Prevalence of Sleep Disorder and Associated Factors in Family Practice / 가정의학회지

BACKGROUND: Sleep is an essential restorative physiologic phenomenon. Impaired sleep results in significant negative effect to the health. Symptoms like sleep initiation difficulty, frequent awakening, severe snoring have related to poor sleep quality. We studied frequency and compared the characteristics of common sleep disorders at family practice. METHODS: We surveyed patients over 18 years of age and their guardians who visited 16 familial practices for 6 days. We investigated sleep characteristics, frequency of sleep disorder and associated factors by questionnaires and analyzed by frequency analysis, Spearman's correlation coefficient, multiple logistic regression. RESULTS: We enrolled 1,117 participants. Older participants were more likely to report early sleep onset and off time, short sleep duration. Mean number of awakening during a typical night is 1.69. Female complained difficulties in initiation and maintenance of sleep more than male. A total of 32.5% had these insomnia symptoms and related to hypertension, stroke, stress, arthralgia, depression, urological disorder. 31.1% had excessive daytime sleepiness, related to stress, arthralgia, depression. Loud snoring and gasp for breath showed positive correlation between male, high BMI. Disrupted sleep over 3 times was related to old age, female, diabetes, hypertension, stroke, stress, arthralgia, depression. Restless leg syndrome were high in elderly, high BMI, stress, arthralgia and depression. CONCLUSION: About one in three who visit in primary medical practice have sleep disorder symptoms like insomnia, daytime fatigue, snoring. 3% of them have gasp for breath, 8% have restless leg syndrome.

Referral Pattern of Family Practitioners : Cheonan Practice-Based Research Network Study

BACKGROUND: Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). METHODS: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. RESULTS: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. CONCLUSION: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty.

Referral Pattern of Family Practitioners : Cheonan Practice-Based Research Network Study

BACKGROUND: Consultation and referral are important characteristics of modern medicine which has become more segmented and more specialized. In particular, they give essential value to family practitioners to coordinate patients accordingly for proper care. This study analyzed the referred patients in family practices under Cheonan practice based-research network (CPBRN). METHODS: The data was collected via questionnaire in ten family clinics under CPBRN system during the four weeks from June 15, 2006 to July 12, 2006. RESULTS: The total number of referred cases was 103 (0.7%) out of a total of 14,466 office visits. Among the total, 68.9% of referred cases was physician-drived and 31.1% was patient-requested. The reason for referral were 'to get a second opinion of specialist' (34), 'high severity' (20), 'lack of examination tool' (18), 'lack of skill' (10) and 'no response to treatment' (2) in physician-drived cases, whereas in patient-requested cases, they were 'request for advanced hospital' (26) and 'want to meet specialist' (2). The patients were referred to tertiary hospital in 66.7%, secondary hospital in 15.9%, and other specialists of primary setting in 10.1%. Overall, 66.7% of the referred hospital was located in the city area. The main health problems of referred patients was divided into 'gastrointestinal' (17.5%), 'musculoskeletal' (13.6%), 'dermatology' (10.7%) and so on. The speciality consulting physicians were 'internal medicine' (34%), 'pediatrics' (13.6%), and 'orthopedic surgery' (10.7%) specialists. CONCLUSION: The referral rate of family practice in Korea was 0.7%. The main reason for referral was 'to get a secondary opinion of a specialist'. The most common referral problem was 'gastrointestinal'. 'Internal medicine' was the most frequently consulted specialty.

Self-care for Diabetic Patients in Primary Care

BACKGROUND: Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. METHODS: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. RESULTS: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. CONCLUSION: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices.