Factors Affecting the Preference for Hospitals Over Clinics in Primary Care in Korea

Background@#While the effect of gatekeeping was extensively studied, few efforts have been made to explain why the measures to strengthen gatekeeping do not work well in some countries. This study examined the patient factors related to the choice of level of health care facilities for outpatient care in Korea. @*Methods@#We examined a population-based sample representative of the population of Korea aged 15 and over in the healthcare experience survey of 2021. A logistic regression model examined the factors associated with choosing hospitals or clinics for outpatient care. @*Results@#Easy accessibility, kindness of medical staff, and recommendations from acquaintances were considered more important for those who chose clinics over hospitals.While those who chose clinics were more likely to feel that physicians and nurses more readily communicated with patients, those who chose hospitals were more likely to feel that the facility was comfortable. Whereas those who chose hospitals were more likely to trust the current health care system in Korea, those who chose clinics were more likely to think that the health care system needed to be reformed. The tendency was similar when analyzed only among those with good perceived health conditions and without chronic diseases. @*Conclusion@#This study demonstrates that the preference for hospitals over clinics is mainly based on desire rather than medical need and is not likely to be affected by measures intended to induce a voluntary change of behavior.

No Change in Complications Following Thyroidectomy Despite Increase in Thyroid Cancer Surgeries: A Meta-Regression Analysis

Purpose@#The increase in thyroid cancer incidence has inevitably led to an increase in thyroid cancer surgeries. This meta-regression analysis aimed to determine if the rate of post-thyroidectomy complications changes by year. @*Materials and Methods@#PubMed and Embase databases were used to perform a systematic literature search of studies published from January 1, 2005, using the keywords “thyroidectomy” and “complication.” A meta-regression was performed for post-thyroidectomy hypocalcemia and bleeding. @*Results@#This meta-analysis included 25 studies involving 927751 individuals. Through the years of publications in this study, there was no significant difference in the proportion of post-thyroidectomy hypocalcemia and bleeding (p=0.9978, 0.6393). @*Conclusion@#Although the number of thyroid surgeries has recently increased, the incidence of post-thyroidectomy hypocalcemia and bleeding did not significantly increase.

Effects of Femoral Head Anterior Glide Fixation during Active Straight Leg Raise on Hip Flexor Strength in Subjects with Femoral Anterior Glide Type

Purpose@#In this study, subjects with femoral anterior glide type were examined to investigate the effects of femoral head anterior glide fixation during active straight leg raise on the strength of the hip flexor in a supine position. @*Methods@#Fifteen subjects participated in this study. All subjects were classified through an evaluation form for femoral anterior glide type (FAGT). The strength of the hip flexor was measured during active straight leg raise test (ASLR test), and compared with and without femoral anterior glide fixation in a supine position. The fixation of the femoral head was achieved as per the therapist’s manual guidelines. Paired t-test was applied to compare changes in the strength of the hip flexor according to fixation conditions. The level of statistical significance was set at α= 0.05. @*Results@#The strength of the hip flexor was lesser during the ASLR test with fixation compared to without fixation (p= 0.007). @*Conclusion@#The strength of the hip flexor decreases with fixation. Results of this study revealed a difference between hip flexor strength, with and without femoral anterior glide fixation during ASLR, in subjects with femoral anterior glide type.

Combating Drug Resistance in Colorectal Cancer Using Herbal Medicines / 中国结合医学杂志

Colorectal cancer (CRC) is one of the most prevalent and lethal cancer types around the world. Most of the CRC patients are treated with chemotherapeutic drugs alone or combined. However, up to 90% of metastatic cancer patients experience the failure of treatment mostly because of the acquired drug resistance, which can be led to multidrug resistance (MDR). In this study, we reviewed the recent literature which studied potential CRC MDR reversal agents among herbal medicines (HMs). Among abundant HMs, 6 single herbs, Andrographis paniculata, Salvia miltiorrhiza, Hedyotis diffusa, Sophora flavescens, Curcuma longa, Bufo gargarizans, and 2 formulae, Pien Tze Huang and Zhi Zhen Fang, were found to overcome CRC MDR by two or more different mechanisms, which could be a promising candidate in the development of new drugs for adjuvant CRC chemotherapy.

The Changes in the Trend of Thyroid Cancer incidence for Korean Population: Consecutive 10 Years Analysis (2004-2013) / 대한두경부종양학회지

Background/Objectives@#To analyze changes in the incidence of thyroid cancer for Korean population using big data from the National Health Insurance Service.Materials & Methods: Sample cohort database between January 2004 and December 2013 with 1,000,000 cases for each year was enrolled in this study. Thyroid cancer incidence was analyzed by sex, age and by region. Public health insurance payment was used to reflect socioeconomic status. @*Results@#The incidence of thyroid cancer in Korea increased for 10 years annually. There are 3 times increasing in the incidence rate of thyroid cancer from 2004, 0.03% to 2013, 0.09%. The sex ratio in the incidence rate of thyroid cancer was male : female = 1:7.2 in 2004 and male : female = 1:3.6 in 2013 that suggest decreased gap between the sex ratio. Between 2004 and 2010, the incidence rates of those in their 40s were found to be the highest, whereas the incidence rates for those in their 50s were found to be highest from 2011 and thereafter. Every year the high socioeconomic status group showed a higher incidence of thyroid cancer than low socioeconomic status group. Some specific region showed continuous high incidence of thyroid cancer, not all city and state. @*Conclusion@#The incidence rate of thyroid cancer for 10 years had special feature by sex, age, socioeconomic status and especially by region. This results will be a barometer for further epidemiologic study about the incidence of thyroid cancer for Korean population

The Changes in the Trend of Thyroid Cancer incidence for Korean Population: Consecutive 10 Years Analysis (2004-2013) / 대한두경부종양학회지

Background/Objectives@#To analyze changes in the incidence of thyroid cancer for Korean population using big data from the National Health Insurance Service.Materials & Methods: Sample cohort database between January 2004 and December 2013 with 1,000,000 cases for each year was enrolled in this study. Thyroid cancer incidence was analyzed by sex, age and by region. Public health insurance payment was used to reflect socioeconomic status. @*Results@#The incidence of thyroid cancer in Korea increased for 10 years annually. There are 3 times increasing in the incidence rate of thyroid cancer from 2004, 0.03% to 2013, 0.09%. The sex ratio in the incidence rate of thyroid cancer was male : female = 1:7.2 in 2004 and male : female = 1:3.6 in 2013 that suggest decreased gap between the sex ratio. Between 2004 and 2010, the incidence rates of those in their 40s were found to be the highest, whereas the incidence rates for those in their 50s were found to be highest from 2011 and thereafter. Every year the high socioeconomic status group showed a higher incidence of thyroid cancer than low socioeconomic status group. Some specific region showed continuous high incidence of thyroid cancer, not all city and state. @*Conclusion@#The incidence rate of thyroid cancer for 10 years had special feature by sex, age, socioeconomic status and especially by region. This results will be a barometer for further epidemiologic study about the incidence of thyroid cancer for Korean population

Factors Associated With Subjective Life Expectancy: Comparison With Actuarial Life Expectancy / 예방의학회지

OBJECTIVES: Subjective life expectancy (SLE) has been found to show a significant association with mortality. In this study, we aimed to investigate the major factors affecting SLE. We also examined whether any differences existed between SLE and actuarial life expectancy (LE) in Korea. METHODS: A cross-sectional survey of 1000 individuals in Korea aged 20-59 was conducted. Participants were asked about SLE via a self-reported questionnaire. LE from the National Health Insurance database in Korea was used to evaluate differences between SLE and actuarial LE. Age-adjusted least-squares means, correlations, and regression analyses were used to test the relationship of SLE with four categories of predictors: demographic factors, socioeconomic factors, health behaviors, and psychosocial factors. RESULTS: Among the 1000 participants, women (mean SLE, 83.43 years; 95% confidence interval, 82.41 to 84.46 years; 48% of the total sample) had an expected LE 1.59 years longer than that of men. The socioeconomic factors of household income and housing arrangements were related to SLE. Among the health behaviors, smoking status, alcohol status, and physical activity were associated with SLE. Among the psychosocial factors, stress, self-rated health, and social connectedness were related to SLE. SLE had a positive correlation with actuarial estimates (r=0.61, p<0.001). Gender, household income, history of smoking, and distress were related to the presence of a gap between SLE and actuarial LE. CONCLUSIONS: Demographic factors, socioeconomic factors, health behaviors, and psychosocial factors showed significant associations with SLE, in the expected directions. Further studies are needed to determine the reasons for these results.

Accuracy of Heart Rate Measurement Using Smartphones During Treadmill Exercise in Male Patients With Ischemic Heart Disease

OBJECTIVE: To evaluate the accuracy of a smartphone application measuring heart rates (HRs), during an exercise and discussed clinical potential of the smartphone application for cardiac rehabilitation exercise programs. METHODS: Patients with heart disease (14 with myocardial infarction, 2 with angina pectoris) were recruited. Exercise protocol was comprised of a resting stage, Bruce stage II, Bruce stage III, and a recovery stage. To measure HR, subjects held smartphone in their hands and put the tip of their index finger on the built-in camera for 1 minute at each exercise stage such as resting stage, Bruce stage II, Bruce stage III, and recovery stage. The smartphones recorded photoplethysmography signal and HR was calculated every heart beat. HR data obtained from the smartphone during the exercise protocol was compared with the HR data obtained from a Holter electrocardiography monitor (control). RESULTS: In each exercise protocol stage (resting stage, Bruce stage II, Bruce stage III, and the recovery stage), the HR averages obtained from a Holter monitor were 76.40±12.73, 113.09±14.52, 115.64±15.15, and 81.53±13.08 bpm, respectively. The simultaneously measured HR averages obtained from a smartphone were 76.41±12.82, 112.38±15.06, 115.83±15.36, and 81.53±13 bpm, respectively. The intraclass correlation coefficient (95% confidence interval) was 1.00 (1.00–1.00), 0.99 (0.98–0.99), 0.94 (0.83–0.98), and 1.00 (0.99–1.00) in resting stage, Bruce stage II, Bruce stage III, and recovery stage, respectively. There was no statistically significant difference between the HRs measured by either device at each stage (p>0.05). CONCLUSION: The accuracy of measured HR from a smartphone was almost overlapped with the measurement from the Holter monitor in resting stage and recovery stage. However, we observed that the measurement error increased as the exercise intensity increased.

Preventable Trauma Death Rate in Daegu, South Korea

PURPOSE: This study was performed to investigate the preventable death rate (PDR) in Daegu, South Korea, and to assess both its affecting- and preventable-factors to improve the treatment of regional trauma patients. METHODS: All cases of traumatic death that occurred between January 2012 and December 2012 in five hospitals in Daegu were analyzed retrospectively by a panel review. Cases were classified into preventable (P) and non-preventable deaths (NP). We determined the affecting factors of trauma deaths and preventable factors during trauma care. RESULTS: The PDR was 25.2%. Significant differences by mode of arrival, day of injury, cause of death, and time of emergency department (ED) arrival were observed between P and NP groups. According to the logistic regression analysis, preventability was associated with patients transferred from other hospitals, ED arrival at night and dawn, and non-head injuries. A total of 145 preventable factors were discovered in 59 preventable trauma deaths. When we categorized by location, the ED was the most common, with 71 cases, followed by 57 prehospital preventable factors. When we classified the preventable factors by process, 76.8% were process-related and 23.4% were structure-related. CONCLUSION: Our study is valuable to build an adequate trauma system in Daegu as it provides the baseline quality control data. Efforts to mediate the preventable factors were revealed in this study, and continuous reviews to calculate and track the PDR are needed to evaluate the local trauma system and establish a system specific to Daegu.

Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries / 예방의학회지

OBJECTIVES: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. METHODS: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. RESULTS: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. CONCLUSIONS: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.

The direction of reform for health care delivery system

Rebuilding a health care delivery system is one of the most important tasks the Korean health system is facing. Health institutions need to each establish their own appropriate roles in rebuilding the system. Community clinics should act as institutions providing primary care services. Small/medium-sized hospitals should act as community general hospitals or shift their functions to specialized care hospitals. Large hospitals should treat inpatients with severe status and act as education and research institutions. Infrastructure reform is an essential component of rebuilding the system. Reimbursement for health institutions and copayment of patients should change from a cost-based system to a value-based system. It is also important to support the facilitation of cooperation between clinics and hospitals. The classical image of a health delivery system is that of a pyramid (vertical) structure. However, the WHO suggests that a health delivery system should be a network structure. Within this conceptual framework, a community clinic should act as a hub of coordination among health-related community resources. The balance between benefits and drawbacks is essential to adjust among conflicting interests while rebuilding the system.

Proposed Master Plan for Reform of the National Infectious Disease Prevention and Management System in Korea

A Middle East respiratory syndrome (MERS) - coronavirus (CoV) cluster that attacked Korea in May 2015 revealed several weaknesses in Korea's health care system in the face of the crisis of an emerging infectious disease and its public health implications. This experience has shown that is necessary to prepare comprehensive countermeasures through the cooperation of civil and public agencies to prevent a second or even third MERS outbreak and to control future crises of infectious disease and public health. The MERS Policy Committee of the Korean Medical Association has thus proposed a master plan for reform of the national infectious disease prevention and management system to prepare a new framework for national infectious disease prevention and control. The specific targets of the master plan are improvement of the system of usage of medical services and of the medical culture among national health insurance subscribers, improvement of the emergency room management system to prevent the spread of infectious disease, the establishment of a support system to promote effective voluntary infectious disease prevention activities among medical institutions, the building of a public health crisis communication system in collaboration with medical organizations, the establishment of an independent Ministry of Health and capacity building of the Korea Centers for Disease Control (KCDC), the securing of an advanced research and development system in the field of prevention and control of infectious disease, and the capacity building of professional epidemiologists and personnel needed to prevent and control infectious disease. The five core strategies of the master plan have been planned by medical experts in this order of priority: the reform of the healthcare delivery system, the independence of the Ministry of Health and capacity building of the KCDC, fundraising for a public infection management fund, enforcement of medical organization infection control, and improvement of the emergency room management system.

The Effect of Sleep Duration on the Risk of Unintentional Injury in Korean Adults / 예방의학회지

OBJECTIVES: The decrease or increase in sleep duration has recently been recognized as a risk factor for several diseases, including hypertension and obesity. Many studies have explored the relationship of decreased sleep durations and injuries, but few have examined the relationship between increased sleep duration and injury. The objective of this research is to identify the risk for injury associated with both decreased and increased sleep durations. METHODS: Data from the 2010 Community Health Survey were used in this study. We conducted logistic regression with average sleep duration as the independent variable, injury as a dependent variable, and controlling for age, sex, occupation, education, region (cities and provinces), smoking, alcohol use, body mass index, hypertension, diabetes, arthritis, and depression. Seven categories of sleep duration were established: or =10 hours. RESULTS: Using 7 hours of sleep as the reference, the adjusted injury risk (odds ratio) for those sleeping a total of or =10 hours. The difference in risk was statistically significant for each category except for the 8 and 9 hours. In this study, risk increased as the sleep duration decreased or increased, except for the 8 and 9 hours. CONCLUSIONS: This research found that either a decrease or increase in sleep duration was associated with an increased risk for injury. The concept of proper sleep duration can be evaluated by its associated injury risk.

Moving toward Universal Coverage of Health Insurance in Vietnam: Barriers, Facilitating Factors, and Lessons from Korea

Vietnam has pursued universal health insurance coverage for two decades but has yet to fully achieve this goal. This paper investigates the barriers to achieve universal coverage and examines the validity of facilitating factors to shorten the transitional period in Vietnam. A comparative study of facilitating factors toward universal coverage of Vietnam and Korea reveals significant internal forces for Vietnam to further develop the National Health Insurance Program. Korea in 1977 and Vietnam in 2009 have common characteristics to be favorable of achieving universal coverage with similarities of level of income, highly qualified administrative ability, tradition of solidarity, and strong political leadership although there are differences in distribution of population and structure of the economy. From a comparative perspective, Vietnam can consider the experience of Korea in implementing the mandatory enrollment approach, household unit of eligibility, design of contribution and benefit scheme, and resource allocation to health insurance for sustainable government subsidy to achieve and sustain the universal coverage of health insurance.

Treatment of Rheumatoid Arthritis Patients with Chronic Hepatitis B: Analysis of Korean National Health Insurance Claims Data

OBJECTIVE: There are currently limited treatment options for rheumatoid arthritis (RA) patients with chronic hepatitis B (CHB). In the process of pursuing further treatment strategies for this subgroup of patients, it is prudent to study what medications have been commonly prescribed, particularly for disease modifying anti-rheumatic agents (DMARDs) in Korea. METHODS: We analyzed the Korean National Health Insurance claims database (2007~2009) of RA patients through co-working with the Clinical Research Center for RA (CRCRA). Patients with CHB were defined by an algorithm including prescription information, blood tests, and the ICD-10 code. RESULTS: There were 8,677 CHB patients (3.8%) among 226,592 RA patients in the database. The age distribution or gender difference in CHB patients was comparable to the general RA population. Hydroxychloroquine was the most frequently (66.2%) prescribed DMARD. Thirty four percent of CHB patients had been prescribed with methotrexate (MTX) during the study period; most of them without concomitant anti-viral treatment. About 3% of RA patients with CHB were prescribed with TNF inhibitors. CONCLUSION: Apart from the published expert recommendations, MTX still seems to be one of the main DMARDs prescribed to Korean RA patients with CHB. This is most likely due to the lack of evidence-based, effective treatment strategies for this subgroup of patients.

Treatment of Rheumatoid Arthritis Patients with Chronic Hepatitis B: Analysis of Korean National Health Insurance Claims Data

OBJECTIVE: There are currently limited treatment options for rheumatoid arthritis (RA) patients with chronic hepatitis B (CHB). In the process of pursuing further treatment strategies for this subgroup of patients, it is prudent to study what medications have been commonly prescribed, particularly for disease modifying anti-rheumatic agents (DMARDs) in Korea. METHODS: We analyzed the Korean National Health Insurance claims database (2007~2009) of RA patients through co-working with the Clinical Research Center for RA (CRCRA). Patients with CHB were defined by an algorithm including prescription information, blood tests, and the ICD-10 code. RESULTS: There were 8,677 CHB patients (3.8%) among 226,592 RA patients in the database. The age distribution or gender difference in CHB patients was comparable to the general RA population. Hydroxychloroquine was the most frequently (66.2%) prescribed DMARD. Thirty four percent of CHB patients had been prescribed with methotrexate (MTX) during the study period; most of them without concomitant anti-viral treatment. About 3% of RA patients with CHB were prescribed with TNF inhibitors. CONCLUSION: Apart from the published expert recommendations, MTX still seems to be one of the main DMARDs prescribed to Korean RA patients with CHB. This is most likely due to the lack of evidence-based, effective treatment strategies for this subgroup of patients.

The Relationship Between the Social Network of Community-living Elders and Their Health-related Quality of Life in Korean Province / 예방의학회지

OBJECTIVES: This study aimed to collect information that will help enhance the social networks and improve the quality of life among elderly people by observing the relationship between their social network and health-related quality of life (HRQoL) and by analyzing social network factors affecting HRQoL. METHODS: This study was based on the 2008 Community Health Survey in Yeoncheon County. Three hundred elders were included in the study population. We compared the revised Lubben Social Network Scale (LSNS-R) score and Euro quality of life-5 dimensions health status index by demographic characteristics and chronic disease prevalence. We analyzed the data using multiple regression and tobit regression by setting the HRQoL as the dependent variable and social network and other characteristics as the independent variables. We analyzed social network factors by using factor analysis. RESULTS: The LSNS-R score differed significantly according to age and existence of a spouse. According to the results from the hierarchical multiple regression analysis, the LSNS-R explained 0.10 of the variance and LSNS-R friends factor explained 0.10 of the variance. The tobit regression indicated that the contribution of the LSNS-R family size factor to the regression coefficient of the independent variable that affected the HRQoL was BT=2.96, that of the LSNS-R family frequency factor was BT=3.60, and that of LSNS-R friends factor was BT=5.41. CONCLUSIONS: Social networks among elderly people had a significant effect on HRQoL and their networks of friends had a relatively higher effect than those of family members.

Erratum: Correction of Misspelling of Title and Author Affiliation

We found two errors, title and author affiliation in our published article.

Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.

Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea / 예방의학회지

OBJECTIVES: The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities. METHODS: Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis. RESULTS: People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities. CONCLUSIONS: These results show that people with physical disability have a higher vulnerability to obesity.