우리나라 일차의료 질평가 연구의 현황 분석
Present Status of Papers on the Primary Care Quality Assessment in Korea
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연구배경: 의료 질평가에 대한 관심은 높지만 일차의료에 대 한 자료는 많지 않기에 지금까지의 연구자료를 분류 및 요약 하여 현재의 수준 인식과 차후 연구방향 정립에 도움을 주고 자 연구를 시작하였다. 방법: 일차의료 관련 논문이 많이 실리는 가정의학회지와 국 내 논문의 대표적 검색엔진에서 ‘일차의료’, ‘일차진료’, ‘개원’, ‘공중보건의’, ‘보건소’로 2008년 10월에 검색을 한 후 결과물에 서 관련 논문을 선별하였으며, 선별된 논문의 참고문헌에서 추가로 자료를 찾았다. 선별 자료를 정리하여 일차의료 전문 가에게 자문하여 빠진 자료를 보충하였다. 질평가 분류는 일 차의료에 적합한 Starfi eld의 분류를 따랐다. 결과: 관련자료는 총 29건이었다. 자료 수집방법으로는 우편 이나 전화를 통하여 공급자 답변을 들은 것이 20건(69.0%), 실 제 자료를 분석한 것이 6건(20.7%), 수요자 답변 분석, 청구자 료와 환자 답변 동시 분석, 합의에 의한 것이 각각 1건(3.4%) 이었다. 질평가 관점별로는 자원 역량분야가 11건(37.9%), 서 비스제공 분야가 4건(13.8%), 서비스에 따른 결과 분야가 2건 (6.9%), 임상적 수행성이 12건(41.4%)이었다. 임상적 수행성 논문의 주제는 대부분이 흔한 질환을 대상으로 하였다. 의료 장비나 술기에 대해서는 기관마다 차이가 많았다. 일차의료 점수는 저조하였다. 결론: 전체적으로 자료가 적고 결과 영역의 연구는 상대적으 로도 부족하다. 수요자가 평가하는 자료, 구체적 처방자료를 이용한 분석으로 객관적인 분석이 필요하다. 추후로 OECD health care quality indicator 중 일차의료 관련 지표를 이용한 연 구가 이루어진다면 국제 간 비교도 가능하며 일차의료 질 향 상에 기여할 수 있을 것이다.
Abstract
Background: The analysis of the papers on the primary care quality assessment in Korea was performed to summarize existing papers, estimate the level of primary care quality, and suggest the directions and areas of the future research. Methods: Primary care quality-related papers were selected via internet web search engines which were Korean Journal of Family Medicine homepage, KMbase, and KoreaMed. Further papers were added after consultation to primary care quality assessment specialists in Korea. Results: The number of related papers was 29. Data collection was done mostly via mail or telephone questionnaire to suppliers, primary care physicians. Papers on resource capacity area were 11, on services delivery 4, on outcome by service 2, and on clinical performance 12. The total primary care score was low. The themes of clinical performance studies were common diseases in Korea. Conclusion: Research volume on primary care quality assessment was poor, especially on outcome area. Data collection methods and quality indicators are needed to diverse. Future researches using OECD health care quality indicators are needed to make international comparison possible, which fi nally contributes to primary care quality improvement in Korea.
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