Evaluating Chronic Care of Public Health Centers in a Metropolitan City
만성질환 관리 평가도구를 이용한 보건소 만성질환 관리수준 평가

Yong-Jun Choi, Dong-Soo Shin, Minah Kang, Sang-Soo Bae, Jaiyong Kim
2014 Health Policy and Management  
To evaluate the quality of chronic care provided by public health centers located in a South Korean metropolitan city using a modified Assessment of Chronic Illness Care (ACIC). Methods: We conducted self-evaluation surveys and collected data using a modified ACIC from twenty five public health centers. Cultural validity of the original ACIC was examined by the public health and nursing science experts. Based on expert reviews, cognitive interviews, pre-test results, five items of the original
more » ... ms of the original ACIC that were not relevant were deleted. The response scale was changed from twelve-point Likert scale to Guttman scale but its scoring system was maintained. Results: Eighty eight percent of public health centers in this study reported that their overall quality of chronic care was at a limited or basic level. About 68% of the centers reported that the organization was as reasonably good or fully developed to provide chronic care. On the other hand, 96% of the public health centers reported that the clinical information system was at a very limited or basic support level. The decision support, the integration of Chronic Care Model components, the delivery system design, the community linkages, and the self-management support were evaluated as limited or basic level of support by more than half of the public health centers, respectively. Conclusion: In a metropolitan area of South Korea, quality of chronic care in public health centers was not found to reach acceptable levels of services. It is critical to enhance the quality of chronic care in public health centers. 서 론 한국에서 만성질환 관리가 중요한 의료정책의 과제라는 점은 의 심할 여지가 없다. 고혈압, 당뇨병 등 만성질환의 질병 부담과 사회 경제적 비용이 적지 않다는 사실이 이미 밝혀졌거니와[1-3] 국가와 지방자치단체, 보험자, 학계 등이 만성질환시대에 대처하기 위하여 다양한 차원에서 노력을 기울이고 있다[4-10]. Wagner 등[11,12]이 정식화한 만성질환 관리모형(Chronic Care Model, CCM)은 이와 같은 대응 과정에서 소개된[6,8,9,13] 대표적 만성질환 관리 패러다임이다. CCM은 무작위 배정 임상시험과 만 성질환 관리프로그램 사례, 유럽 일부 국가의 일차의료의 경험으 로부터 만성질환 관리에 적합한 요소를 추출하여 모형으로 만든 것이다[11,12]. 충분한 정보와 자원을 바탕으로 건강관리에 적극적 인 환자와 잘 준비된 의료진의 생산적인 상호작용 형성을 목표로 삼는 CCM은 지역사회, 보건의료체계, 자가관리 지원, 의료제공체 계 디자인, 의사결정 지원, 임상정보체계를 모형의 여섯 가지 핵심 (http://creativecommons.org/licenses/by-nc/3.0) whichpermit sunrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
doi:10.4332/kjhpa.2014.24.4.312 fatcat:6lptub4j55hi5m7tgmv4l3345e