Yong-Jun Choi

Patient's assessment of primary care of medical institutions in South Korea by structural type

OBJECTIVE To compare patients assessment of primary care of medical institutions by structural type. DESIGN Cross-sectional study. SETTING Primary care clinics where family physicians work in South Korea (nine private clinics, three health cooperative clinics, three public health center clinics and five teaching hospital clinics). We collected data by questionnaire survey from April 2007 to June 2007. PARTICIPANTS Study subjects were patients who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. MAIN OUTCOME MEASURES Scores in each domain of primary care, evaluated by the Korean Primary Care Assessment Tool. RESULTS A total of 968 subjects were surveyed. The median of primary care average scores was the highest (78) in health cooperative clinics, the second in teaching hospitals clinics, the third in private clinics and the lowest (62) in public health center clinics. When compared with private clinics, the odds ratio for having a high primary care average score was 2.1 (95% confidence interval 1.3-3.3) for health cooperative clinics, and 0.55 (95% confidence interval 0.34-0.88) for public health center clinics. CONCLUSION Among medical institutions where family physicians work in South Korea, health cooperative clinics showed the highest primary care average score, and public health center clinics the lowest. To reinforce primary care in South Korea, where medical service delivery systems are only loosely established, health cooperative clinics could serve as an alternative.

Association of the Length of Doctor-Patient Relationship with Primary Care Quality in Seven Family Practices in Korea

Countries with historically unlimited patient choice of medical provider, such as Korea, have been promoting rational health care pathways. Factors related to the length of doctor-patient relationship (DPR) for enhancing primary care in those countries should be studied. Participants were patients who had visited their family practices on six or more occasions over a period of more than 6 months. Five domains (21 items) of the Korean Primary Care Assessment Tool (first contact, coordination function, comprehensiveness, family/community orientation, and personalized care) and general questions were administered in the waiting rooms. From seven practices, the response rate was 83.7% (495/591). The older the age, the lower the income, the shorter the duration of education, the more the number of diseases the patients had, and in provincial cities rather than in Seoul, the longer length of DPR ( ≥ 4 yr) was shown. The long-term DPR was associated with total primary care quality score (upper [ ≥ 71.4] vs lower [ < 71.4], OR, 1.74; 95% CI, 1.10-2.76), especially with coordination function (OR, 1.01; 95% CI, 1.00-1.02), being adjusted for confounding variables. Strengthening the coordination function may have to be the first consideration in primary care policy in countries like Korea.

Older Adults' Perception of Chronic Illness Management in South Korea

Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants’ compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

Primary Care Comprehensiveness Can Reduce Emergency Department Visits and Hospitalization in People with Hypertension in South Korea

Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i.e., primary care) physician as a USC with experience of emergency department (ED) visits and hospitalization within a year. After adjusting for cofounding variables including Charlson comorbidity index scores, those having a primary care physician as a USC remained associated with a decrease in an experience of ED visits (OR: 0.61, 95% CI: 0.40–0.93) and hospitalization (OR: 0.69, 95% CI: 0.49–0.96), compared to those not having a usual physician. Health policies that promote having a primary care physician as a USC could decrease unnecessary experience of ED visits and hospitalization by adults with hypertension. This can partly reduce ED overcrowding and avoidable hospitalization in Korea.

The Ecology of Medical Care in Korea

This study aimed to describe the ecology of medical care in Korea. Using the yearly data of 2012 derived from the Korea Health Panel, we estimated the numbers of people per 1,000 residents aged 18 and over who had any health problem and/or any medical care at a variety of care settings, such as clinics, hospitals, and tertiary hospitals, in an average month. There was a total of 11,518 persons in the study population. While the number of those who had any health problem in an average month was estimated to be 939 per 1,000 persons, the estimated numbers of ambulatory care users were 333 at clinics, 101 at hospital outpatient departments, 35 at tertiary hospital outpatient departments, and 38 for Korean Oriental medical providers. The number of people who used emergency care at least once was 7 per 1,000 persons in an average month. The numbers of people hospitalized in clinics and hospitals were 3 and 8, respectively, while 3 persons were admitted to tertiary hospitals. There was a gap between the number of people experiencing any health problem and that of those having any medical care, and primary care comprised a large share of people’s medical care experiences. It was noteworthy that more patients received ambulatory care at tertiary hospitals in Korea than in other countries. We hope that discussion about care delivery system reform and further studies will be encouraged.

How Much Do Older Adults Living Alone in Rural South Korea Know About Dementia

Objectives This study aimed to examine the level of dementia knowledge of older Korean adults living alone in rural areas and to identify related factors. Methods A cross-sectional descriptive design was applied. The participants were 231 older adults living alone who were recruited from 12 of the 13 primary health care posts in the rural area of Chuncheon. Participants’ level of dementia knowledge was assessed using the Dementia Knowledge Scale. Data were analyzed using descriptive statistics, and the t-test, analysis of variance, chi-square test, and Mann-Whitney test were applied. Results Participants’ mean age was 77.3±5.4 years, and women comprised 79.7% of the sample. Over half of the participants (61.9%) had no formal education, and all the participants were enrolled in Medical Aid. The participants’ average percentage of correct answers was 61.6%. The highest rate (94.4%) was for the item “Dementia can change one’s personal character.” The item with the lowest proportion of correct answers was “Dementia is not treatable” (23.4%). Dementia knowledge was significantly associated with age, education, health coverage, source of living expenses, and dementia risk. Conclusions Dementia knowledge among Korean rural older adults living alone was relatively low. Participants’ misconceptions about symptoms and treatment could hinder them from seeking early treatment. The results of this study suggest the need for active outreach and health care delivery for rural older adults living alone in South Korea.

A pilot study of team-based primary health care for people with disabilities in South Korea

ABSTRACT To assess the feasibility of a primary health care (PHC) project for people with disabilities (PwDs) in South Korea, participants’ experiences and perceptions were explored using the Analysis of Determinants of Policy Impact (ADEPT) model as a guide. Three focus group interviews and three one-on-one interviews were administered, and a directed content analysis was conducted based on four determinants from the ADEPT model. The findings showed that the project goal should be specified and reviewed periodically by participants. Although they were willing to devote themselves to the project, lack of a clear job description or mutual understanding often led to participants, especially health coordinators, feeling overwhelmed with their workload. Nevertheless, the project gave PwDs an opportunity to feel that they were being cared for by their care providers, while the participants as service providers had an opportunity to provide integrated care to their patients. For the successful settlement of team-based, person-centered PHC in South Korea, the formal PHC education should include an interprofessional team approach emphasizing communication skills among the health workforce. Opinions of PwDs and their family members also need to be reflected in the content of PHC.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term ‘social medicine’ is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of ‘preventive medicine’ course in medical colleges to ‘preventive and social medicine,’ as in many other countries, and to adjust the course contents accordingly.

Effects of an empowerment program for self-management among rural older adults with hypertension in South Korea

OBJECTIVE This study aimed to examine the effects of an empowerment program for hypertension self-management among rural older adults in South Korea. DESIGN A pretest-posttest controlled design for a 12-month hypertension self-management program with assessments at commencement, 6 months and 12 months. SETTING Two subsistence farming areas. PARTICIPANTS Subsistence farmers aged 65 and over: intervention group (n = 41) and control group (n = 36). INTERVENTION Twelve-month empowerment program for hypertension self-management. MAIN OUTCOME MEASURES Self-efficacy, social support, self-care behaviours, blood pressure control and renal function. RESULTS There were significant interactions of group by time for self-efficacy (P < 0.001) and self-care behaviour (P = 0.019). Blood pressure control at 12 months also showed a significant improvement in the empowered group compared with the control group (82.8% versus 56.8%, P < 0.014). Other clinical outcomes, including systolic blood pressure (P = 0.006) and renal function (P < 0.001), showed significant interactions of group by time. CONCLUSIONS The empowerment program was effective for rural older adults with hypertension in South Korea. Further investigation of the relationships among core components of empowerment would be beneficial.