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민간의료기관 참여방식과 보건소 서비스 강화방식의 국가필수예방접종 보장범위 확대 시범사업에 관한 보건소 직원의 인식 비교
김춘배,이석구,이중정,안양희,김민경,김영택,김이경,고운영 한국모자보건학회 2009 한국모자보건학회지 Vol.13 No.2
Objectives : To assess comparatively the perceptions of Public Health Center (PHC) staffs for the National Expanded Programme on Immunization (NEPI) according to the provision method in 2005 (the participation of private medical facilities) and 2006 (the enhancement of vaccination services of public health centers) Demonstration Project in Korea. Methods : A questionnaire survey was conducted for 344 and 51 PHC staffs in Daegu metropolitan city and Gunpo city in 2005 (a response rate of 79.1%, 84.3%, respectively). Also, we sampled 90, 70, and 56 PHC staffs in Gangneung city, Yangsan city, and Yeongi-gun, respectively in 2006 (a response rate of 50.0%, 100%, and 100%, respectively). We analyzed these data set using descriptive analysis and χ2-test through SPSS for Windows (12.0). Results : The perceptions and performance rates (including the improvement of the immunization coverage rate, the control of under-immunised or incompletely immunised groups in a community, etc.) of the PHC staffs for the Demonstration Project of Daegu metropolitan city and Gunpo city in 2005 were significantly higher than the rates of the PHC staffs in 2006 Demonstration Project regions. However, the PHC staffs in Gangneung city, Yangsan city, and Yeongi-gun in 2006 answered significantly higher rates about the satisfaction and achievement categories on this project than those in the 2005 Demonstration Project regions. Conclusions: We show that there is significant gaps in the perceptions and satisfaction of PHC staffs between the provision method of two Demonstration Project areas and periods. In the near future, the central government must facilitate the feedback mechanism for the acceptance of PHC staffs' opinion in the process of implementation and evaluation of the NEPI.
한국인 치료순응도 향상을 위한 개입 효과에 대한 메타분석
김춘배,조희숙,현숙정,박애화 한국보건행정학회 2002 보건행정학회지 Vol.12 No.2
The purpose of this study was to analyze the results of 133 studies related to patient compliance published between 1980 and 2001 and to assess the effectiveness of intervention on compliance by using meta-analysis. We collected the existing literatures by using web and manual search 'patient compliance', 'sick role behavior', ‘major clinical disease', and 'intervention' as key words and by reviewing content of journals related to medicine, nursing and public health. The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance- related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), (5) utilization (appointment making and keeping, use of preventive services). Quantitative meta-analysis was performed by MetaKorea program which was developed for meta-analysis in Korea. Among the 133 articles, 10 studies were selected through the qualitative meta-analysis process, and then only 6 studies were selected for the quantitative meta-analysis finally. The interventions produced significant effects for all the compliance indicators with the magnitude of common effect size (4.1192) than the non-intervention group in a random effect model. The largest effects were each study for patient of hypertension using health outcome such as blood pressure (0.4679) and diabetes mellitus using direct indicator such as glucose level in blood and urine (0.7753). These results suggest that strategic interventions showed clear advantage for improvement of patient compliance compared with non- intervention group.