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Background@#This study examined the characteristics of pediatric patients through surveys and in-depth interviews with pediatricians who have experience in telemedicine, and analyzed the current status of telemedicine in pediatrics and the perception of telemedicine among pediatric patients. We also evaluated the associated risks and unsuitability of telemedicine for pediatric patients and presented pertinent policy recommendations. @*Methods@#A questionnaire survey was conducted using the Doctor Survey by the Korean Medical Association. The survey was distributed via email and was open from July 24, 2023 to August 6, 2023. Of the 643 responses, 42 were used for analysis in this study. We examined the perception about providing telemedicine, and the reasons for not providing telemedicine to pediatric patients. In terms of perceptions about telemedicine for pediatric patients, we examined opinions on (1) whether pediatric patients are appropriate candidates for telemedicine, and (2) whether telemedicine could be administered to first-time pediatric patients (including medical consultation) during holidays and at night. @*Results@#Pediatric patients constitute a patient group with distinct characteristics, entailing more careful attention than adult patients. According to the survey results, 42.9% of respondents were not providing telemedicine for pediatric patients. Furthermore, the respondents perceived telemedicine for pediatric patients as unsafe (61.1%), unrealistic (73.8%), and unsuitable (69.0%). @*Conclusion@#Telemedicine for pediatric patients can be viewed as risky and inappropriate. Therefore, the government needs to involve pediatricians in the policy development process for telemedicine aimed at pediatric patients.
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Background@#The purpose of this study is to analyze the differences in the acceptability of telemedicine between telemedicine-experienced and -inexperienced physicians. @*Methods@#A questionnaire survey was conducted using the Doctor Survey of the Korean Medical Association. A total of 1,385 physicians were included in the analysis. Propensity score matching was used to control selection bias. The chi-square tests were used for bivariate analysis. Multiple logistic regression analysis and multinomial logistic regression analysis were used to adjust for covariates (gender, age, working area, working type, institution type, and the specialty of physicians). @*Results@#Physicians with experience in telemedicine were 2.53 times more likely to accept to allow telemedicine as a medical system than physicians without experience in telemedicine. Physicians with experience in telemedicine responded that telemedicine should be allowed to returning patients only and not be allowed to first-time patients. This response of telemedicine-experienced physicians was 3.73 times higher than that of telemedicineinexperienced physicians. Physicians with experience in telemedicine responded that telemedicine for first-time patients should be only allowed under specific situations. This response of telemedicine-experienced physicians was 2.59 times higher than that of telemedicine-inexperienced physicians. @*Conclusion@#Telemedicine-inexperienced physicians were more acceptable to telemedicine as a medical system than telemedicine-inexperienced physicians. Physicians with experience in telemedicine suggested that telemedicine should be allowed to returning patients only and might be allowed to first-time patients only under specific situations.
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Background@#The purpose of this study is to describe the current status of the payment rate of the Korean Medical Association (KMA) membership fee and to suggest a way to overcome the decreased payment rate of membership fees by analyzing the causal factors of the decrease. @*Methods@#Quantitative analysis of the KMA membership data, qualitative research of in-depth interviews with 2 staff members of the regional subsidiaries, and literature research were conducted. @*Results@#From the results, 6 major factors for reducing the membership fee payment rate were derived, and plans to improve the payment rate of membership fees were suggested to improve the factors. First, the role of the KMA and the promotion of its members should be strengthened. Second, there should be a flexible adjustment of the membership fee. Third, there should be an enhancement of the transparency of budget execution and increased awareness through the promotion of the members. Fourth, differentiated incentives should be offered to the members who pay dues. Fifth, an improvement of a more efficient and easier payment method should be installed. Finally, legal enforcement measures to pay the membership fee should be considered. @*Conclusion@#In order to improve the payment rate of the KMA membership fee, the KMA should try to make the members understand the performance of the business affairs and health policies. Furthermore, incentives that members can feel should be given.
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Since the coronavirus disease 2019 outbreak, telemedicine has become an important means of providing medical care worldwide. This study aims to highlight the implications of establishing telemedicine policies in Korea. Japan’s telemedicine policies were reviewed from the time of the first trial to the present official allowance.Current Concepts: Since telemedicine demonstration work began in 1971, telemedicine in Japan has advanced in four stages. The first stage was the operation of a remote regional comprehensive medical information system from 1971 to 1997. The second stage was when telemedicine was officially institutionalized from 1997 to 2018. The third stage was the time of expansion of telemedicine, from the announcement of the “Guidelines for the Implementation of Proper Online Care” in 2018 to when online first-time examinations were temporarily allowed in 2020. The fourth stage began in 2021 when the “Permanent Establishment of Special Cases for Online Care” was announced, and telemedicine has been officially allowed to supplement face-to-face care. Telemedicine usage was estimated to be about 53.65 million in 2021, and the total number of treatments in Japan in 2021 was estimated to be about 1.32 billion, accounting for about 4.1% of medical care.Discussion and Conclusion: For the Korean government to establish telemedicine, it needs to be promoted step by step through discussions with the medical community. Also, an appropriate medical remuneration system needs to be prepared along with guidelines reflecting the opinions of the medical community to secure the safety of telemedicine.
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As the world faced a pandemic caused by the coronavirus disease (COVID-19) outbreak in 2019, telemedicine quickly spread and was widely adopted. This was the first instance where telephone consultations were temporarily allowed in Korea. We used data from the 2020 Korean Physician Survey and analyzed the physicians’ perceptions of telephone consultations, the reasons for providing these consultations, and the level of physician satisfaction after providing it.Current Concepts: A total of 6,342 respondents were selected for the final analysis of the research results. Regardless of the COVID-19 pandemic, the data showed that most physicians had a negative perception (77.1%) toward the introduction of the telemedicine system. A third (31.1%) of physicians surveyed had provided medical treatment via telephone consultation. According to the position the physicians held, professors, fellows, self-employed physicians, and public health physicians had the most experience in this method of consultation. The use of telephone consultation was highest in the field of internal medicine (44.5%) treatment. Data also showed that most physicians (83.5%) who provided such consultations experienced difficulties in making a medical judgment that could ensure their patients’ safety.Discussion and Conclusion: The results of this study verified that physicians’ opinions about the telemedicine system differed according to service, area of specialization, region, and type of medical institution. A closer review and establishment of policy alternatives are required to explore the possible expansion of teleconsultations and related medical treatments in the future.
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This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.
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This study aims to suggest practical strategies for improving the governance system of the Korean Medical Association (KMA). To this end, we used survey studies, statistical analysis, and literature reviews. The statistical analysis was performed using an analytic hierarchy process and frequency analysis. In our previous study, we proposed some measures to improve the governance system of the KMA. These measures included the organization of top decisionmakers’ meetings, recruitment of non-member officers, new qualification requirements for representatives and officers, commitment of functional roles to six vice-presidents, and organization of professional committees supporting the roles of six vice-presidents. In this study, we proposed practical strategies for the improvement measures and an implementation organization to achieve the suggested practical strategies. For the implementation of the practical strategies, the members of the KMA should understand the issue and the importance of the KMA’s governance. Additionally, the strong support of the members should be required to solve the internal problems of the KMA and to improve its governance system.
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The quality of medical services and the health of patients can be guaranteed when the doctors are healthy. In this study, we used the data from the 2016 Korean Physician Survey and analyzed the relationship of lifestyle, stress, and chronic diseases status with the self-rated health of Korean doctors. Among 7,631 doctors in Korea, 2,336 (30.6%) reported their self-rated health as ‘good’, 4,462 (58.5%) as ‘moderate’, and 833 (10.9%) as ‘bad’. The multinominal logistic regression analysis, showed that factors related to the self-rated health were age, type of healthcare facility, smoking, exercise, sleep duration, stress, and chronic diseases status. Since doctors’ lifestyle, stress, and chronic disease status were closely related to their self-rated health, it is imperative to prepare measures to protect doctors’ health in an intensive medical environment, where too many patients require treatment, due to the characteristics of the medical system in Korea.
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The year 2020 marks the 112th year of the Korean Medical Association (KMA), which is a historic organization of medical experts. Since its foundation the KMA has contributed to the promotion of the health and medical care environment as well as the establishment and development of related policies. In times of health and medical care crises in the country, the KMA has always fought at the front lines. However, recent internal conflicts in the medical community have caused a lack of consistency and persistence in responding to or pursuing various health and medical policies. It weakens the KMA’s social status and influence, raising demands for its improvement. The first step for the betterment of the KMA is to analyze its critical situation. This study assumes that the internal conflicts are caused by the KMA’s governance. Through an analysis of how the KMA is currently governed, this study highlights the problems and suggests a direction for improvement.
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The purpose of this study is to suggest improvement measures to solve the problems of governance within the Korean Medical Association (KMA), and to outline future tasks to implement these measures. The following measures are proposed to improve the governance of the KMA: a new representative system, the revision of the term of officers, new qualification requirements for representatives and officers, a clear business division for vice presidents, the organization and operation of councils by professional fields, and an organization of a top decision making committee. Future tasks to apply these measures in practice include the establishment of the direction of improvement of the KMA‘s governance, organization and operation of the presidential committee, and active participation and support of the KMA members. In order to improve the KMA‘s governance, the bodies of the KMA must avoid conflicts and criticisms; taking collective decisions about all tasks and policies should be made an essential principle. In conclusion, the bodies of the KMA must cooperate with each other while constantly considering and discussing the purpose of the establishment of the KMA. These measures will ensure the improvement of KMA’s governance.
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PURPOSE: As an alternative to core-needle biopsy in confirming the diagnosis of breast cancer, the usefulness of (99m)Tc-sestamibi scintimammography (MIBI scan) has been rarely reported. Thus, we aimed to evaluate a direct comparison between general diagnostic modalities and breast MIBI scan, which may be revealed as a potential diagnostic alternative.METHODS: In a retrospective study, 301 patients with 801 lesions, who underwent breast MIBI scan, ultrasonography, and mammography simultaneously between January 2013 and February 2015, were reviewed. All data were analyzed by McNemar and Kappa test for statistical significance.RESULTS: Mean age was 49.2±9.37 years old (range from 26 to 85 years old). Results of Breast MIBI scan were divided into three categories: 236 positive intensity uptakes (29.5%), 565 negative intensity uptakes (70.5%), and 67 suspicious abnormal intensity uptakes (8.4%). Pathologic reports were also allocated into four subgroups: 122 invasive cancers (15.2%), 44 non-invasive cancers (5.5%), 194 proliferative benign lesions (24.2%), and 441 non-proliferative benign lesions (55.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of MIBI scan were 83.5%, 55.6%, 59.1%, and 95.2%, respectively. Specificity of MIBI scan plus general diagnostic modalities increased dramatically, up to 85.2%, compared to general modalities (6.8%).CONCLUSION: In general diagnostic modalities, such as mammography and ultrasound, BI-RAD category 4 or higher lesions were performed by needle biopsy rather than observation. The outstanding specificity and negative predictive value of MIBI scan provided confident results on non-proliferative benign lesions. MIBI scan may offer an alternative diagnostic tool for “invasive” biopsy procedures.
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Humanos , Biopsia , Biopsia con Aguja , Mama , Neoplasias de la Mama , Diagnóstico , Mamografía , Estudios Retrospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
The purpose of this study was to suggest signposting strategy for healthcare policy. Analytic hierarchy process analysis was used to classify the decision levels of healthcare policies using the Delphi professional survey and a literature review. National health insurance was identified as a priority healthcare policy. After that, arranged in order of priority, were the healthcare delivery system, health and medical care, and healthcare resources. Among the sub-levels in healthcare policy, the reimbursement system was a priority policy. This study confirmed that healthcare providers are interested in national health insurance. because their greatest concern was the reimbursement system. Consequently, in order to determine and implement healthcare policy efficiently, the government should consider the opinions of healthcare providers.
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Humanos , Atención a la Salud , Personal de Salud , Recursos en Salud , Seguro , Programas Nacionales de SaludRESUMEN
BACKGROUND: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. METHODS: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. RESULTS: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. CONCLUSION: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.
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Humanos , Atención Ambulatoria , Estudios de Cohortes , Deducibles y Coseguros , Atención a la Salud , Hospitales Generales , Modelos Logísticos , Enfermos Mentales , Programas Nacionales de Salud , Pacientes Ambulatorios , PrescripcionesRESUMEN
The purpose of this study was to analyze the current status of utilization of medical and Korean traditional medical institutions. In this study, we used a sample cohort database from the National Insurance Service and frequency analysis was performed. The major results are as follows. First, the majority of users of medical institutions were found to use medical facilities. However, patients with three musculoskeletal disorders and two disease of respiratory diseases showed higher utilization rates of Korean traditional medical institutions and a highter overlapping utilization rate than those with other diseases. Second, they also visited medical facilities more often and spent more on medical expenses than those who used only medical institutions. Therefore, there is a need for policies that directly or indirectly restrict the use of overlapping medical care for the same disease so that limited medical resources can be used efficiently.
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Humanos , Estudios de Cohortes , Seguro , Pacientes AmbulatoriosRESUMEN
The main objective of this study to propose an implementation about telemedicine policy in Korea through analyzing current status of state telemedicine policy in the United States. To achieve the result, three types of data sets were used to draw conclusions; 1) status of insured service of telemedicine in each state, 2) physician practice standards related to telemedicine, and 3) licensure. Analyzed results indicated differentiation in insured status of telemedicine service among private insurance parity law, medicaid coverage parity law, and state employee health plan parity in each states. Only two states provide insured service of telemedicine without any limits or certain conditions. Other states have a strict regulation or coverage condition about providing insurance. Each states also apply rigorous standards to telemedicine providers about physician practice standards and licensure. Some states restrict telemedicine itself or provide strict regulation process of telemedicine in Physician-patient encounter. Also, the most strict type 'full state license' and 'consulting exemptions (applied in certain condition)' are applied in most of states. On the basis of study result, environmental and conditional requirement implementation in application of telemedicine policy in Korea is provided in conclusion.
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Femenino , Conjunto de Datos , Seguro , Jurisprudencia , Corea (Geográfico) , Concesión de Licencias , Medicaid , Salud Laboral , Paridad , Telemedicina , Estados UnidosRESUMEN
Telemedicine is a critical infrastructure that directly affects people's lives. In this vein, the government announcement of the introduction of a telemedicine service has caused controversy among the government and medical institutions over the safety of the service. Before the introduction of the telemedicine service, its technical safety and effectiveness should be validated. The telemedicine system should be supported by proper policies to ensure a secure, continuous service. To this end, we have conducted research to derive the security requirements from domestic and foreign standards and laws relating to telemedicine and information security. Based on the derived requirements, we have developed a security standard for telemedicine that facilitates the objective assessment of the security of the telemedicine service. Furthermore, we have analyzed the vulnerabilities of telemedicine devices through penetration tests. Finally, using a risk analysis method, we have created risk scenarios that might occur in the provision of telemedicine services, and have calculated risk levels and expected loss for each scenario. We expect that the results of this research will be a basis for ensuring a sufficient budget and staff for the safety of telemedicine, and for establishing relevant policies.
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Presupuestos , Jurisprudencia , Telemedicina , VenasRESUMEN
The objectives of this study are (1) to examine the training and working conditions of residents after revision of the 'Regulations on Specialist Training and Accreditation,' (2) to determine the causes of problems with these training and working conditions, and (3) to seek improvement in these conditions. A questionnaire survey was conducted over two weeks. A total of 10,768 respondents and 1,793 valid responses were analyzed. Although revised regulations had been implemented, training conditions did not appear to have undergone any improvements. 52.9% of residents work over 80 hours per week and 27.1% respondents exceeded 100 hours per week. 76.9% of respondents indicated that they exceed the maximum continuous training time of 36 hours. 64.5% of respondents said their emergency room training time was over 12 hours. 25.4% of respondents' duty days exceeded three days a week. 34.7% of respondents said that they had less than three days off per month. The proportion of those with annual leave under 14 days is 70.2%. For substantive improvements in training and working conditions, new plans must consider practical factors in the implementation of improvements. This requires a governance structure based on participation, and an independent, objective training evaluation organization should be established to perform a reliable assessment. Above all, the government financial compensation plan must prepare for improving the training environment.
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Compensación y Reparación , Educación , Servicio de Urgencia en Hospital , Control Social Formal , Especialización , Encuestas y CuestionariosRESUMEN
The hypoglossal nerve palsy receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. A literature review revealed that in most cases, isolated hypoglossal nerve palsy indicates the presence of an intracranial or extracranial space occupying lesion, head and neck injury, vascular abnormality, infection, autoimmune disease or neuropathy. Reports of idiopathic cases are rare and treated with steroid therapy. We report a 38-year-old woman with isolated hypoglossal nerve palsy improved spontaneously without steroid use. Considering our experience with isolated hypoglossal nerve palsy, we believe that no therapy is required in the patients with hypoglossal nerve palsy of probably idiopathic causes.
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Adulto , Femenino , Humanos , Enfermedades Autoinmunes , Enfermedades de los Nervios Craneales , Cabeza , Enfermedades del Nervio Hipogloso , Nervio Hipogloso , Traumatismos del Cuello , ParálisisRESUMEN
An inflammatory pseudotumor [IPT] is a rare benign lesion, characterized by nonneoplastic proliferation of inflammatory cells and presence of intermingling collagen fibers. IPT commonly occurs in the lungs and orbita, while an intraspinal IPT is extremely rare. IPT can mimic both clinically and radiologically malignant processes, and making a definitive preoperative diagnosis is often difficult. Recently, 18-fluorine fluorodeoxyglucose [[18]F-FDG] has been reported to accumulate in IPT in the lung, spleen, liver, pancreas, colon, orbit, mediastinum, and mesentery. However, to the best of our knowledge, accumulation of [18]F-FDG has not been reported in lumbosacral intraspinal IPT. Herein, we report a case of IPT in the epidural space of the lumbar spine, using the imaging findings of [18]F-FDG positron emission tomography-computed tomography [PET/CT] and contrastenhanced magnetic resonance imaging [MRI]. This is the first case of IPT in the epidural space, depicted by [18]F-FDG PET/CT, which revealed a homogeneous, intense [18]F-FDG uptake
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Humanos , Masculino , Granuloma de Células Plasmáticas/diagnóstico , Espacio Epidural , Región Lumbosacra , Columna Vertebral , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
Expression of HER2 in gastric carcinoma has direct prognostic and therapeutic implications in patient management. The aim of this study is to determine whether a relationship exists between standardized uptake value [SUV] and expression of HER2 in advanced gastric carcinoma. We analyzed the 18F-FDG PET/CT results of 109 patients that underwent gastrectomy for advanced gastric carcinoma. The 18F-FDG PET/CT imaging was requested at the initial staging before surgery. The examinations were evaluated semi-quantitatively, with calculation of maximum standardized uptake values [SUVmax]. The clinicopathologic factors, including HER2 overexpression, were determined from tissue obtained from the primary tumor. Metabolic and clincopathologic parameters were correlated using a t-test, one way ANOVA and chi-square test. Immunohistochemically, 26 patients [23.8%] showed HER2 overexpression. This overexpression was significantly associated with high SUV level [P=0.02]. The SUV level was significantly correlated with tumor size [P=0.02] and differentiation [P<0.001], and Lauren histologic type [P=0.04]. Multivariate analysis showed HER2 overexpression, large tumor size, and differentiation [P=0.022, P=0.002, P<0.001] were significantly correlated with the high level of SUV in advanced gastric carcinoma. No association was found between SUV and T stage and lymph node metastasis. A receiver-operating characteristic curve demonstrated a SUVmax of 3.5 to be the optimal cutoff for predicting HER2 overexpression [sensitivity; 76.9%, specificity; 60.2%]. An association exists between high SUV and HER2 overexpression and 18F-FDG PET/CT could be a useful tool to predict the biological characteristics of gastric carcinoma