서울시 장애인의 치과의료서비스이용에 관한 연구

장수현 ( Suhyun Jang ),권혜영 ( Hye Young Kwon ),이호용 ( Ho Yong Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2016 보건경제와 정책연구 Vol.22 No.4

본 연구는 서울시에 거주하는 장애인들의 치과의료서비스 이용 현황을 파악하고 거주지역을 벗어난 관외의료이용을 하는 요인들을 로지스틱 회귀분석을 통해 고찰하였다. 이를 위해 서울시에 등록된 장애인의 치과서비스 이용내역을 2014년 건강보험 청구자료에서 추출하였다. 분석결과 서울시 등록 장애인 중 치과의료이용이 있었던 환자는 169,114명(42.4%)으로 1인당 평균 입내원일수 1.8일, 연간 1인당 진료비는 179,671원으로 확인되었다. 전체 의료이용건 중 거주지역 외 의료기관을 이용한 경우는 29.2%로 나타났다. 남성일 때, 고소득층에서, 건강보험이용자일 때 관외의료이용 확률이 높은 것은 것으로 나타났다. 특히 상급의료기관을 이용하기 위한 관외의료이용이 주요 요인으로 의원 대비 종합병원(OR=4.6)이나 병원(OR=4.3)을 이용하기 위해 관외의료이용을 하는 것으로 보인다. 이를 다시 병원급 이상 의료이용과 의원급 의료이용으로 구분하여 분석한 결과 서남권의 경우 전반적으로 장애인 치과서비스가 부족한 것으로 확인되었으며 동북2권역은 병원급 의료기관이, 동남1권역에서는 의원급 의료기관에 대한 관외이용이 많은 것으로 나타났다. 본 연구는 서울시 장애인의 치과 의료이용 현황과 관외의료이용의 영향요인을 살펴본 첫 번째 연구라는 의미를 가지며 특히 장애인 치과 관외의료이용에서 서울 내 지역격차를 확인할 수 있었다는 점에서 의미가 있다. 무엇보다 의료기관 종별에 따라 생활권별로 관외의료이용 양상의 차이를 확인하여 서울시 내에서도 생활권역에 따라 치과 의료서비스가 다르다는 점을 확인하였다. 이러한 결과를 바탕으로 지역사회 내에서 장애인의 미충족 치과 의료서비스를 충족시킬 수 있는 양질의 서비스를 제공할 수 있는 정책이 요구되며 특히 접근성을 향상시킬 수 있는 장기적인 정책이 뒷받침되어야 할 것이다. 향후 장애인의 치과 서비스이용에 대한 보다 체계적인 전국단위의 연구와 함께 서비스의 질, 생활권역별 특성 등 관외의료이용을 유발하는 추가적인 요인에 대한 후속 연구들이 활발히 이루어질 필요가 있으며, 서울시 거주 장애인의 치과의료 접근성을 강화할 수 있는 정책적 보완책 마련이 요구된다. This study was to investigate dental service utilizations and determinants of external service use among disabled patients living in Seoul. Data were extracted from 2014 National Health Insurance Claims Data, provided by the NHIS(National Health Insurance Service). Among the disabled living in Seoul, 42.4% of them used dental services in 2014. The average length of stay per patient was 1.8 days, Annual medical costs incurred per patient was KRW 179,671. A binary logistic regression model was used to identify determinant factors of external dental service uses. Independent variables including age, sex, income level, severity of disability, type of disability, type of hospitals and residential districts were considered. Male, younger disabled and physical disabled were more likely to seek dental services in other districts. Specifically, those who were affluent were much more likely to use external dental services since economic barriers were lessened compared to the poor. Compared to those living in South-East 2 area, the disabled living in Central and South-East 1 area was more likely to use external dental services (OR=1.54[1.49:1.58] and OR=1.69[1.64:1.73], respectively). In the subgroup analysis by segmenting hospitals and clinics settings, South-West area had a poor distribution of dental care resources for the disabled, followed by Central and North-West districts. North-East 2 district was to be lack of hospital-level dental services whereas South-East 1 district was to be lack of dental clinics for the disabled. In conclusion, this study is meaningful to investigate dental service uses among the disabled living in Seoul. Policy that enhancing access to dental services for the disabled should be developed and implemented.

국가건강보장체계에서 의약품 시장 구조와 제네릭 사용추세 분석(2007-2017)

장수현(Suhyun Jang),장선미(Sunmee Jang) 대한약학회 2023 약학회지 Vol.67 No.3

We aimed to analyze the market structure and changes in the market share of new drugs, original drugs, and generic drugs in the pharmaceutical market over the past ten years. We utilized national health insurance claims data, including both national health insurance and medical aid, from 2007 to 2017 to establish pharmaceutical expenditure and usage data. The drugs are categorized into new drugs, original drugs (expired patents), and generic drugs. Furthermore, we classified the original drugs as single-source and multi-source original drugs based on whether generic drugs had entered the market. Market share is calculated based on the volume and value of drugs in each category. The results indicate that the total pharmaceutical expenditure increased by 1.75 times, from 10.4 trillion Korean won (KRW) in 2007 to 18.2 trillion KRW in 2017. The number of claimed ingredients and drug items also increased during the same period. In 2017, the market share of new drugs accounted for 10.3% of the total pharmaceutical expenditure, while original drugs and generic drugs accounted for 45.9% and 43.8%, respectively. The study reveals a slight decline in the market share of generics in the decade. Further sub-analyses based on formulation, medical center types, and the number of generic drugs provide additional insights into the market dynamics. These findings contribute to understanding the trends and implications of pharmaceutical expenditure and the role of generics in achieving sustainable development in national health insurance.

커뮤니티 케어에서의 약물관리 체계 고찰 : 영국, 일본, 싱가포르, 호주를 중심으로

이유민(Yumin Lee),장수현(Suhyun Jang),이은지(Eunji Lee),신명인(Myungin Shin),이정은(Jungeun Lee),강희진(Hee-Jin Kang),장선미(Sunmee Jang) 대한약학회 2021 약학회지 Vol.65 No.2

As a policy response to an aging population, the Korean government has implemented community care, integrating housing, health, nursing care, and other care services. Medication management services are included in community care programs as an area of chronic disease management; however, till date, the content and methods of this service have not been structured systematically. In this study, we aimed to obtain recommendations for the development of a medication management system in Korea by analyzing and comparing with the medication management systems in the UK, Japan, Singapore, and Australia. These countries currently provide medication management services and have strict qualifying criteria for patients. Common qualification criteria for service recipients include, two or more chronic diseases, or high-risk medications. The system by which pharmacists obtain medication records differs depending on the medical coverage system adopted by the country. In countries that have adopted a, such as the UK and Australia, medical information is obtained through the national public health record platform. Singapore also utilizes a similar national health record platform. In Japan, which has adopted a National Health Insurance system, each patient has a personal medicine note. Pharmacists and other medical staff can obtain patient information through this handbook. Through this study, it was found that community care and medication management services have been established according to social and geographic conditions in each country.

진화 알고리즘에서 실수처리 방법들에 대한 비교 연구

이동원(Dongwon Lee),장수현(Suhyun Jang),윤병주(Byungjoo Yoon) 한국정보과학회 1996 한국정보과학회 학술발표논문집 Vol.23 No.2A

초기의 진화 알고리즘은 염색체를 이진 스트링을 사용하여 표현하였다. 그러나 이진 스트링 표현으로는 실수(real number) 표현을 주로 사용하는 실세계 문제들을 해결하기 어려웠기 때문에, 이를 해결하기 위해 실수 값을 염색체에 표현하는 여러가지의 다양한 표현방법들과 각 표현방법의 특성을 이용한 연산자들이 제시되었다. 본 논문은 여러가지 표현방법들과 연산자들이 각각 어떤 문제에 적합한지를 실험을 통하여 알아보았으며, 또 다른 대안으로, 실수 영역을 정수부와 소수부를 분할하여 탐색하는 염색체 표현방법과 탐색전략을 제시하였다.

장기요양보험 수급자와 비수급자의 의료이용 및 의약품 처방 양상 비교

강희진(Hee-Jin Kang),장수현(Suhyun Jang),장선미(Sunmee Jang) 대한약학회 2021 약학회지 Vol.65 No.6

Older adults who receive long-term care (LTC) services are expected to differ from older adults who do not receive such services. These differences are expected in healthcare utilization and drug prescription, as older adults in LTC services, have more difficulty in daily life. This study aimed to compare the differences in healthcare utilization and drug prescription between LTC beneficiaries and those who do not receive LTC services. Using the senior cohort from the National Health Insurance Service, LTC beneficiaries and non-beneficiaries were defined, and their patterns of healthcare utilization and drug prescription were analyzed for the year 2015. The total number of participants in the study was 239,873, and the number of LTC beneficiaries was 20,619 (8.6%). For LTC beneficiaries, the average number of hospitalizations per year was two, total hospitalization days 70, and the number of outpatient visits per year 28.8, and for non-beneficiaries, these were 1.7, 49, and 34.9, respectively. LTC beneficiaries had more frequent hospitalizations, longer hospital stays, and fewer outpatient visits. In terms of drug prescription for LTC beneficiaries, the average number of prescription days was 280, the number of the daily pills was 4.7, and total prescription days per year per prescription were 22.9, and for nonbeneficiaries, these were 277, 3.8, and 18.1, respectively. LTC beneficiaries took more daily pills and had longer prescriptions than non-beneficiaries. LTC beneficiaries showed differences in healthcare utilization and drug prescription patterns in comparison to non-beneficiaries. Further research based on the characteristics of LTC beneficiaries is needed.

장기요양시설에서의 약물 관리와 약사의 역할

문아름(Arum Moon),조혜민(Hyemin Cho),장수현(Suhyun Jang),강은정(Eunjeong Kang),장선미(Sunmee Jang) 대한약학회 2020 약학회지 Vol.64 No.2

The elderly usually have a high risk of drug-related problems by polypharmacy, therefore they are in need of drug management in long-term care facilities. This study aims to obtain the implications for developing a drug management system in long-term care facilities by pharmacists suitable for Korea by reviewing the drug management programs in long-term care facilities in countries that experienced population aging first. The United States, Canada, Australia, and Japan have enacted laws to optimize drug management in long-term care facilities according to the social demands of the aging population and operate specific programs based on those laws. Drug management programs in longterm care facilities operate in a variety of forms to suit the circumstances of each country. In long-term care facilities, pharmacists participate in the medication regimen review, in setting up drug related service frames and in developing relevant policies of the facilities. The results of the pharmacist s medication regimen review are not only provided to the doctor but also included in the medical record and kept for a while. Pharmacists emphasize cooperation with physicians and other health practitioners for proper drug management in long-term care facilities. In Korea, where the number of long-term care facilities is increasing along with the surge in the elderly population, it is necessary to develop a drug management system by pharmacists for safe drug use in long-term care facilities.

노변 기지국 기반 실외 이동체 측위 기술

윤상훈(Sanghun Yoon),진성근(Seongkun Jin),장수현(Suhyun Jang),정한균(Hangyun Jung),신대교(Daegyo Shin),임기택(Kitaeg Lim) 한국통신학회 2017 한국통신학회 학술대회논문집 Vol.2017 No.11

하수관망 수질 모니터링을 위한 온라인 스마트센서 적용

김종락(Jongrack Kim),유광태(Kwangtae You),장수현(Suhyun Jang),박기정(Gijung Pak) 대한환경공학회 2021 대한환경공학회 학술발표논문집 Vol.2021 No.11

장기요양시설 노인의 포괄적 약물관리 프로그램 운영현황

조현지(Hyunji Cho),김태현(Taehyun Kim),장수현(Suhyun Jang),강희진(Hee-Jin Kang),이주연(Ju-Yeun Lee),배은영(Eun-Young Bae),이주헌(Joohyun Lee),아영미(Young-Mi Ah),박혜경(Hyekyung Park),장선미(Sunmee Jang) 대한약학회 2023 약학회지 Vol.67 No.2

Polypharmacy and potentially inappropriate medication use have increased among the residents of long-term care facilities (LTCF). Nevertheless, Comprehensive Medication Management (CMM) for LTCF residents was not implemented in Korea. The United Kingdom, Canada, the United States, and Australia have already introduced CMM for managing drug-related problems in LTCF. This study discussed the implications of developing the CMM service for LTCF residents in Korea by reviewing the system of these countries. The contents and requirements of CMM are investigated through relevant papers and official reports of the public institution of each country. The CMM service of these countries is regularly conducted based on their system and laws. In Canada, there are no additional requirements such as special education and qualifications for pharmacists providing CMM. But in other countries, it is preferred that pharmacists providing CMM are geriatric pharmacists or take the education that is equivalent to them. In addition, all these countries utilize national computer networks or electronic healthcare records that are used for executing CMM and for sharing with other medical experts, and then they are retained as official medical records. It is necessary to consider the system of other countries when introducing the CMM service for LTCF residents in Korea.

토석류 모니터링 계측자료 신뢰도 향상을 위한 중앙값필터와 칼만필터 적용

김종락(Kim, Jongrack),유광태(You, Kwangtae),장수현(Jang, Suhyun),박기정(Pak, Gijung),이득수(Pak, Gijung) 한국방재학회 2017 한국방재학회논문집 Vol.17 No.1

원격 모니터링 시스템에서 계측되는 자료는 다양한 요인에 의해 이상값 및 잡음을 포함하게 된다. 정확한 분석을 위해서는 계측자료의 신뢰도가 매우 중요하다. 본 연구에서는 계측자료의 신뢰도 확보를 위해 이상값 제거에 개선된 중앙값 필터 알고리즘, 잡음 제거에 칼만필터 알고리즘을 함께 사용할 것을 제안하였다. 제안한 알고리즘을 현장 계측 자료에 적용한 결과, 잡음과 이상값을 모두 제거하였으며, 채널당 연산 시간이 1밀리초 이하로 매우 빨라 저사양 계측모듈에 쉽게 적용 가능함을 확인하였다. The data measured in the remote monitoring system will contain outlier values and noise due to various factors. Reliability of measured data is important for accurate analysis. In this study, we propose the use of an improved median filtering algorithm to remove outlier data, and Kalman filter algorithm to remove noise. After applying to the field measurement data, the proposed algorithm removed both outlier values and noise, and it was confirmed that the calculation time per channel was significantly low, at less than 1 millisecond, thus it can be easily applied to the low measurement module.