In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.
Linear Models ; Primary Health Care ; Secondary Care

The Objectives of this study are to evaluate the user satisfaction and actual data input time through an enterprise ICNP-based electronic nursing record system using the controlled vocabulary in a secondary care hospital (BSNUH). Study design is a formative evaluation using the QUIS (Questionnaire user interaction satisfaction) self-reported in a secondary care hospital operating EMR(electronic medical record) system in Korea. Participants were two hundred fifty nurses in BSNUH. All of them were registered nurses participated in day-to-day nursing care during study periods. Participants were asked to fill in the SNCEQ(The Staggers Nursing Computer Experience Questionnaire) and QUIS(Questionnaire for User Interaction Satisfaction). Also requested were the data input time(sec) required for entry of approximately 20 times of nursing documentation tasks and the number of standardized precoordinated phrases used for documenting routine nursing records. The mean score of user satisfaction was 4.56 (SD 1.25) and the mean time of data input and the average number of precoordinated phrases used in nurses notes was 2.25min and 3.7 respectively.
Korea ; Nursing Care ; Nursing Records* ; Nursing* ; Secondary Care ; Vocabulary, Controlled

The objective of this study was to evaluate outcome for the patients of the intensive care unit, using APACHE III prognostic system. We prospectively collected the information of 429 patients in intensive care units at 2 tertiary care hospitals and 4 secondary care hospitals in PUSAN who had been admitted from December 1, 1993 to February 28, 1994. The results were as follows. 1. APACHE 111 scores were various from 0 to 173. But the distribution of the scores were similar between tertiary care hospitals and secondary care hospitals. 2. The mortality rate significantly increased as APACHE 111 score rised (P<0.001). Within the interval of same score, generally, the mortality of operative patients was higher in secondary care hospitals but in the case of nonoperative patients higher in tertiary care hospitals. 3. when the tertiary care hospitals compared with secondary for ratio of the predicted mortality rate to the actual mortality rate, there was little difference. 4. when we compared the 6 hospitals, one hospital had significantly better results and another hospital was significantly inferior (P<0.05).
APACHE* ; Busan ; Humans ; Intensive Care Units* ; Critical Care* ; Mortality ; Prospective Studies ; Secondary Care ; Tertiary Healthcare

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.
Delivery of Health Care ; Health Policy ; Health Resources ; Insurance, Health ; Investments ; Referral and Consultation ; Secondary Care ; Tertiary Healthcare

BACKGROUND: The expansion and strengthening of primary care is approved as the only method to revise the ineffective health care system in Korea. In such a system, we intended to analyze the functional and regianal distribution of specialists by investigating and classifying the hospitals where residents who completed their training in a university hospital located in Seoul for seven years are working and by acquiring the distribution of the subjects who are practicing as primary care physicians by year, specialties and location. METHODS: We selected 384 specialists, all of whom were trained as residents at a university hospital located in Seoul from 1987 to 1993. The hospitals they worked at were classified as primary, secondary and tertiary care hospitals according to the classification in the health care administration. The location of primary care hcspitals among them was plotted an two maps; one of Seoul, the other of Korea. RESULTS: The number of females in the subjects was 68(17.7%) and that of males 316(82.3%). The number of practitianers was 156(40.6%) and that of specialists working at the secondary care hospitals was 55(14.3%), and 147 specialists were working at the tertiary care hospitals(38.3%). With regard to the pereentage of practitioners, dermatologic specialists presented with 60%, and relatively high group included obstetrics and gynecology(59.2%), family medicine(54.5%), plastic surgery(52.6%), otolaryngology (52.0%), pediatrics(51.7%), and orthopedics(48.6%).In tertiary care hospital, chest surgery showed 72.7% as highest. Radiologic ancology presented with 66.7% and anatamical pathology with 66.7%. As to the location of primary care hospitals, 41.0% were in Seoul and 38.5% in Kyungkido. And the rest of the 20. 5% were located in other areas of Korea. CONCLUSIONS: Considering the results of the study that show a great number of specialists are actually practicing as primary care physicians after their specialists training, the present training system of specialists needs to be revised and cantrolled in structure.
Classification ; Delivery of Health Care ; Female ; Gyeonggi-do ; Humans ; Korea ; Male ; Obstetrics ; Otolaryngology ; Pathology ; Physicians, Primary Care ; Primary Health Care ; Secondary Care ; Seoul ; Specialization ; Tertiary Healthcare ; Thorax

OBJECTIVES: The practice of telemedicine requires social interventions and systems for efficient implementation. Further, it requires sufficient discussions among related parties because the purpose of telemedicine is diagnosis and treatment, and the participation of medical specialists is essential. Based on the characteristics of the healthcare structure of Korea, which has a low proportion of public healthcare and most patients are taken care of by a few large tertiary care hospitals, the fundamental issues need to be discussed. METHODS: A comparison was conducted with overseas cases to discuss the prerequisites for the effective implementation of telemedicine in South Korea under the current situation. We also examined the structural characteristics of the Korean medical community. RESULTS: The current paper recommends that an in-depth analysis and studies are conducted on the following aspects: a search for telemedicine services focused on public healthcare, a search of services for illnesses that impose high levels of burden on households, and the development and implementation of a telemedicine system for follow-up management at primary and secondary care hospitals after the patient undergoes surgery or treatment at tertiary care hospitals. CONCLUSIONS: As the technology develops, the focus should also be on factors such as safety, usefulness, availability, and how the functions will be realized in order to enable user communication. A clear system should be established to regulate and manage the lack of sufficient discussions. In addition, seeking projects and systems that reflect the characteristics of each country will facilitate the efficient implementation of telemedicine.
Delivery of Health Care ; Diagnosis ; Family Characteristics ; Follow-Up Studies ; Health Policy ; Humans ; Korea* ; Secondary Care ; Specialization ; Telemedicine* ; Tertiary Healthcare

OBJECTIVE: to describe our experience and examine the frequency of gynecologic laparoscopy complication performed in a secondary care hospital. METHODS: We retrospectively studied 262 patients were treated by gynecologic laparoscopy (mean age 43 yrs). Period of study were from March 2003 through March 2005 in one teaching hospital. Data were analyzed using SPSS for windows software. Frequency and descriptive statistics were calculated. RESULTS: The overall number of complication in 262 laparoscopies was 16 (6.1%). 5 ureter injuries, 3 stump disruption, 2 troca site hematoma, 1 bladder injury, 1 small bowel injury, 1 post operative bowel obstruction, 1 leg neuropathy, 1 leg weakness, 1 massive bleeding. The complication rates were analysed by type of surgery. We evaluated correlation with variable factors. Our complication rates were higher to those reported in the literature and were significantly different by type of surgery. Complications were related to variable factors of blood transfusion and anesthetic time. CONCLUSION: The complication rate occurred at higher rates in our institution. All patients complications developed were treated and none sustained long-term morbidity. However, operative laparoscopy should be performed carefully. Early recognition of injuries, preferably intraoperatively, with immediate appropriate treatment is crucial. It is also important to be alert to early manifestations of complications in the postoperative observation period.
Blood Transfusion ; Hematoma ; Hemorrhage ; Hospitals, Teaching ; Humans ; Laparoscopy* ; Leg ; Retrospective Studies ; Secondary Care ; Ureter ; Urinary Bladder

Nutritional support is one of the major advances in the history of medicine in the 20th century. Since Dudrick and associates (1968) achieved the first successful nutritional support in puppies and human infants with short bowel syndrome, this technology has expanded as a gospel throughout the world. We can supply almost all of the macro-and-micro-nutrients and calories as much as we need. However, utilities of some specific nutrients have to be limited only by the defined metabolism and the pathophysiology under the concept of nutritional pharmacology. This paper is for a practical review of the nutritional support for physicians who are working in the primary and secondary care centers in this country.
History of Medicine ; Humans ; Infant ; Malnutrition ; Metabolism ; Nutritional Support* ; Pharmacology ; Secondary Care Centers ; Short Bowel Syndrome

PURPOSE: The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS: A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS: During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION: Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.
Abdominal Pain ; Appendicitis ; Emergency Service, Hospital* ; Humans ; Retrospective Studies ; Secondary Care Centers* ; Tomography, X-Ray Computed*

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated.
Christianity ; Diagnosis ; Endoscopy ; Hemorrhage* ; Hemostasis ; Humans ; Palliative Care ; Proton Pump Inhibitors ; Secondary Prevention ; Stomach Neoplasms*