의사결정트리를 이용한 성인의 미충족 치과의료 영향 요인과 이유 분석

유세희,박일수,김유미 한국보건사회연구원 2017 保健社會硏究 Vol.37 No.4

The purpose of this study was to analyze the factors affecting the unmet dental care of adults using decision trees and to classify them according to the risk group of unmet dental care and the group of reasons for unmet dental care. The data are 15,918 adults aged 19 and over in the National Health and Nutrition Examination Survey during the 6th period (2013 - 2015). The variables used in the study were socio-demographic characteristics, health behavior characteristics, mental health characteristics, oral health characteristics. Data were analyzed by composite sample, decision tree, and logistic regression analysis. The results of this study are as follows. Dental complaints such as mastication discomfort were the most important factors affecting unmet dental care, followed by household income level, stress, age, economic activity status. 67.8% of those who have a complaint of mastication discomfort, low income and medical aid-insured group 65 years old or older experienced unmet dental care. This is over two times compared with overall unmet dental care experience 31.3%. In addition, the reason for the unmet dental care was classified according to the stages of the access model to health care. The results were as follows: recognition of dental needs (12.5%), dental care pursuit (21.8%), dental reach (27.0%), and use of dental care (36.9%). This study analyzed systematically the factors and reasons of unmet dental care using a health care access model and decision tree analysis. In order to improve accessibility of dental care, interventions such as health education and social support are needed for each type of unmet dental health risk group, especially classified according to early stages of access to health care such as first stage of perception of needs and desire for care and second stage of health care seeking. 본 연구는 의사결정트리를 이용하여 성인의 미충족 치과의료 경험의 영향 요인을 파악하고, 미충족 치과의료 경험 가능성이 높은 위험집단 및 치과의료 미충족 이유에 따른 집단을 분류하여 그 특성을 분석하였다. 자료는 제6기(2013~2015년) 국민건강영양조사의 만 19세 이상 성인 15,918명이며, 연구에 이용된 변수는 인구사회학적 특성, 건강행태적 특성, 정신인지적 특성, 건강관련 특성, 구강건강 특성 등이다. 자료는 복합표본분석, 의사결정트리, 로지스틱회귀 분석을 실시하였다. 연구결과 미충족 치과의료에 미치는 영향 요인은 저작불편호소가 가장 중요한 요인이었으며 다음으로 가구소득수준, 스트레스, 연령, 경제활동 상태, 고할압 의사진단 등의 순으로 나타났다. 저작불편을 호소하고 가구소득 수준이 낮은 65세 이상의 보험급여 가입자 그룹의 미충족 치과의료 경험이 67.8%로 전체 미충족 치과의료 경험률 31.3% 대비 두 배 이상 높았다. 또한 미충족 치과의료의 이유를 의료접근성 모형의 단계에 따라 위험집단의 특성을 파악해 본 결과, 의료필요의 인지(12.5%), 의료추구(21.8%), 의료도달(27.0%), 의료이용(36.9%)의 단계에 이를수록 미충족 치과의료의 이유에 대한 분율이 높았다. 본 연구는 미충족 치과의료의 영향요인과 이유를 체계적으로 분석하기 위해 의료접근성 모형 및 의사결정트리를 이용하여 위험집단을 분류하고 이들의 특성을 파악하였다. 치과의료 접근성 향상을 위해서는 미충족 치과의료 위험집단의 특성별로 의료인지, 의료추구 단계에서부터 보건교육, 사회적 지지 등의 개입이 필요하다.

예방위주의 계속구강건강관리 제도의 운영사례에 대한 분석 연구 : 16세 이하 연령층을 대상으로

원준영,신승철,서현석,류현 대한구강보건학회 2003 大韓口腔保健學會誌 Vol.27 No.3

The purpose of this study was to obtain database for developing a model of incremental dental care system in Korea. The author conducted the incremental dental care for 232 persons during one year in personal dental hospital. The data was analyzed improvement of oral health conditions during initial stage and 1st incremental care stage, and required cost during one year. The results were as follows ; 1. Active caries free rate was increased from 75.43% to 94.83% during incremental dental care. 2. The mean care time was estimated 486.1 minutes per one person. The dental chair-time for incremental dental care was 314.9 minutes and the indirect required time was 171.2 minutes. 3. The mean care cost of incremental dental care was estimated 413,159 Won based on customary fee and 284,576 Won based on relative value scale, 278,521 Won based on labor cost and clinic operating cost. 4. The proper incremental dental care cost of the first year until highschool student was estimated about 280,000 Won, and the cost seemed to be reduced from second year. 5. It is suggested that incremental dental care program in personal dental clinic is effective means of improving oral health and it is recommended to extend the incremental dental care program.

강릉시 지역아동센터 치과주치의사업의 1년 후 성과평가 및 사업참여 아동의 중도탈락 이유

정세환 ( Se Hwan Jung ),신보미 ( Bo Mi Shin ),박덕영 ( Deok Young Park ),마득상 ( Deuk Sang Ma ) 대한예방치과·구강보건학회 2013 大韓口腔保健學會誌 Vol.37 No.2

Objectives: This study aimed to determine the effectiveness of the continuous dental care program of the Community Child Center in Gangneung city by evaluating one-year outcomes and determining the reasons for dropout. Methods: A total of 180 children in the study group were provided with continuous dental care in 2008. The control group consisted of 131 children whose 2009 dental records from Gangneung- Wonju National University Dental Hospital were retrospectively reviewed. The outcome of dental caries prevention was evaluated by prevalence rates and number of decayed teeth. The evaluation of dental care outcome was based on cost and frequency of dental care. A chi-square test and Mann-Whitney U test were used to assess differences between the study group and the control group. In addition, the dropout rate and the reasons for dropout by the time of dental service supply were investigated for 427 children who participated in this program in 2010. Results: Dental caries prevention results of the study group were better than those of the control group, but significant differences were found only in the dt rates of girls (P<0.001). The average frequency of dental care per child in the study group was lower than that of the control group. The average cost of dental care per child was 56,910 won per boy in the study group, 124,893 won per boy in the control group, 71,657 won per girl in the study group, and 127,296 won per girl in the control group. Significant differences in dental care results were found for both boys and girls (P<0.05). The reasons for dropout were leaving the center, absence, use of another dental clinic, parents` or child`s rejection of the program, and disability. Conclusions: On the basis of these results, we could logically assume that promoting oral health and reducing the cost of dental care might be achieved through the introduction of a continuous dental care program for vulnerable children and adolescents in the community.

치위생 과정(Dental hygiene process of care)에 대한 치과의사의 인식조사

김민지 ( Kim Minji ) 대한통합의학회 2018 대한통합의학회지 Vol.6 No.3

Purpose : The purpose of this study was to conduct an in-depth interview with dentists in order to provide fundamental data regarding their thoughts in relation to the dental hygiene process of care and its necessity in clinical practice, with the aim of ensuring that dental hygienists can perform their duties as experts. Method : Following explanation of the study, we administered the questionnaire to those who agreed to participate between September 26 and October 28, 2017. A Naver-form (mobile) questionnaire was distributed to the research subjects for data collection. Data were analyzed using SPSS (Statistical Package for the Social Sciences) 24.0. Analysis was performed by calculating the frequency and percentage of the general characteristics of the subjects, occupational expertise, and the dental hygiene process of care. Result : Among the 56 research subjects, 48 (85.7 %) were men and 8 (14.3 %) were women. Awareness on the part of respondents of the job responsibilities associated with the dental hygiene process of care ratio was as follows: 11 (19.6 %) categorized their level of knowledge regarding the dental hygienist’s job duties as “very much know”; 13 (23.2 %) as “somewhat know”; 18 (32.1 %) as “neither”; and 9 (16.1 %) as “somewhat don’t know”, while 5 (9.0 %) said “I have no idea”. The dental hygiene process of care was categorized as “very much necessary” by 50.0 % of respondents; as “somewhat necessary” by 35.7 %; and as “neither” by 14.3 %. Conclusion : The dental hygiene process of care is one of the methods used to continuously manage patients with dental- related concerns. Recently, the management of patients in the dental clinic has changed from a disease treatment model to a concept of active prevention for improving the quality of life related to oral health. The dental hygiene process of care is considered a very necessary dental health care service because it functions to continuously introduce oral health care or preventive care programs in clinical practice.

학부모의 학교계속구강건강관리사업에 관한 지식수준과 지지정도

이정옥,문혁수,김종배,백대일 대한구강보건학회 2002 大韓口腔保健學會誌 Vol.26 No.4

The purpose of this study was to clarify and eliminate the obstacles in developing the incremental dental care programs, The author had reported the results of investigating and analysing the knowledge and attitude on school-based incremental dental care programs of 955 students' parents in middle size of urban community. A Questionnaire was used to interview 955 students' parents in Sunchon. The data were analysed by age and gender, The results obtained and conclusions discussed were as follows ; 1. Most of students' parents have a little knowledge on school-based incremental dental care programs. 2. They got the informations about school-based incremental dental care programs mostly through their children and mass media, not through dentists. 3. After listening to the explanation about school-based incremental dental care programs, an absolute majority of them accepted that their children received school-based incremental dental care. 4. The majority of them agreed that school-based incremental dental care programs should be supported by social security. 5. The main obstacle in developing school-based incremental dental care programs was the poor knowledge of parents and dentists about them. 6. The more education about oral health care system is needed in dental college education for general dentist. 7. As a part of social and school education, it should be developed immediately the school-based oral health education about school-based incremental dental care.

한국 노동시장 불안정성과 미충족 치과의료의 관련성: 고용과 소득 불안정성을 중심으로

차선화 ( Xianhua Che ),박희정 ( Hee-jung Park ) 대한예방치과·구강보건학회 2018 大韓口腔保健學會誌 Vol.42 No.4

Objectives: The aim of this study was to analyze the accessibility of dental care services among individuals with precarious employment in South Korea. Methods: We used the 9th wave of the Korean Health Panel data (2015) and included 7,736 wage and non-wage earners in our study. We determined precariousness in the labor market as a combination of employment relationship and job income, and categorized individuals based on this into the following four groups: Group A comprising those who report job and income security, Group B comprising those who experience job insecurity alone, Group C comprising those who report a stable job but low income, and Group D comprising those who experience both job and income insecurity. Accessibility to dental care services was determined by experience of unmet dental care needs and unmet dental care needs caused primarily by financial burden. Logistic regression analyses were used to assess the effect of precarious work on access to dental care services. Results: Individuals with job insecurity (Group B; OR=1.445; 95% CI=1.22-1.70) and both job and income insecurity (Group D; OR=1.899; 95% CI=1.61-2.24) were more likely to have unmet needs than the comparison group. Both groups B and D were also 2.048 (95% CI=1.57-2.66) times and 4.435 (95% CI =3.46-5.68) times more likely, respectively, to have unmet dental care needs caused by financial burden. Education status, health insurance, and health status were all also effective factors influencing unmet dental care needs. Conclusions: Unstable employment and low income resulted in diminished access to dental care services. Therefore, governments should consider health policy solutions to reduce barriers preventing individuals with employment and income instability from accessing adequate dental care.

Improvement of Oral Environment Indices of Oral Preventive Care Program, and Change in Oral Health-related Behaviors based on Dental Hygiene Process

Yu Rin Kim,Hyun Kyung Kang 보안공학연구지원센터 2016 International Journal of Bio-Science and Bio-Techn Vol.8 No.1

This study aims to ensure the autonomy of dental hygienists through an oral preventive care program based on the dental hygiene process, and to provide basic data to support systematic and professional oral care. It was intended to determine changes in patients’ oral-related knowledge, awareness, practice, OHB and other various oral hygiene care indices through the dental hygiene process. Data analysis was performed using IBM SPSS Statistics (version 21.0), and statistical significance level was set at p<0.05. Frequency analysis was performed for general characteristics and two-way repeated measures ANOVA was performed to compare changes in the oral health care indices of the dental hygiene process. In addition, paired t-test was performed to compare differences in oral health knowledge, awareness, practice and OHB, and bivariate correlation analysis was performed to determine correlations between them. In the results of this study, it was found that there were significant decreases in S-0HI, PSR Score and BOP, O’Leary through the dental hygiene process, showing that the oral preventive care program was effective (p<.001). Oral health knowledge, awareness, practice and OHB were also found to be significantly increased, revealing that there were positive changes (p<.001). It is expected that the clinical application of this dental hygiene program would be established as an effective manual to improve the oral environment.

Analysis of the Effects of Unmet Dental Care on Dental Treatment Needs: Based on the 8th Korea National Health and Nutrition Examination Survey (2019)

Jin-Sil Kim,박효정 대한예방치과학회 2022 International Journal of Clinical Preventive Denti Vol.18 No.4

Objective: The purpose of this study is to investigate the factors that unmet dental care in terms of oral health problems and dental care requirements affect the need for dental treatment. Methods: We used data from the 8th National Health and Nutrition Survey 1st Year (2019), which surveyed 10,859 participants. We included 5,581 adults aged ≥19 years. To analyze the general characteristics of the participants and determine whether and why their dental care was unmet, survey responses were reclassified and a frequency analysis was conducted. The Rao–Scott chi-square test and composite sample multiple logistic regression analysis was conducted to determine the relationship between general characteristics, oral health behavior, oral conditions, dental needs, and unmet dental care. Results: Multiple logistic regression analysis revealed association between dental needs and access to dental care. Unmet dental care-based analysis revealed that women were 0.77 times more likely to receive dental treatment than men. When prosthetics and implants were in the oral cavity, they were 1.30 and 1.36 times higher. Conclusion: Due to its retrospective cross-sectional design, the study only included participants of the 8th National Health and Nutrition Survey, limiting its ability to establish causal relationships. Future studies are warranted to provide an in-depth analysis by expanding not only the subjective oral health status but also objective oral health indicators according to dental preventive treatment standards and to use these data to determine the factors affecting the systemic health status of citizens.

흡연이 치과 외래 이용 및 치과 외래 의료비에 미치는 영향

정선락 ( Sun Rak Jeong ),김영희 ( Young Hee Kim ),장지언 ( Ji Eon Jang ),이원기 ( Won Kee Lee ) 대한예방치과·구강보건학회 2015 大韓口腔保健學會誌 Vol.39 No.4

Objectives: The objectives of this study were to evaluate the effect of smoking on utilization of and expenses in ambulatory dental care. Methods: The subjects of this study were 5,751 men aged over 20 years selected from the Korea Health Panel data collected during 2010-2012. Pack-years of smoking were calculated based on the survey data. Dental utilization was defined as dental outpatient clinic use least once in three years. The expenses in ambulatory dental care were summed to determine total dental health care spending for three years. To detect the effect of smoking, we used multiple logistic regression analysis for dental utilization and multiple linear regression for expenses in ambulatory dental care after changing log. Results: The pack-years had a significant effect on dental utilization and expenses in participants aged 40-59 years. After controlling for income level, bedtime brushing, and the presence of chronic disease, dental care utilization rates in the over 10 to less than 25 pack-year and the over 25 pack-year groups were about 1.4 (OR=1.37, (P =0.007)) and 1.6 times (OR=1.59, (P =0.001)) those in the 0 pack-year group. In comparison with the 0 pack-year group, the over 10 to less than 25 pack-year group spent 50,000 won more over dental expenses, while the corresponding number for the over 25 pack-year group was about 100,000 won. Thus, the ambulatory dental care expenses increased with the packyears of smoking. Conclusions: Smoking significantly influenced the utilization and expense in ambulatory dental care in men aged 40-59 years.

치과 진료 경험 유무에 따른 구강건강관리에 대한 조사 연구: 수도권 지역을 중심으로

박명숙 ( Myung Suk Park ),남영신 ( Young Shin Nam ) 아시아.유럽미래학회 2010 유라시아연구 Vol.7 No.3

As a survey on oral health care according to the appearance of experiencing dental treatment, the purpose of this study was to grasp factors relevant to oral health care by subject through analyzing and comparing characteristics in each between the subjects with experience of dental treatment and the subjects without experience. It carried out self-reported questionnaire survey targeting totally 600 people such as 300 subjects without experience of dental treatment and 300 subjects with experience of dental treatment. As a result of analyzing by using SPSS 15.0, the following conclusions were obtained. 1) University graduates were large in people with experience of dental treatment. As for residence, there were large people who dwell in city region. Among them, subjects with experience of dental treatment were 180 people(60%). Subjects without experience of dental treatment were 156 people( 52%). As for job, it was the largest in students as for people without experience of dental treatment, and in professional job as for people with experience. 2) In the appearance of experiencing the oral-related education, the subjects, who responded as saying of ``Yes,`` were 159 people(53%) as for subjects with experience, and 117 people(39%) as for subjects without experience. Thus, the experience of having ever been educated was larger in people with experience. 3) As for toothbrushing frequency, three times a day was the largest both in people with experience of dental treatment and people without experience. One time was larger in people without experience than people with experience. In 3 times and over 4 times, people with experience were indicated to be larger than people without experience, on the contrary. It was statistically significant. 4) In the response as saying of having experience of the oral-related education regarding people with experience of dental treatment, the subjects, who toothbrush over 4 times a day, were 27 people(17%), and were 6 people(4.3%) in respondents as saying of having no experience of education. In the respondents as saying of having experience of the oral-related education regarding people without experience of dental treatment, the subjects, who toothbrush over 4 times a day, were 20 people( 17.1%) and 10 people(5.4%) for the respondents as saying of having no experience of the oral-related education. As for all of subjects with experience of dental treatment and of subjects without experience, people of toothbrushing 4 times a day were large in the respondents as saying of having experience of the oral-related education. 5) The awareness level according to the appearance of experiencing dental treatment was 4.14 points in people with experience and 3.96 points in people without experience. Thus, the awareness level was high in subjects with experience of dental treatment. The knowledge level was 1.86 point in people with experience and 1.75 in people without experience. Thus, the awareness level was high in people with experience of dental treatment. Statistically significant difference was shown. It aims to suggest as follows. First, regardless of subjects`` general characteristics(educational level, income, residence), there will be necessity for striving to reinforce practice on toothbrushing, which becomes the basis in oral health care. Second, oral health care program needs to be developed that can be approached by people without experience of dental treatment. Third, the working places of most of dental hygienists are now concentrated on dental clinic. Still, there is necessity for dental hygienists`` positioning in diverse fields, through expanding dental hygienists`` role through more researches. Furthermore, it is considered to be likely to greatly contribute to promotion in people``s oral health.