Background : This study aims to find the direction of health care and health insurance system reform to strengthen primary care in Korea.
Methods : A comparative analysis was performed on health care system and health insurance system between Korea, Japan, and Taiwan.
Results : (1) Functional differentiation between the hospital and the clinic is unclear and many clinics run beds for in-patient care. However, Japan and Taiwan have clear rule on the function of the hospital and the clinic, and only temporary observation beds are allowed for the clinic. (2) Health service delivery system is not defined in the Korean Health care Act. However, Japan and Taiwan have rules on health service delivery system in their health care act. (3) The system of co-payment ceiling is operated in Japan and Taiwan, but not in Korea. And Taiwan has various co-payment system including exemption of co-payment to fulfill the mission of health security. (4) Japan and Taiwan have many fee schedules for enforcing primary care, while Korea has little.
Conclusion : Health care and health insurance system should be reformed in order to strengthen primary care. Most of all, the role of the hospital and the clinic should be classified. Fee schedule for primary care should be changed to encourage coordinated management of chronic diseases. Reform of co-payment system is also required.
Background : Recently, physicians have been challenged to see more patients per office session while maintaining patient satisfaction. We examined the variables related to patient satisfaction with the time spent with physician during office visit.
Methods : In the department of family medicine of an university hospital, a trained researcher observed patient visits by VTR and collected additional data using medical record reviews and patient exit questionnaires from July 1 to July 31, 2002 The data was analyzed statistically by SPSS ver11.0/PC+.
Results : Visits by 103 patients were observed in this study. Age, functional health status, time of Dr.'s talking to patients and the ratio of Dr.'s talking time to visit length were significantly associated with patient satisfaction (P＜0.05). Sex, marital status, education level, new vs. established patient, reason for visit, visit length, number of problems, number of medications, body mass index, and satisfaction for time spent were not significantly associated with patient satisfaction. According to logistic regression analysis, greater patient satisfaction were associated with better perceived health status, with more ratio of Dr.'s talking time to visit length and with age younger than 40 years.
Conclusion : Physician can enhance patient satisfaction during an office visit by spending sufficient time to talk with patients during each visit and should take an interest in elderly patients and patients with multiple problems.
Background : Hormone replacement therapy (HRT) is the most effective treatment for climacteric symptoms. It also has definitive role in reducing or preventing the risk of osteoporosis. However, compliance with HRT is very poor. This study was conducted to know the compliance of hormone replacement therapy and investigate the determining factors for compliance.
Methods : Review of charts and telephone questionnaires were completed among 107 women who had received HRT in a family medicine clinic at a university hospital. Compliance was determined by the medication availability ratio (MAR): (HRT treated days)/(total number of observed days). An individual with MAR less than 0.75 was considered as partial compliance, and more than 0.75 was considered as complete compliance group.
Results : The average age of 107 subjects was 57.4 years. Among the 107 study subjects, 59 persons (55.1%) were compliant with HRT. Mean observation period was 17.6 months. The compliance with HRT was 60.9%, 55.1%, 49.6% at 12, 24, 36 months, respectively. The compliance was higher in high-perception group compared to low- perception group (P=0.01). Education level, presence of osteoporosis, hysterectomised state, difference in doctor and past fracture history were not associated with compliance. The reasons for starting HRT were physician's recommendation, osteoporosis prevention, treatment of menopausal symptoms, and influence of mass media, in descending order.
Conclusion : The compliance with HRT was 61% at one- year treatment and 50% at three-year teatment period. Positive attitude for HRT was related to higher compliance with HRT. Patient education on HRT is essential for successful compliance of HRT.
Background : Obesity can be considered as hyperaccumulation of body fat. Therefore, the aim to treat obesity is to decrease body fat. Abdominal total fat calculated in computed tomography is thought to be the most accurate index measuring body fat. The body mass index (BMI) and body fat mass are the representative indices also. Leptin is a protein hormone expressed by obesity gene in adipose tissue. It inhibits food intake and increases energy consumption, thereby controls obesity. With a study of relationship between plasma leptin level and body mass index and abdominal total fat area, we tried to find the usefulness of leptin as an index of adiposity.
Methods : The adiposity level was approximated by BMI, computed tomography and bioelectical impedence. To further explore the relationship with body composition, body fat distribution was determined by computed tomograph. To quantify the relationship between serum leptin level and adiposity, correlation analyses have been conducted.
Results : The subjects were 32 females with a BMI of over 25 kg/m2. The mean plasma leptin level was 14.2±5.9 ug/L. We investigated the correlation of plasma leptin level with subcutaneous and visceral fat. The plasma leptin level showed a significant correlation with BMI and body fat mass, and was significantly correlated with subctaneous fat (P＜0.01), but not with abdominal visceral fat.
Conclusion : A significant correlation between plasma leptin level and body fat mass was observed. The distribution of subcutaneous fat showed differences in plasma leptin level. Therefore, the plasma leptin level may be used as an index of change of body fat mass, especially subcutaneous fat.
Background : With the population aging, osteoporosis is becoming a major health issue. Although not as common as women, osteoporosis and its clinical end point of fracture are significant health care concern in men. Despite the considerable public health burden, our understanding of their pathogenesis is incomplete, and several factors known to affect bone metabolism in men are still controversial. So this study was made to investigate relationship between testosterone and bone mineral density in men.
Methods : This was a cross-sectional study of 432 men undertaken health screening program in Pundang CHA General Hospital from January 2000 to December 2000. We surveyed information concerning exercise and consumption of alcohol and smoking by means of self questionnaire records. Serum total testosterone, SHBG, and osteocalcin were measured at a fasting state. Second morning urine was tested for deoxypyridinoline. BMD was assessed using pQCT.
Results : FTI (free testosterone index) was positively correlated with BMD (r=0.265, P＜0.01). Age, osteocalcin, SHBG, and urine deoxypridinoline were negatively correlated with BMD (r=-0.397, P＜0.01, r=-0.121, P＜0.05, r=-0.214, P＜0.01, and r=-0.126, P＜0.01). BMI and total testosterone had no significant correlation with BMD, and there were no apparent association among the level of alcohol and tobacco use, regular exercise and BMD. FTI was not independently correlated with BMD after age, BMI and urine deoxypyridinoline were adjusted, but showed a trend to significantly predict BMD (β=0.10, P=0.052).
Conclusion : These data suggest that FTI may play a role in determination of BMD in men, allowing the potential for clinical intervention. But further investigation of the role of testosterone in bone metabolism in men is necessary.
Background : In comparison to the decreasing smoking rate of adults, the smoking rate in adolescents and women is still increasing worldwide including Korea. Previous studies on the smoking rate of adolescents were done by questionnaires allowing bias in their response because of smoking ban among adolescents in Korea. In order to know the actual smoking rate of Korean adolescents, we performed an objective study using urine nicotine detection.
Methods : From April to July 2002, 306 boy's high school students and 325 girl's high school students in Seoul were included for this study. We obtained self-reported questionnaire from them and assessed urine nicotine level by NicCheck I Test Strip to check their actual smoking status.
Results : The current smoking rate of male students by self-reported questionnaire was 14.9%, 20.4%, 22.5%, respectively and that by detection of urine nicotine was 26.6%, 38.0%, 29.6%, respectively, in the 1st, 2nd and 3rd grade. The current smoking rate of female students by self-reported questionnaire was 22.6%, 23.9%, respectively and that by detection of urine nicotine was 46.6%, 35.4%, respectively in the 2nd and 3rd grade. The Kappa index of the questionnaire results was 0.27, 0.46, 0.75, respectively in the 1st, 2nd and 3rd grade male students and 0.33, 0.44, respectively in the 2nd and 3rd grade female students respectively.
Conclusion : The smoking rate of students by detection of urine nicotine was higher than that of the self-reported questionnaire results. The validity of the questionnaire results was more accurate in males than females, and higher grade than lower grade. The self-reported questionnaire was an insufficient tool for evaluation of adolescents' smoking status, especially in female students and lower grade students.
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