| Home Visits in an Office Practice in Seoul. |
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Kyoung Ae Kong, In Mee Baik, You Ji Chung, Sang Hwa Lee, Hong Soo Lee |
1Department of Family Medicine, Ewha Womans University College of Medicine, Korea.
2Dr. Baik's Family Clinic, Korea. |
| 서울의 한 의원에서 시행한 방문 진료 |
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공경애,백인미,정유지,이상화,이홍수 |
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| Abstract |
Background
: As the population with chronic degenerative disease or functional impairment has increased in terms of the advanced aging society, the inevitability of home health services for the homebound have been augmented as a token of the trend toward the nuclear family along with the family capacity of care declined. For the past several years, home nursing service facilities have been enlarged and partially have been fulfilling these requirements. However, there are a great number of demands for home health service by physicians. Thereupon, we designed the following study to observe the cases of home visits by a medical office practice and to provide some information about the need of the home visit and its clinical features.
Methods : The study was conducted reviewing currently remained 84 data of home visit records at a home-visit- specialized medical office practice for 10 months in 1999. Its information collected was as below: patient's sex, age, frequency and duration of visit, distance to visit location, reason being homebound, and reason for visit.
Results : Of the reviewed records of 84 patients, comprised of 356 home visits, the median age of the patients was 67.5 years. They were visited 2 times as a median and with a median duration of 4 days. Physician drove a median distance of 6.1km one-way. Most common diagnoses were cancer and cerebrovascular diseases, equally with 10.8%. Reasons for being homebound were neurologic problem (28.6%), frail elderly (21.4%), terminal illness (20.2%) in order. Sixty two patients (73.8%) were permanently homebound and 12 patients (14.3%) were not. Reasons for visits were routine follow-up (42.1%) and evaluation of a new problem (19.9%) in the chronic homebound and terminal illness care (17.1%). While 102 visits (28.6%) should have begun by doctor-based visit, 233 visits (65.4%) including routine follow-up could be considered to be replaced for home nursing services. Even out of 233 visits, not all could be replaced and some should remain as physician's regular follow-up.
Conclusion : There were needs of home visit in both permanent and transient homebound patients, in cases of exacerbation, new problem and routine follow-up of chronic homebound patients, and also in acute illness of previously healthy persons. To meet the needs of homebound patients in seeing the physician, and to offer adequate health services, the physician's role should be acknowledged in home nursing service, and home visit by physician should be institutionalized and carried into effect. |
| Key Words:
home visits, house calls, home health services, homebound patient |
| 초록 |
연구배경 : 노령화사회의 진전으로 만성퇴행성질환과 거동불편인구는 증가하고 있으나 핵가족화로 가족의 간병능력은 감소하면서 재가환자에 대한 가정의료의 요구가 커지고 있다. 최근 가정간호사업이 확대되어 이러한 요구의 많은 부분을 담당하고 있으나 이와는 별개로 의사의 진료에 대한 요구가 있을 것으로 생각된다. 이 연구에서는 한 의원에서 시행되었던 방문진료들의 사례들을 검토하여 방문진료에 대한 요구와 특성을 기술하고자 한다.
방법 : 1999년 10개월간 방문진료를 전문으로 하였던 한 의원의 자료 중 현재 남아있는 84권의 진료기록부를 검토하여 환자의 성별, 연령, 방문횟수와 기간, 방문거리, 진단명, 재가환자가 된 이유와 방문진료를 요청한 이유를 평가하였다.
결과 : 84명의 환자 356건의 방문진료에서 환자의 연령 중위수는 67.5세, 남자 39.3%, 여자 60.7%였으며 환자당 방문횟수 2회, 기간 4일, 직선 방문거리는 6.1km였다. 암과 뇌혈관질환이 각각 17건(10.8%)으로 가장 많았으며 재가상태가 된 이유는 신경과적 문제(28.6%), 노환(21.4%), 말기질환(20.2%) 순이었고 12명(14.3%)은 비영구적, 62명(73.8%)은 영구적인 재가환자였다. 방문진료를 요청한 이유는 만성재가환자의 추적관찰(42.1%)과 새로운 문제발생(19.9%), 말기환자진료(17.1%)의 순이었으며 일단 의사의 진찰이 필요했다고 생각되는 경우가 102건(28.6%)이었고 재가환자의 추적관찰 등 233건(65.4%)은 가정간호사의 방문으로 대치하더라도 그중 일부는 의사의 정기적인 진찰이 필요한 경우였다.
결론 : 가정에서의 의료서비스는 영구적 또는 일시적인 재가환자에서, 만성질환의 악화나 새로운 문제의 발생뿐 아니라 급성질환과 만성재가상태의 정기적 관리에서 모두 요구되었다. 재가환자들의 진료 요구를 충족시키고 적절한 의료서비스를 제공하기 위해 현재 시행되고 있는 가정간호에서 의사의 역할을 실제적으로 인정하고 방문진료를 제도화, 현실화해야 할 것이다. |
| 중심 단어:
방문진료, 가정의료, 재가환자 |
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