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Patient assessment of primary care under the Designated Practice Scheme for Medical Aid beneficiaries, using the Korean Primary Care Assessment Tool (K-PCAT): a district of Seoul, South Korea.

Jae Ho LEE ; Yong Jun CHOI ; Ji Sook CHOI ; Sera KIM

Journal of the Korean Medical Association.2012;55(2):187-197. doi:10.5124/jkma.2012.55.2.187

To control excessive utilization of medical care services by Medical Aid beneficiaries (MABs), the Korean government has introduced the Designated Practice Scheme (DPS, July 2007). The purpose of this study was to assess the primary care quality of the DPS using the Korean Primary Care Assessment Tool (K-PCAT). Data were collected from the survey (2008-2009) of MABs who had to designate a community clinic as the first contact practice obligatorily in one district of Seoul. Among all eligible (n=164), we analyzed the data of 154 beneficiaries, excluding those who did not meet the K-PCAT criteria of a usual source of care. Primary care quality under the DPS was poor (58.1 points) on a 100-point scale, compared with those previously studied under the Korean health care system. More seriously it was very poor (48.9 points) in MABs without intention to continue participation in the DPS, who were 50% of all participants. Among 5 domains of the K-PCAT, comprehensiveness (44.7 points) and coordination (39.3 points) were lower in score than other domains, comparable to previous studies, representing the reality of primary care in South Korea. Primary care quality was better in MABs using primary care practices including general practice, family medicine, and internal medicine instead of other specialty practice groups (60.2 vs. 53.9 points, P=0.015), and in MABs with longer duration (> or =3 vs. <3 years) since the first visit (59.7 vs. 51.9 points, P=0.010). These patterns were maintained after multivariate analysis, controlling for confounding variables. This research suggests that a complete overhaul of the scheme itself, such as the introduction of pay-for-performance method, etc., is necessary to improve primary care quality of the DPS.
Confounding Factors (Epidemiology) ; Delivery of Health Care ; General Practice ; Humans ; Intention ; Internal Medicine ; Multivariate Analysis ; Primary Health Care ; Republic of Korea

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A survey of physicians working in a community health center.

Sun Mi LIM ; Kyung Hwa SEO ; Hye Kyung KIM ; Yoon Hyung PARK

Journal of the Korean Medical Association.2012;55(2):174-186. doi:10.5124/jkma.2012.55.2.174

In Korea, physicians of the public health sector have significantly contributed to health services such as prevention and treatment of disease. However, advances in the field of public health have not provided sufficient institutional strategies and systems for reinforcement of administrative capabilities and health services. As a result, the satisfaction of physicians working in community health centers has been decreasing and their advances in the field of public health have also decreased. This study was conducted to examine the work status, working conditions, and overall job satisfaction physicians in order to strengthen of the role of physicians who work in community health centers. The subjects of the study included 191 individuals. The data were analyzed by frequency analysis and descriptive analysis using SAS. It was found that among physicians working in a community health center, the overall degree of job satisfaction was satisfactory, at 52.2% of respondents. However, it was found that employment stability (81.3%), salary increases (78.8%), the abolition of new recruitment of managing physicians on the basis of temporary (5-year term) employment (75.4%), and the provision and support for education (71.2%) should be improved to increase the job satisfaction of physicians in the community health center. Regarding this, the physicians responded that the most important conditions for them to work in the community health center were actualization of salary (63.3%) and the change of job status from temporary to full-time employment (17.0%). In conclusion, we must increase the job satisfaction of physicians working in community health centers to improve the quality of the public health care system in Korea and systematically improve the personnel system, salary, administration, and job status to increase job satisfaction.
Community Health Centers ; Employment ; Health Services ; Job Satisfaction ; Korea ; Phenothiazines ; Public Health ; Reinforcement (Psychology) ; Salaries and Fringe Benefits ; Surveys and Questionnaires

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New antiepileptic drugs.

Kyoung HEO

Journal of the Korean Medical Association.2012;55(2):155-173. doi:10.5124/jkma.2012.55.2.155

Epilepsy is one of the most common chronic neurologic conditions. Pharmacologic therapy is by far the most common approach, with the other modalities typically limited to patients with pharmacoresistant epilepsies. A host of new antiepileptic drugs (AEDs) have been introduced over the last 20 years. The AEDs including the conventional ones are more or less equally effective in patients with partial epilepsy. Therefore, relative efficacy is not a useful factor in selecting a particular drug. A conventional AED, valproic acid is regarded as having superior efficacy than the other broad-spectrum AEDs including new ones in patients with generalized epilepsy. However, it can have considerable side effects, such as reproductive dysfunction and teratogenicity to young women with epilepsy. One of the clearest advantages of many new AEDs over the conventional ones has been their more favorable pharmacokinetic and drug-drug interaction profiles compared with the conventional ones involved in the cytochrome P450 enzymatic system, which may change the levels of other antiepileptic and nonantiepileptic drugs, and endogenous substances. Many new AEDs have unique mechanisms of action and slightly better tolerability than the conventional ones. Several new AEDs can allow young women with epilepsy, particularly those with idiopathic generalized epilepsy, to avoid valproic acid treatment. Furthermore, the new AEDs may provide a modest but positive effect in seizure control, particularly as an add-on treatment. The greater variety of AEDs allows better patient tailoring according to patient's characteristics and contributes to improvement in quality of life.
Anticonvulsants ; Cytochrome P-450 Enzyme System ; Drug Interactions ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Female ; Humans ; Quality of Life ; Seizures ; Valproic Acid

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Updates on the prevention and treatment of AIDS.

Jun Yong CHOI ; June Myung KIM

Journal of the Korean Medical Association.2012;55(2):146-152. doi:10.5124/jkma.2012.55.2.146

June 5, 2011, marked the 30th year since the first cases of acquired immunodeficiency syndrome (AIDS) were reported. From just five cases in the initial publication, AIDS has grown into a global pandemic that has resulted in the deaths of more than 33 million people around the world. There have been many successful stories of human immunodeficiency virus (HIV) treatment and prevention during the past 3 decades of the AIDS epidemic. Among them, HIV chemotherapy has been a major medical accomplishment and has dramatically reduced the morbidity and mortality of those with access to care. The combination of prevention and treatment has substantially decreased the spread of the disease and dramatically increased life expectancy among treated patients. Ongoing studies on curing HIV infections are providing us with hopeful perspectives for eradicating this huge epidemic. We must attain the sustainability of economic resources in order to ensure the continuation of the advances that have been achieved and provide new perspectives on future challenges.
Acquired Immunodeficiency Syndrome ; Dietary Sucrose ; HIV ; HIV Infections ; Humans ; Life Expectancy ; Pandemics ; Publications

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Diagnostic aspects of polysomnography in obstructive sleep apnea.

Seung Hoon LEE

Journal of the Korean Medical Association.2012;55(2):138-145. doi:10.5124/jkma.2012.55.2.138

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder which is characterized by intermittent hypoxia and frequent arousals because of partial or complete upper airway obstruction during sleep. This condition may be associated with various clinical sequelae such as hypertension, cardiovascular disorders, and metabolic syndrome in adults, and failure to thrive, deformity of dentofacial structures, behavioral problems, impairment of sleep-related quality of life, and enuresis in children. Although technician-attended, in-laboratory, overnight standard polysomnography (PSG) is considered a basic and important diagnostic test to classify the severity of respiratory disturbance and define the proper treatment modality in adults and children with OSA, it is too expensive and complicated to perform. Recently, in order to overcome the disadvantages of standard PSG in the clinical field, a portable sleep monitoring device has been introduced as an alternative to standard PSG in selected patients. The purpose of this article is to elucidate the clinical indications of polysomnography in OSA, to define the differential characteristics of polysomnographic indices between children and adults with OSA, and to introduce the clinical efficacy of a portable sleep monitoring device.
Adult ; Airway Obstruction ; Anoxia ; Arousal ; Child ; Congenital Abnormalities ; Diagnostic Tests, Routine ; Enuresis ; Failure to Thrive ; Humans ; Hypertension ; Polysomnography ; Quality of Life ; Respiration ; Sleep Apnea, Obstructive

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Emerging tasks of specialty certifying examination: educational measurement considerations.

Inhong HWANG

Journal of the Korean Medical Association.2012;55(2):131-137. doi:10.5124/jkma.2012.55.2.131

Medical specialty systems were launched in 1951 by the National Medical Services Law. The following year, the specialty certifying examination had implemented in the form of portfolio evaluation. A paper-and-pencil type examination was implemented in 1960, and the 55th examination was carried out in January 2012. Currently, 26 specialties are represented, and the overall pass rate is over 90%. The examination consists of a step 1 paper-and-pencil test and step 2 skills test. In the step 1 test, the test items are multiple choice questions and short answer questions. Clinical performance examination is partially applied to the step 2 test. To cope with changes in the social situation and the growth of medical services, developmental changes are needed in the specialty certifying examinations. Performance assessment is an alternative worth considering. CPX should be a major part of the skill test. A computer-based test should be introduced as soon as possible, and it could eventually be developed into an adaptive test.
Educational Measurement ; Jurisprudence ; Phosphatidylethanolamines

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Can computerized tests be introduced to the Korean Medical Licensing Examination?.

Sun HUH

Journal of the Korean Medical Association.2012;55(2):124-130. doi:10.5124/jkma.2012.55.2.124

In November 2011, the standing Committee of the Korean Medical Licensing Examination (KMLE) recommended that the National Health Personnel Licensing Examination Board introduce computerized testing to the KMLE. Therefore this article contextualizes and explores the possibility of applying computerized testing to the KMLE. Computerized testing comprises computer-based testing (CBT), ubiquitous-based testing (UBT), internet-based testing (IBT), and computerized adaptive testing (CAT). CBT refers to testing administered via a computer as the user interface, while testing with a smart phone or smart pad as the user interface is known as UBT. IBT is testing done online, and CAT is testing tailored so that each item provided fits the examinee's ability level. The benefits and drawbacks of each computerized testing option were surveyed. Among them, I propose CAT as the final goal for KMLE. In order to implement the computerized testing more effectively, it is recommended that items contain multimedia data and should involve interpretation or problem-solving. More evidence is needed to support the positive impact of computerized testing for undergraduate medical education and primary health care. Since the rapid progress of information technology such as internet bandwidth and human-computer interface methods, the introduction of computerized testing to KMLE will soon be plausible. It is possible to increase the quality of the KMLE with the introduction of computerized testing. Medical schools should prepare for the new testing environment of the KMLE by recruiting or training specialists in this field.
Animals ; Cats ; Education, Medical, Undergraduate ; Health Personnel ; Humans ; Internet ; Licensure ; Multimedia ; Primary Health Care ; Schools, Medical ; Specialization

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The impact of introducing the Korean Medical Licensing Examination clinical skills assessment on medical education.

Hoon Ki PARK

Journal of the Korean Medical Association.2012;55(2):116-123. doi:10.5124/jkma.2012.55.2.116

Evaluation systems can produce curricular change. Korean medical schools face a new responsibility to prepare students for the Korean Medical Licensing Examination (KMLE) clinical skills test (CST) that had been administered since 2009. Several innovations in medical education have resulted, including augmentation of hand-on skills training and a standardized patient program during clerkships. This review explored the results of a survey of 41 medical schools on the impact of the CST on medical education in Korea as of 2011. The majority of respondents reported having an independent skills training laboratory and conducting a clinical skills assessment during the third or fourth year of medical school. The preparatory undergraduate courses were perceived as helpful for self-confidence, communication with real patients, basic clinical skills for work, information sharing with patients, and getting the confidence of patients during internship and residency. However, an extreme policy emphasizing maintenance of a high pass rate has warped the curriculum with simple preparatory courses for the CST. The long-term educational outcomes of the CST of the KMLE must be evaluated again a few years later focused on searching for any relationship with a reduction in medical errors or increase in patient satisfaction in real practice.
Clinical Competence ; Curriculum ; Education, Medical ; Education, Medical, Undergraduate ; Humans ; Information Dissemination ; Internship and Residency ; Korea ; Licensure ; Medical Errors ; Patient Satisfaction ; Schools, Medical ; Surveys and Questionnaires

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How can high stakes examination in Korean medical society be improved to the international level?.

Sun HUH

Journal of the Korean Medical Association.2012;55(2):114-115. doi:10.5124/jkma.2012.55.2.114

No abstract available.
Societies, Medical

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Physicians for 'here and now'.

Jung Gi IM ; Jwa Seop SHIN

Journal of the Korean Medical Association.2012;55(2):110-112. doi:10.5124/jkma.2012.55.2.110

Three reports published in the 20th century have functioned as standard guidelines for medical education: the General Professional Education of the Physician report by the Association of American Medical Colleges, Tomorrow's Doctors from the General Medical Council of the UK, and Korean Physicians for the 21st Century by the Korean Association of Medical Colleges. At the moment, a great deal of innovation is occurring in Korean medical societies. However, these innovations bring to mind the parable of the blind men and an elephant in which each blind man feels part of an elephant with his hands and misunderstands the elephant's nature because he cannot see the whole animal. In the same way, there is no comprehensive picture of 'what is the good doctor' for here and now. Korean society is changing more and more rapidly in the 21st century due to influences such as an influx of immigration and resulting multiculturalism. We could not predict these changes even in the 1990s, when Korean Association for Medical Colleges was preparing its report. In light of a dynamically changing society, we must review and revise our definitions of a 'physician for here and now' every ten or twenty years.
Animals ; Cultural Diversity ; Education, Medical ; Education, Professional ; Elephants ; Emigration and Immigration ; Hand ; Humans ; Light ; Male ; Needs Assessment ; Societies, Medical

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