The ongoing pandemic in Singapore is part of a global pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To control the spread of COVID-19 and prevent the healthcare system from being overwhelmed, 'circuit breaker' measures were introduced between 7 April and 1 June 2020 in Singapore. There is thus a crucial need for innovative approaches to the provision and delivery of healthcare in the context of safe-distancing by harnessing telemedicine, especially for patients with chronic diseases who have traditionally been managed in tertiary institutions. We present a summary of how the Virtual Monitoring Clinic has benefited the practice of our outpatient rheumatology service during the COVID-19 pandemic. The virtual consultations address the need for safe-distancing by limiting face-to-face appointments and unnecessary exposure of patients to the hospital where feasible. This approach ensures that the patients are monitored appropriately for drug toxicities and side-effects, maintained on good disease control, and provided with patient education.
Ambulatory Care/methods* ; Antirheumatic Agents/therapeutic use* ; COVID-19 ; Delivery of Health Care ; Humans ; Nurse Practitioners ; Pharmacists ; Rheumatic Diseases/drug therapy* ; Rheumatology/methods* ; SARS-CoV-2 ; Singapore ; Telemedicine/organization & administration* ; Tertiary Care Centers

BACKGROUND: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public- private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. METHODS: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. RESULTS: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. ‘Transfers from government domestic revenue’ share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to ‘compulsory contributory health financing schemes,’‘Transfers from government domestic revenue’ share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. CONCLUSION: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.
Ambulatory Care ; Belgium ; Censuses ; Classification ; Delivery of Health Care ; Family Characteristics ; Financing, Government ; Gross Domestic Product ; Health Expenditures* ; Healthcare Financing ; Humans ; Information Storage and Retrieval ; Inpatients ; Insurance ; Insurance, Health ; Japan ; Korea* ; Organisation for Economic Co-Operation and Development ; World Health Organization

BACKGROUND: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public- private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. METHODS: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. RESULTS: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. ‘Transfers from government domestic revenue’ share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to ‘compulsory contributory health financing schemes,’‘Transfers from government domestic revenue’ share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. CONCLUSION: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.
Ambulatory Care ; Belgium ; Censuses ; Classification ; Delivery of Health Care ; Family Characteristics ; Financing, Government ; Gross Domestic Product ; Health Expenditures* ; Healthcare Financing ; Humans ; Information Storage and Retrieval ; Inpatients ; Insurance ; Insurance, Health ; Japan ; Korea* ; Organisation for Economic Co-Operation and Development ; World Health Organization

Smoking is a leading cause of premature death, and the World Health Organization estimates 8 million deaths per year are due to smoking-related diseases. Most smokers want to quit smoking, which is not easy because of nicotine dependence. Physicians can help smokers quit smoking by assessing their dependence and motivating them on their clinic visits. Brief advices provided by doctors is a simple and very cost-effective methods of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with advice and behavioral intervention. Sometimes, intensive counseling, either individual or group, is needed to promote smoking cessation. Health care providers also need to be familiar with pharmacotherapy. Additionally, other sources of support, such as written materials, a telephone quit-line, and strategies for preventing relapses should be integrated into the treatment. Future research could contribute to further understanding about the effects of various intensities of treatment, particular settings for treatment, or a treatment's effect among specific populations. This could include identifying the optimal amount of behavioral support to use with pharmacotherapy.
Ambulatory Care ; Counseling ; Drug Therapy ; Health Personnel ; Humans ; Methods ; Mortality, Premature ; Recurrence ; Smoke* ; Smoking Cessation* ; Smoking* ; Telephone ; Tobacco Use Disorder ; World Health Organization

PURPOSE: This study was to estimate salt preference and sodium intake of pregnant women, and identify the relationship between salt preference and sodium intake. METHODS: Research design was a cross sectional correlational survey with 197 pregnant women who visited outpatient clinics for antenatal care. The sodium intake levels were estimated by the amounts of sodium intake using the 24-hour recall method and sodium concentration in spot urine. The data were analyzed using descriptive statistics, t-test, ANOVA and Pearson's correlation. RESULTS: Sodium intake using 24-hour recall method was 3,504±1,359 mg. Sodium intake levels had statistically significant differences depending on income. The average amount of sodium in spot urine was 2,882±878mg/day. Sodium excretion levels had statistically significant differences depending on whether participants had preexisting hypertension in their family history and Body Mass Index (BMI) pre-conception. Salt preference was 62.61±20.96 out of 180 points. Salt preference had significant differences depending on income, parity, gestational age, BMI pre-conception and showed negative correlation with sodium quantity in spot urine. CONCLUSION: Sodium intake in pregnant women recommended by World Health Organization recommended is 175%. Salt preference was not significantly different between sodium intake levels, however it was negatively correlated with sodium quantity in spot urine among pregnant women.
Ambulatory Care Facilities ; Body Mass Index ; Female ; Gestational Age ; Humans ; Hypertension ; Methods ; Parity ; Pregnant Women* ; Research Design ; Sodium* ; World Health Organization

PURPOSE: This study was done to develop and implement the Nursing KMS (knowledge management system) in order to improve knowledge sharing and creation among clinical nurses in outpatient departments. METHODS: This study was a methodological research using the 'System Development Life Cycle': consisting of planning, analyzing, design, implementation, and evaluation. Quality Function Deployment (QFD) was applied to establish nurse requirements and to identify important design requirements. Participants were 32 nurses and for evaluation data were collected pre and post intervention at K Hospital in Seoul, a tertiary hospital with over 1,000 beds. RESULTS: The Nursing KMS was built using a Linux-based operating system, Oracle DBMS, and Java 1.6 web programming tools. The system was implemented as a sub-system of the hospital information system. There was statistically significant differences in the sharing of knowledge but creating of knowledge was no statistically meaningful difference observed. In terms of satisfaction with the system, system efficiency ranked first followed by system convenience, information suitability and information usefulness. CONCLUSION: The results indicate that the use of Nursing KMS increases nurses' knowledge sharing and can contribute to increased quality of nursing knowledge and provide more opportunities for nurses to gain expertise from knowledge shared among nurses.
Ambulatory Care/*organization & administration ; Attitude of Health Personnel ; Humans ; Internet ; Nursing Staff, Hospital/*psychology ; *Program Development ; *Program Evaluation ; Tertiary Care Centers ; User-Computer Interface

This study investigated the German experience in the transition to a unified health care system and suggests the following implications for Korea. First, Germany could have made use of the unification process better if there had been a good road map. Therefore Korea must develop a well prepared road map that considers all possible situations. Second, Germany saw an opportunity for the improvement of the health care system in the early stage of unification but could not take advantage of it because the situation changed dramatically and they had not sufficiently prepared for it. Korea should take into account the opportunity for improvement of the present health care system, such as the roles of public health and traditional medicine. Thirdly, the conditions f North Korea seem to be far worse than those of former East Germany and also worse than even those of other transition countries. Therefore Korea should design a long-term road map taking as many variables into account as possible, including the different rigid way of thinking and the interrelationship among the social sectors. Fourthly, during the German reunification unexpected factors changed the direction of the events. Korea should have a separate plan for the unexpected factors.
Ambulatory Care ; Delivery of Health Care/methods/*organization & administration/standards ; Germany ; Germany, East ; Humans ; Medicine, Traditional ; Public Health ; Republic of Korea

To study the interaction between establishment of wound care center and development of discipline of burns and plastic surgery. The changes in number of outpatient, time for dressing change per patient, outpatient service income, number of inpatients and operations in our hospital were summarized and retrospectively analyzed before and after establishment of wound care center. The proportion of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients in the same term were investigated. Meanwhile, the development of discipline of burns and plastic surgery before and after establishment of wound care center was analyzed. Compared with those in the year before establishment of wound care center, outpatient number, time for dressing change per patient, outpatient service income, inpatient number, and amount of operations were all increased (with increase rate of 330%, 569%, 325%, 161%, and 173%, respectively) in the year after establishment of wound care center. The ratio of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients was respectively increased from 4.3% and 4.5% in the year before establishment of wound care center to 9.2% and 12.4% in the year after establishment of wound care center. Patient satisfaction, bed utilization rate, levels of wound treatment and repair were all improved after establishment of wound care center. So we come to conclusions as follows. Establishment of wound care center can promote development of the standard of burns and plastic surgery. Comprehensive use of multidisciplinary theories and techniques concerning burns, plastic and aesthetic surgery, medical aesthetics, etc. can be beneficial for improvement of quality of wound healing and achievement of cosmetic effect, and wound care center may be further developed.
Ambulatory Care ; organization & administration ; Burn Units ; organization & administration ; Burns ; surgery ; Humans ; Patient Care Team ; organization & administration ; Surgery, Plastic ; organization & administration ; Surgicenters ; organization & administration ; Wound Healing

INTRODUCTIONThis paper aims to illustrate the use of computer simulation in evaluating the impact of a prototype automated dispensing system on waiting time in an outpatient pharmacy and its potential as a routine tool in pharmacy management.

MATERIALS AND METHODSA discrete event simulation model was developed to investigate the impact of a prototype automated dispensing system on operational efficiency and service standards in an outpatient pharmacy.

RESULTSThe simulation results suggest that automating the prescription-filing function using a prototype that picks and packs at 20 seconds per item will not assist the pharmacy in achieving the waiting time target of 30 minutes for all patients. Regardless of the state of automation, to meet the waiting time target, 2 additional pharmacists are needed to overcome the process bottleneck at the point of medication dispense. However, if the automated dispensing is the preferred option, the speed of the system needs to be twice as fast as the current configuration to facilitate the reduction of the 95th percentile patient waiting time to below 30 minutes. The faster processing speed will concomitantly allow the pharmacy to reduce the number of pharmacy technicians from 11 to 8.

CONCLUSIONSimulation was found to be a useful and low cost method that allows an otherwise expensive and resource intensive evaluation of new work processes and technology to be completed within a short time.

Ambulatory Care ; Automation ; Computer Simulation ; Efficiency, Organizational ; Medication Systems, Hospital ; organization & administration ; Pharmacy Service, Hospital ; standards ; Singapore ; Time Factors

This paper introduces the application of a calling and queuing system for blood sample collection in a large hospital in China. Besides the basic function, it has following functions. (a) A real name system: get the number according to the laboratory application form to prevent the phenomena of buying a number and an empty number. (b) Two times waiting: the patient should wait at the main hall, then at the blood sampling window so as to improve the work efficiency. (c) The flowchart for an outpatient blood testing is as following: getting the number --> waiting --> blood sampling --> getting the test information report. This system is capable of not only optimizing the work flow, but also improving the clinical environment. It shortens the patient's waiting time and raises the laboratory quality as well.
Ambulatory Care ; methods ; Ambulatory Care Information Systems ; Blood Specimen Collection ; Laboratories, Hospital ; organization & administration