BACKGROUND: Several practice guidelines for management of dyslipidemia including the National Cholesterol Education Program recommend regular physician follow-up and lipid testing to promote adherence with lipid-modifying drugs. The objective of this study was to analyze the pattern of medical care use among lipid-modifying drug users. METHODS: A retrospective cohort study was conducted with 57,801 new users of lipid-modifying drugs who initiated treatment in 2005. The Korean National Health Insurance Claims Data was used to examine the pattern of medical care use and related factors after treatment initiation for up to two years. Getting the prescription and follow-up lipid testing were considered use of medical care. RESULTS: More than 95% of the patients visited physicians for prescriptions or lipid testings in the first year after initiating drug therapy. In the first two months, 77% had both prescription and follow-up lipid testing, while in the second year, approximately 57% had. Rate for follow-up lipid testing in the first two months was about 78%, but 55% in the second year. Approximately 74% of the patients continued using ambulatory medical care in the second year. In multiple logistic regression analysis, the probability of continual visits in the second year increased in patients who visited one medical institution for prescription and lipid testing within six months. CONCLUSIONS: Early and frequent visits, especially for lipid testings, were associated with continuous medical care use. Patients should be educated regarding the importance of dyslipidemia management in the early stage after treatment initiation.
Cholesterol ; Cohort Studies ; Drug Users ; Dyslipidemias ; Follow-Up Studies ; Humans ; Logistic Models ; National Health Programs ; Prescriptions ; Retrospective Studies

BACKGROUND: There have been deviations in the regional rate of certification in Korean long-term care insurance (LTCI). This study aimed to explore the determinants of the rate of certification in LTCI. METHODS: The panel data of the year 2010–2014 of the 227 National Health Insurance Service (NHIS) regional office were used. Making use of 26 explanatory variables (socio-demographic factors, access to the long-term care services, etc.), we estimated the random effects model using STATA SE ver. 13.0 program (Stata Corp., College Station, TX, USA) and tried to find out the determinants of the regional rate of certification. RESULTS: Estimation results showed that the most important determinants of the regional rate of certification in LTCI are the long-term care infrastructure such as capacity or number of the homecare service institution, sanatorium, or convalescent hospital. The number of the elderly who lives alone and the dimentia patients were positively related to the regional rate of certification in LTCI. CONCLUSION: The estimation results implied that the regional variation in the rate of certification in LTCI has nothing to do with the NHIS regional offices or their employees. To alleviate the deviation in the regional rate of certification in LTCI, we suggested the analysis of the deviation in the survey checklist. We also proposed to found the regional comprehensive support center to prevent the geriatric illness and to improve the residents' health, etc.
Aged ; Certification* ; Checklist ; Hospitals, Convalescent ; Humans ; Insurance, Long-Term Care* ; Long-Term Care* ; National Health Programs

BACKGROUND: This study was to provide an analysis of long-term care hospitals in major foreign countries and to ultimately drive suggestions for the role of the long-term care hospital system in Korea. METHODS: Services, composition of the workforce, admission criteria, and collaboration with related organization were reviewed. Japan, Canada, United States (US) and the Netherlands were selected for analysis using the case study research method. RESULTS: Organization for Economic Co-operation and Development (OECD) defined long-term care hospital as long-term care beds in hospitals. A few OECD countries institutionalized long-term care beds in hospitals, focusing at palliative care or geriatric care. In Japan, Canada, US, and the Netherlands, all having similar long-term care hospitals as Korea, a key difference was that the hospitals in these four countries provide comprehensive post-acute and nursing care. They have clearly defined admission criteria by preadmission review and systemization of referral from other organizations. CONCLUSION: Based on this review of the systems in foreign countries serving as examples for Korea and considering the policy needs and the present problems raised by providers, discussions on the future role of long-term care hospitals in Korea should be conducted.
Canada ; Cooperative Behavior ; Developed Countries ; Japan ; Korea ; Long-Term Care ; Netherlands ; Nursing Care ; Palliative Care ; Referral and Consultation ; United States

PURPOSE: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). METHODS: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. RESULTS: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. CONCLUSION: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.
Aged ; Humans ; Inpatients ; Insurance, Health ; Long-Term Care* ; Nursing ; Pneumonia*

BACKGROUND: Intention to leave was an important managerial issue among physicians working in public health centers. This study was conducted to explore the relationship between job participations and intention to leave among physicians working in health centers. METHODS: A cross-sectional questionnaire survey was conducted to gather information about job participation, intention to leave and demographics among physicians (n=243) in public health centers in Korea. Job participation was measured by 15 items categorized 3 dimensions. Multiple regression analysis was performed to determine the effect of job participation on intent to leave among physicians working in public health center. RESULTS: Participation of medical treatment and administrative job were significantly associated with intention to leave adjusted for sex, age, income, working area, working duration, tenure, and overall job satisfaction. Therefore, physicians who actively participated in administrative job showed a lower turnover intention. Physicians who actively participated in medical treatment job had a higher quit intention. CONCLUSION: To retain qualified physicians in public health center, education should be reinforced to physician for administrative capacity building.
Capacity Building ; Demography ; Education ; Intention* ; Job Satisfaction ; Korea ; Public Health Practice ; Public Health*

OBJECTIVE: The injury-related disease burden in South Korea is relatively high compared to that in other nations. This study was conducted to identify the scale and causes of injury by severity, using an injury pyramid and analyzing the sex and age-dependent differences and the basic demographic characteristics. METHODS: Unintentional injury was estimated for each group after classifying injury-related deaths, hospitalizations, and outpatient department (OPD) visits based on their severity. The injury pyramid was calculated by classifying the injury outcomes into deaths, hospitalizations, and outpatient visits. RESULTS: The incidence of unintentional injury included 31.74 deaths, 1,715.27 hospitalizations, and 7,317.55 OPD visits per 100,000 persons. The incidence of injury was higher among males than that among females. There were more hospitalizations and OPD visits than deaths among females. The mortality and hospitalization rates due to injury per 100,000 persons were the highest among those ≥75 years old, and the OPD visit rate was the highest among preschool children aged 0 to 6 years. The injury mechanisms that caused most deaths and hospitalizations in South Korea were injuries related to traffic, falls, poisoning, and burns/fires. CONCLUSION: The scale of unintentional injury varies based on sex, age, and injury mechanism; additionally there are differences in the incidence of injuries between males and females depending on their age and injury mechanism. The high incidence of injury in elderly people could be a factor that increases the burden of injury in South Korea; hence, it is necessary to develop an injury prevention program that targets the elderly.
Accident Prevention ; Accidental Falls ; Aged ; Child, Preschool ; Epidemiology ; Female ; Hospitalization ; Humans ; Incidence ; Korea* ; Male ; Mortality ; Outpatients ; Poisoning

PURPOSE: The purpose of the study was to investigate the usefulness of quantitative salivary single-photon emission computed tomography/computed tomography (SPECT/CT) using Tc-99m pertechnetate in Sjögren's syndrome (SS).METHODS: We retrospectively reviewed quantitative salivary SPECT/CT data from 95 xerostomic patients who were classified as either SS (n = 47, male:female = 0:47, age = 54.60 ± 13.16 y [mean ± SD]) or non-SS (n = 48, male:female = 5:43, age = 54.94 ± 14.04 y) by combination of anti-SSA/Ro antibody, labial salivary gland biopsy, unstimulated whole saliva flow rate, and Schirmer's test. Thyroid cancer patients (n = 43, male:female = 19:24, age = 46.37 ± 12.13 y) before radioactive iodine therapy served as negative controls. Quantitative SPECT/CT was performed pre-stimulatory 20 min and post-stimulatory 40 min after injection of Tc-99m pertechnetate (15 mCi). The %injected dose at 20 min and the %excretion between 20 and 40 min were calculated for parotid and submandibular glands, generating four quantitative parameters: %parotid uptake (%PU), %submandibular uptake (%SU), %parotid excretion (%PE), and %submandibular excretion (%SE). The most useful parameter for SS diagnosis was investigated.RESULTS: The uptake parameters (%PU and %SU) were significantly different among the SS, non-SS, and negative controls (p = 0.005 for %PU and p < 0.001 for %SU, respectively), but the excretion parameters (%PE and %SE) were not (p > 0.05 for both). The%PU and%SU were significantly lower in SS than in the negative controls and non-SS (p < 0.05 for all pair-wise comparisons). Additionally, the %SU was significantly lower in non-SS than in the negative controls (p < 0.05). Receiver-operating characteristic analysis revealed that the %SU had the greatest area-under-the curve of 0.720 (95% confidence interval = 0.618–0.807). Using the optimal cut-off value of %SU ≤ 0.07%, SS was identified with a sensitivity of 70.21% and a specificity of 70.83%.CONCLUSION: Reduced submandibular uptake of Tc-99m pertechnetate at 20 min (%SU) was proved useful for the diagnosis of SS. Quantitative salivary gland SPECT/CT holds promise as an objective imaging modality for assessment of salivary dysfunction and may facilitate accurate classification of SS.
Biopsy ; Classification ; Diagnosis ; Humans ; Iodine ; Retrospective Studies ; Saliva ; Salivary Glands ; Sensitivity and Specificity ; Sodium Pertechnetate Tc 99m ; Submandibular Gland ; Thyroid Neoplasms

PURPOSE: The purpose of the study was to investigate the usefulness of quantitative salivary single-photon emission computed tomography/computed tomography (SPECT/CT) using Tc-99m pertechnetate in Sjögren's syndrome (SS). METHODS: We retrospectively reviewed quantitative salivary SPECT/CT data from 95 xerostomic patients who were classified as either SS (n = 47, male:female = 0:47, age = 54.60 ± 13.16 y [mean ± SD]) or non-SS (n = 48, male:female = 5:43, age = 54.94 ± 14.04 y) by combination of anti-SSA/Ro antibody, labial salivary gland biopsy, unstimulated whole saliva flow rate, and Schirmer's test. Thyroid cancer patients (n = 43, male:female = 19:24, age = 46.37 ± 12.13 y) before radioactive iodine therapy served as negative controls. Quantitative SPECT/CT was performed pre-stimulatory 20 min and post-stimulatory 40 min after injection of Tc-99m pertechnetate (15 mCi). The %injected dose at 20 min and the %excretion between 20 and 40 min were calculated for parotid and submandibular glands, generating four quantitative parameters: %parotid uptake (%PU), %submandibular uptake (%SU), %parotid excretion (%PE), and %submandibular excretion (%SE). The most useful parameter for SS diagnosis was investigated. RESULTS: The uptake parameters (%PU and %SU) were significantly different among the SS, non-SS, and negative controls (p = 0.005 for %PU and p < 0.001 for %SU, respectively), but the excretion parameters (%PE and %SE) were not (p > 0.05 for both). The%PU and%SU were significantly lower in SS than in the negative controls and non-SS (p < 0.05 for all pair-wise comparisons). Additionally, the %SU was significantly lower in non-SS than in the negative controls (p < 0.05). Receiver-operating characteristic analysis revealed that the %SU had the greatest area-under-the curve of 0.720 (95% confidence interval = 0.618–0.807). Using the optimal cut-off value of %SU ≤ 0.07%, SS was identified with a sensitivity of 70.21% and a specificity of 70.83%. CONCLUSION Reduced submandibular uptake of Tc-99m pertechnetate at 20 min (%SU) was proved useful for the diagnosis of SS. Quantitative salivary gland SPECT/CT holds promise as an objective imaging modality for assessment of salivary dysfunction and may facilitate accurate classification of SS.