importance of the participation of clinical practitioners in the development of guideline is increasingly emphasized. We studied the attitude of family physicians to the guideline for hypertension management and compared it with their reported practice patterns. METHODS We developed a guideline for hypertension management with reference to other guidelines previously published and used by WHO and health organizations in many countries. A questionnaires asking attitude to the contents of the guideline and real practice pattern was sent to 200 Korean family physicians. Response rate to the questionnaire was 27.5%. RESULTS The agreement rate to annual blood screening in persons aged 15 and older was 87%, while the reported practice rate in most of patients was only 42%. The agreement rates to medical history taking in hypertensives were high in all items, but reported practice rate was very low. The agreement rates to physical examination in hypertensives were relatively high in all items, while reported practice rate was high only in lung and heart examination. The reported practice rate of laboratory tests were less than 60% and that of electrolyte check was only 22%. Most of the study subjects agreed with all behavior modification methods. Although 80% of the subjects agreed that diuretics or beta blocker should be used as an initial regimen, the reported practice rate was only 36 %. CONCLUSION There observed a big difference between attitude to the guideline and reported practice pattern in this study. It showed the need to narrow the gap between them.
Background : Pharmacists could dispense medicines without doctors’ prescription in Korea before July 2000. The aim of this study was to compare the prescription behaviors of practicing doctors and pharmacists to arthritis by the simulated patients. We selected the arthritis as a subject of simulation because the arthritis was one of the major health problems and the abuse of corticosteroids might be prevalent in management of arthritis patients.
Methods : Seventy five private clinics and drug stores were selected in Seoul, Korea. The simulated patients were selected and trained standardized symptoms of arthritis. The simulated patients recorded the prescription behaviors of doctors and pharmacists.
Results : Mean number of prescribed medicines were 3.6 and 4.4 in clinic and drug store, respectively. 16.2% of the clinics and 25.3% of the drug stores prescribed corticosteroid respectively with no significant difference. 45.3% of the pharmacists prescribed more than two kinds of antiinflammatory or analgesics and it was significantly higher than those of doctors. 65.3% of doctors intended to prescribe parenteral injection and 40% of the pharmacists performed some kinds of physical examination to the simulated patients. Both doctors and pharmacist gave little information or advice on use of medicines, possible side effects and past side effects of medicines.
Conclusion : There were frequent abuse of corticosteroids and analgesics in private clinics and drug stores. Both doctors and pharmacists did not give enough information on use of medicines to the simulated patients.
BACKGROUND The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more. METHODS 247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program. RESULTS As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%). CONCLUSION The perception of family medicine are still scanty compared to the old studies.
Background : Stomach cancer is the most common cancer in Korea. Stomach cancer has been the focus of screening for early detection. Few data are available regarding factors associated with participation in cancer screening examinations in general population. This study investigated associations of age, sex, residence, economic state, occupation, education years, marital status, health state, faith for stomach cancer screening with participation in screening tests for stomach cancer.
Methods : To identify the factors associated with participation in the stomach cancer screening examinations, 2133 persons above 40 years old were surveyed in 1998.
Results : Statistically significant (P<0.05) strong predictors of regular stomach cancer screening were as follows: (1) unban residence, (2) high economic state, (3) possession on faith for regular screening of stomach cancer.
Conclusion : Especially, rural residents should be educated about importance of stomach cancer screening.
Background : For gastric cancer, primary prevention by risk factor modification might have some important roles. However, previous studies having investigated the factors associated with stomach cancer reported various results. In addition, there were only a few studies based on Korean population.
Methods : A case-control study was carried out on 106 cases matched for age and sex with 106 controls in a tertiary care hospital. In patients who were aged 75 years or less and had been newly diagnosed as adenocarcinoma of stomach between July 1996 and January 1997 were included into the case group. Information on baseline characteristics, health habits, dietary habits of study subjects was obtained through an interview using structured questionnaire. Conditional logistic regression analysis was used to evaluate the factors associated with stomach caner.
Results : Salt preference was associated with significantly increased risk of stomach cancer(odds ratio[OR]=9.81, 95% confidence interval[CI]=2.28-42.2). Eating broiled food more than three times a week significantly increased the risk of stomach cancer (OR=3.33, 95% CI=1.16-9.55) compared to eating it less than once a week. Blood type, family history of stomach cancer, smoking, and alcohol consumption were not associated with stomach cancer.
Conclusion : Salt preference and frequent eating of broiled food are the risk factors significantly associated with stomach cancer in this study subjects.
Background : Waist circumferences are widely used to diagnosis and assessment of obesity but various standards of the measuring waist circumference originate the confusion on diagnosis and assessment of obesity. According to this, this study is willing to light up standards of measuring waist circumference what is intimate with body mass index(BMI) and have a precision of intra-observer and inter-observers in repeated measurements of the waist.
Methods : Measuring of waist circumference by the 4 different standards(anterior superior iliac crest(ASIC), umbilicus, above 3 cm to ASIC, the thinnest area in the waist by the range of seeing) were preformed on 102 people visiting Health Promotion Center of one medical college hospital by two observers in each 2 times, total 16 times. Each data were analyzed by the relativity between the BMI and the each means measuring waist circumference and by ANOVA test , intra-observer and inter-observer bias.
Results : The relation between BMI and data in measuring standard of ASIC of the waist circumference is the highest(r=0.900) and the following umbilicus(r=0.896), above 3 cm to the anterior superior iliac crest(r=0.888), the thinnest area in the waist by the range of seeing(r=0.877). It is the lowest in intra-observer bias that the thinnest area in the waist by the range of seeing, and ASIC in inter-observer.
Conclusion : It is desirable that ASIC is the standard of measuring waist circumference in the diagnosis of obesity and measuring that by different two persons, because of the highest relativity in BMI and the lowest inter-observers bias. But the thinnest area in the waist by the rage of seeing is desirable in measuring by same person because of intra-observer bias.
Background : Weight loss in obese patients has been shown to decrease plasma lipid level and high blood pressure, to improve glycemic control in diabetic patients and to decrease cardiovascular risk in obese patients. But, study for association of weight loss and Health-related Quality of Life is not well known yet worldwide. This study was to determine whether weight loss would associate with improvements on Health-Related Quality of Life.
Methods : Participants was recruited in 48 obese patient visiting obesity clinic of Family Medicine of Sungkyunkwan University Hospital. 27 patients who answered mailed questionnaire was analyzed. Health-Related quality of life was measured by Catholic Medical Center Health Survey(CMCHS) V 1.0. Questionnaire included not only Health Related Quality of Life but also alcohol habit, exercise, smoking, marital status, economic status, education.
Results : In multiple regression analysis, weight loss is statistically significant differences on satisfaction, vitality, physical function, social function, role limitation, general health dimensions of CMCHS.
Conclusion : The results of this study demonstrate that weight loss on obese patients may be associated with an improvement in Health-Related Quality of Life.
Background : Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not.
Methods : The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung-Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well-controlled group(SBP<140mmHg and DBP<90 mmHg) and the uncontrolled group(SBP≥140mmHg or DBP ≥ 90mmHg) and compared the quality of life and lifestyle.
Results : The total number of subjects was 119, that of well-controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1±7.5mmHg and 85.3±5.2 mmHg in the well-controlled group, 159.2±7.4 mmHg and 100.2±5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda-7 questionnaire showed no difference, too. As for the comparison of quality of life between two groups, the well-controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparison of quality of life between two groups showed similar results.
Conclusion : We confirmed that the well-controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.
Background : Brief intervention with problem drinkers have been shown to be effective, but physicians often do not ask about alcohol use because of time constraints and lack of knowledge. If a single question can be used to screening for problem drinker effectively, primary care physicians could detect problem drinker earlier and reduce future complication and morbidity. The purpose of this study was to evaluate the usefulness of single-question.
Methods : One family medicine’s resident interviewed 163 patients who visited Dongdaemun Hospital’s Health care management center of Ewha Woman’s university from January 27th 1999 to February 26th 1999, and the patients answered the written forms of questionnaires. This written forms contained the followings: (1) age, sex, education, income level, occupation, smoking, drunken driving, (2) “On any single occasion during the past 3 months have you had more than a bottle of Soju or three bottles of beer or five glasses of whisky?” (3) CAGE, NAST test, Quantity of alcohol was determined by the calendar-based review in the past 4 weeks. At-risk drinker defined as drinking more than 56g on one occasion, or more than 196g of pure alcohol during a week for men; more than 42g on one occasion, or more than 96g of pure alcohol during a week for women. Also alcohol use disorder was defined by the DSM-IV criteria and problem drinker was defined as either at-risk drinker or a alcohol use disorder.
Results : The single question had a positive predictive value of 82.2%, and negative predictive value of 95.5% with a sensitivity of 93.8% and a specificity of 86.9% for problem drinkers.
Conclusion : A single question about alcohol-use would be a effective tool for detecting problem drinker.
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