Earticle

Objectives: The purpose of this study was to identify the needs of the senior welfare center users of the health service program, and to establish a plan to adjust the health service functions of the senior center. Methods: A survey of 2,130 users of the Gyeonggi-do Senior Welfare Center was conducted from May 28 to June 30, 2018. Results: The major results of the study are as follows. First, 66.8 percent of senior welfare center users were willing to participate in health care. The requirement for health service programs was 3.87 points out of 5 points followed by cognitive ability improvement programs, senior movement programs, and chronic disease programs in lower areas. Second, the factors affecting the needs of health care service programs of senior welfare center users had a significant impact on women; the younger the age, the better the subjective health condition; the higher the number of medical conditions, the lower the out-of-patient experience; the longer the welfare center isused, the more people are willing to participate in healthcare. Conclusions: We believe that there is a need for social service policies and management to better understand the situation of senior citizens who are demanding various services due to illness and to integrate health and welfare services.

Objectives: The aim of this descriptive survey study was to examine and compare health status and health care service needs in older adults living with family and those living alone, the relations among the factors. Methods: The participants of this study, conducted from May 28 to June 30, 2018, were 2,003 members of the Gyeong-gi-do Senior Welfare Center. Results: In the case of older adults living with family, the needs for senior movement and cognitive ability improvement programs were high in the lower areas of health care services, while in the case of older adults living alone, there were high needs for chronic disease and cognitive ability improvement programs. The factors affecting the needs for health care service were that female gender, younger age, better subjective health condition for both the older adults living with family and those living alone. Conclusions: We believe that there is a need for social service policies and management to better understand the situation of older adults. who require various services owing to illness.

본 연구는 지역사회 거주노인의 일상생활 현황과 건강상태, 재가복지서비스 욕구등을 분석하여 효과적인 재가노인복지서비스 프로그램 개발의 기초 자료를 제시하고자 하였다. 연구결과 독거노인과 후기고령자는 식생활에 있어 어려움을 호소하고 있었고, 수면/식생활/ADL 곤란이 있는 고령자일수록 건강상태가 좋지 않았으며 수면/식생활/ADL 곤란은 생활만족도(QOL) 저하에도 영향을 미치는 것으로 나타났다. 서비스 욕구에 있어서는 의료서비스와 일상생활지원서비스에 대한 욕구가 높았고, 건강관련 요소와 서비스욕구와의 관계에서는 불면증이 있는 노인과 운동을 하지 않는 노인의 경우 방문간호서비스에 대한 욕구가 높았다. 따라서 수면, 식생활, 운동, ADL 등 고령자 개개인의 건강관련 요소의 상태를 고려한 효과적인 재가복지서비스 개발이 요구되어진다.

With the beginning of Long Term Care Insurance in 2008, the need to develop and expand the Community Care Services for the Elderly Living at Home is now gaining its power. The purpose of this study is to clear the realities and the problems of Community Care Services and present the preliminary data for developing Community Care Service Program through understanding the elderly’s daily lives, state of health and needs for services. The following results are shown up from our investigations. First, the elderly who were living alone or very old had problems in eating. Second, the elderly who had difficulties in sleeping/eating/ADL had worse health conditions and these difficulties in sleeping/eating/ADL also lowered the Quality of their Lives(QOL). Third, in terms of their needs, the elderly had stronger desires for the medical services and daily living support services. In the relation between the elements of good health and their needs, the elderly who suffered from insomnia or didn’t exercise at all had higher needs for Home Nursing Services. On the basis of these results, it is required to develop more comprehensive Community Care Services considering the elderly’s individual health conditions and the factors of health like sleeping, eating, exercising, ADL, etc.

Purpose: This study is a repetitive comparative analysis of a qualitative case study that carried out a home visiting oral health education program. Method: This study conducted an interview survey through medical examination by interview before and after the home visiting oral health education and measured some pathogenic microorganism counts in the denture. Results: There was a positive change in the self oral care ability of the elderly at home after home visiting oral health education, including the behavior of self management of dentures, and some pathogenic microorganism counts in the dentures. Conclusion: The home visiting oral health education of home care service centers can improve oral health care for the elderly at home.

The purpose of this study is to investigate the home-health-care workers licensing education course in Seoul, Korea. Based on the previous research, a conceptual model was suggested explaining the dynamics of perceived educational service quality (SERVQUAL), educational satisfaction and the occupational readiness. The data set for this study drawn from the 297 self-administered surveys were analyzed with the suggested conceptual model by utilizing AMOS program. The measurement models and conceptual model fit well with the collected data set. As results of this study, 5 domains of SERVQUAL were produced including accountability, trustiness, responsiveness, sympathy, and assurance. The results of structural modeling with latent variables confirmed that SERVQUAL were influenced perceived educational satisfaction as well as occupational readiness. Among the SERVQUAL domains, accountability, trustiness, responsiveness, and assurance had significant impacts on the educational satisfaction while accountability, trustiness and responsiveness had significant direct effects on the occupational readiness. The trustiness had significant indirect effects on the occupational readiness via the educational satisfaction. Hence, the educational satisfaction had the significant impacts on the occupational readiness. Based on the findings of this study, we suggest to intense the educational program or curricular focusing on the SERVQUAL elements. Those changes will enhance self-confidence among the prospective home-health-care workers as well as public trustiness on the national long-term care program.

본 연구는 장기요양기관 사례관리 강화 시범운영에 참여한 국민건강보험공단 운영센터 직원과 재가 장기요양기관 사회복지사의 협업 경험을 탐색하고, 장기요양 사례관리 협업의 의미와 제도적 함의를 도출하는 데 목적이 있다. 이를 위해 공단 직원 11명을 대상으로 초점집단면접을, 재가 장기요양기관 사례관리자 11명을 대상으로 심층면접을 실시하였으며, 수집된 자료는 질적 내용분석 방법으로 분석하였다. 분석 결과, 장기요양 사례관리 협업 경험은 ‘장기요양 사례관리의 정립 과정’, ‘사례관리 협업구조의 형성과 긴장’, ‘지속 가능한 협업체계 형성을 위한 조건’의 세 가지 주제로 도출되었다. 시범운영을 통해 공단과 장기요양기관의 역할이 구분되고, 기관 사례관리자의 전문적 역할 인식을 형성하기 시작하였으나, 반복적인 기록 작성과 행정부담 증가, 전산 중심 운영의 한계, 지역사회 자원연계의 제한성은 협업의 지속가능성을 제약하는 요인으로 확인되었다. 본 연구는 장기요양 사례관리가 보험자와 장기요양기관 간 협업을 통해 구조화되는 과정을 실증적으로 분석하고, 공단의 지원·조정 중심 역할 정립과 기관 사례관리자를 위한 실천 중심 교육체계 마련의 필요성을 제안하였다는 측면에서 의의가 있다.

This study investigated the collaborative experiences of National Health Insurance Service (NHIS) staff and social workers from home-based long-term care institutions involved in a pilot project aimed at enhancing case management. Qualitative content analysis was applied to data gathered from focus group interviews and in-depth interviews with 22 participants. Three themes emerged: "the establishment of long-term care case management," "the formation and tensions of collaborative structures," and "conditions for sustainable collaboration." The pilot project successfully clarified the roles of the NHIS and long-term care institutions and boosted professional role awareness among institutional case managers. However, several barriers to sustainable collaboration were identified, including administrative burden, repetitive documentation, and limited community resource linkages. The findings underscore the importance of the NHIS adopting a support- and coordination-centered role and the need for practice-oriented education systems for institutional case managers.

This study was designed out to develop a home health care service for nurses working in community care services. This study investigates actual conditions at welfare institutions related to health needs the demands of clients, and the state of home health care services we hope that this study will improve upon the current service system. In Korea home health care services are still developing and only new becoming a part of the health care supply system. The data was collected by recording the client home nursing assessments modified to the situation of UTMB home health agency. In this study 107 clients were selected for home care who needed care for physical and mental deficits. The study lasted from March to November of 1995 at one of the welfare service institutions in Chunchon city. The results show that those who most frequently needed care services were over 50 years old with a health deficit of 80.3%, followed by sex as women who needed care at 59.8%. 50.5% of the clients had very little education. 99.1% of the clients live with their family, and a medical diagnostic analysis reveals that 73.9% of the 5 year period of illnesses were the following : 38.8% - muscular -skeleton system disorder, 24.4% - hypertension and stroke, 25.7% sole disease of arthritis. For behavioral conditions 43.3% of the patients were without care services, 56.6% of the patients were taking treatment that 73.5% of those were taking medication. The most main complaint of patients were 22.4% of pain in the extremities, next were 16.8% of a limitation of body activities, 15.0% was lumbo-sacralgia. According to the investigator who was a senior student nurse, the following suggestions were made: 32.7% for curative medical services, 29.9% for physical exercise, 19.6% for emotional support. Consultation nursing services consisted of 67.2% for physical therapy, 11.2% for the maintaining healing, 9.4% for counseling. The patients at home, required assistance most frequently for muscular-skeleton problems under the category of physical systems (33.3%). But, on the other hand, 49.5% of the patients required care givers at home, 28.2% had a knowledge deficit, 21.0% had malnutrition, 18.4% had bad impaired communication. The character of health problems were devided into chronic disease(67.0%), accidents(I3.1%), and general disease(15.9%). 86% of the disabled client had an impairment of the physical system. Eating (86.9%) , Toileting(77.6%), and personal care showed much the same of ADL condition, the level and range of achievement of mobility, the most frequently self performed was 81.3% only in a room size area, and 40.2% were completely dependent when going out. Although there were a large number of home care services in th community at these welfare institutions, many clients needed a variety of curative services. As policy changes have gathered momentum, responsibility for the development of a more suitable program was demanded by the clients from the community.

전 세계적으로 암 발생률과 사망률, 암관리비용이 증가하고 있다. 우리나라 또한 사회경제적 수준에 따라 암 치명률과 사망률의 격차를 보일 뿐 아니라, 오히려 사회경제적 취약계층 일수록 암 치료를 위한 의료이용에서 소외되는 건강불평등 양상이 나타나기 시작했다. 따라서 효과적이고 효율적인 의료재원 활용의 필요성이 제기되고 있다. 외국의 경우 우리보다 앞서 암 치료 소외계층이 의료 서비스 이용 과정에서 겪게 되는 물리적․경제적 장애요소에 적절히 개입하여 의료이용 접근성을 높이기 위한 ‘환자 네비게이션 프로그램’이 개발․적용되고 있으며 지속적으로 여러 연구를 통해 프로그램의 효과가 검증되고 있다. 미국 및 캐나다에서 진행된 200개 이상의 환자 네비게이션 프로그램을 통해 사회경제적 취약계층이 암 의료이용 시 겪게 되는 경제적 어려움, 물리적으로 낮은 이용 접근성, 문화적 차이와 언어적 제약, 분절된 서비스 전달체계, 인종에 따른 차별 등을 줄이고 암 의료이용에의 접근성을 높인 결과 암 생존율이 높아진 것으로 보고되었다. 이러한 검토에 따라 우리나라 암 치료 소외계층의 의료이용 형평성 제고를 위한 환자 네비게이션 프로그램 적용 가능성 탐색을 위해서는 우선 암 환자 및 가족 등 프로그램 대상자의 요구도 조사가 이뤄져야 하며 운영 주체를 통한 원활한 프로그램의 기틀 마련, 그리고 네비게이터의 발굴이 이뤄져야 한다. 한국형 환자 네비게이션 프로그램의 성공적인 적용을 위해서는 암 환자 의료이용 실태에 대한 체계적인 조사와 네비게이터 양성을 위한 교육 프로그램이 과제로 제시되었다.

The rate of cancer and the cost of treatment for cancer have increased exponentially worldwide. Given the social costs attributed to the rising rate of cancer-related mortality and death, medical inequality became an issue, and there is a recognized need for effective medical support for cancer patients. In several countries, the Patient Navigation Program, a systematic cancer prevention and intervention program designed to be accessible to Health care disparities in need of cancer treatment, has been reported to be effective. The focus of the study is to investigate the characteristics of Patient Navigation Program and to examine the feasibility of the program in South Korea. The navigation program train paraprofessionals to provide intervention services for cancer patients who experience barriers to medical services. Presently, there are over 200 Navigation Programs in the United States and Canada. As a result, the program has been found to be effective as increasing number of low-income patients have access to medical service which has reportedly decreased the rate of cancer-related mortality. In order to examine whether such program would be as effective in South Korea, our study examines the background and characteristics of Navigation Program use. There is a need for survey for data base for cancer patient service utility and develop navigator training program. The navigation program will decrease the rate of cancer related mortality and serve for medical inequality.