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수도권지역 개원의의 진료내용 분석

Other Titles
 (The) analysis of clinical contents of general practioners in the Capital city 
Issue Date
1987
Description
의학과/석사
Abstract
[한글] 우리나라 일차진료기관의 진료내용을 규명하기 위하여, 개원가에서 1차진료를 담당하는 개원의들의 환자의 특성, 질병의 종류와 빈도를 조사하고 의사들간의 차이점을 분석하고자, 1986년 9월 1일 현재, 대한가정의학회서울지부에 등록된 수도권내의 개원의 311명 전수를 대상으로 우편과 전화를 이용하여 1986년 10월 1일에서 9일까지 평상시 진료를 한 3일간의 환자에 대한 조사표를 기록하도록 한후에 회수된 161명의 자료를 전산처리, 기술적 통계방법 및 교차제표에 의한 X**2 검정을 통하여 다음과 같은 결과를 얻었다. 1. 개원의들의 평균연령은 53.9세, 평균개원연수는 18.4년이었고, 정규레지던트수련을 받지 않은 의사가 89.4%이었다. 2. 남자의사가 전체의사의 66.5%, 여자의사가 33.5%이었으며, 진료업무최고령은 남자가 79세, 여자가 58세이었다. 3. 방문환자를 성별로 보면 여자환자가 7,855명(55.8%)으로 남자환자보다 많았으며 이를 각 연령계급으로 구분하여 보면 0∼19세 계급을 제외한 전 연령계급에서 여자환자가 남자환자보다 많았다. 4. 남자의사 1인당 진료한 평균 환자수는 각각 남자47.7명, 여자51.5명이었고, 여자의사 1인당 진료한 환자수는 각각 남자21.2명, 여자44.3명으로, 여자의사는 남자환자보다 여자환자를 많이 진료하였다. 5. 30∼39세, 40∼49세, 50∼59세, 60∼69세 의사가 진료한 30세미만 환자의 백분율은 각각 80.6%, 70.8%, 63.0%, 57.5%이었고, 60세이상의 환자백분율은 각각 1.4%, 5.1%, 6.2%, 7.5%로 의사나이가 많으면 30세미만 환자백분율이 낮아지는 반면에 60세이상 환자의 백분율은 높아졌다. 6. 개원의가 환자에 사용한 진단명은 총274개였고, 이중 흔한 진단명 1위에서 10까지가 전체환자의 66.9%이었다. 이들의 진단명에는 각 임상과의 흔한 질병과 복합적 치료를 요하는 질병이 골고루 포함되어 있어 대학병원에 내원하는 환자의 진단명 분포와는 차이가 있었다. 7. 환자가 호소하는 주소(chief complaints)를 보면 전체 208종류의 주소중 빈도가 높은 순으로 1위에서 10위까지의 주소를 호소하는 환자가 전체환자의 77.6%이었다. 8. 의사가 시행한 진단검사를 보면 환자1인당 평균0.14건의 검사를 시행하였고, 검사종류는 38가지이었다. 이중 시행빈도순으로 상위 10개의 검사는, 시행된 전체검사중 87.6% 이었으며, 가장 시행빈도가 높은 검사를 보면 그람염색과 현미경검사(25.1%), 소변검사(22.0%) 흉부X선검사(12.0%)순이었다. 9. 질환별 환자 100명당 시행된 검사건수를 보면, 요로생식기, 소화기, 호흡기질환에서 각각 65.5건, 2.6건, 2.1건으로 요로생식기질환에서 소화기, 호흡기질환에서 보다 많은 검사가 시행되었다. 이상의 결과로 수도권의 개원의들은 외래에서 각과의 흔한 질병에서부터 복합적인 치료를 요하는 질병에까지 다양하게 진료를 하며, 이들이 진료하는 환자의 성과 연령분포는 각각 의사의 성과연령에 영향을 받았으며, 환자진료에 사용하는 검사이용빈도는 질환의 종류에 영향을 받았다.
[영문] This is a fundamental study concerning the clinical contents in primary care facilities in Korea. It explains the role of the general practioners, what characteristics the patient might have, the types of disease and their frequencies, the kinds of diagnostic tools used and their frequencies, and the different medical management among physicians using the data of patients seen by all the members of Academy of family physicians during the 3 days in family practice setting situated in the capital city. The data collected was analyzed by descriptive statistical method and X**2 test by cross tabulations. Followings are the result of the study: 1. The average age of family doctors was 53.9 years. The average years of general practice was 18.4 years of which 89.4% did not receive regular training in residency. 2. Male physicians continued to work in clinics until they were 79 years of age whereas the oldest of working female doctor was 58 years of age. 3. The highest number of visitors was shown in age between 0-9. Male patients was more dominant ages under 20, however ages over 20, female patients outnumbered male patients. 4. The average number of male and female patients per male doctor was 47.7 and 51.5 respectively, and that of female doctor was 21.2 and 44.3 respectively, illustrating that female patients were seen more by female doctors than their counterparts. 5. According to doctor's age divided into age groups 30-39, 40-49, 50-59 and 60-69 years of age, the percentile of patients who were 30 years old or younger were 80.6%, 70.8%, 63.0%, 57.5% respectively and those of patients who were 60 years and older were 1.4%, 5.1%, 6.2%, 7.5% respectively. As doctor's age increased, the percentile of patients who were 30 years old or younger decreased whereas that of patients who were 60 years and older increased. 6. Of 14,254 patients seen by family doctors, 274 kinds of diseases were diagnosed. The percentile of diseases from the most frequent to the 20th frequent disease diagnosed accounted for 66.9% of th total. Diagnosis varied from some of the common diseases on can face in clinical practice to the ones which required complexive therapy. There was difference in the distribution of diagnosis in this study as compared to situations made in medical school training hospitals in Korea and in foreign countries. 7. Among the chief complaints made by patients numbering 208 in number, the cummulative percentile from the most common to the 10th accounted for 77.6%. 8. The average number of laboratory tests done per patient was 0.14 of which the top 10 most commonly performed tests comprised 87.6% of the total. Gram stain and microscopic exam ranked first comprising 25.1% of the total followed by urinalysis with 22.0% and chest X-ray with 12.0%. 9. Of the number of tests performed per 100 patients with urologic, respiratory, and gastrointestinal problems, more exams were done on patients with urologic problems numbering 65.5 to that of 2.1 for respiratory problems and 2.6 for patients of gastrointestinal problems. As a result general practioners in Capital city treat various kinds of disorder from the most common to the ones requiring complexive therapy. The distribution of patient's age and sex were each influenced by doctor's age and sex and the frequency of laboratory tests performed was influenced by th types of disorders.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/116552
Appears in Collections:
2. 학위논문 > 1. College of Medicine > 석사
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