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The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program.
We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined.
No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform.
The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
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We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables.
A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion.
Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases.
Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers.
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Patients with parkinsonism exhibit motor symptoms, cognitive impairment, and neuropsychiatric changes, and these symptoms increase caregiver burden. Family dynamics can be influenced by the presence of comorbidities, which is especially important in diseases causing caregiver burden. We investigated the effects of spousal parkinsonism on family functioning and communication.
Couples without parkinsonism, who visited hospital-based family practices, were recruited by 28 family physicians from 22 hospitals between April 2009 and June 2011; patients with parkinsonism and their spouses were recruited from a single institution. The participants completed questionnaires on demographic characteristics, lifestyle factors, family functioning (the Korean version of the Family Adaptation and Cohesion Evaluation Scale [FACES] III), and family communication (the Family Communication Scale of the FACES-IV). We compared family functioning and communication between spouses of the patients with and without parkinsonism.
The mean family adaptability and cohesion scores of the spouses of the patients with parkinsonism were 23.09±6.48 and 32.40±8.43, respectively, whereas those of the control group were 23.84±5.88 and 34.89±7.59, respectively. Family functioning and family communication were significantly different between the spouses of individuals with and without parkinsonism. After adjusting for age, sex, income, and cardiovascular disease in the logistic regression analysis, family functioning was found to significantly deteriorate in the spouses of patients with parkinsonism but not the control group. Family communication decreased significantly in spouses of patients with parkinsonism.
Family functioning and family communication significantly deteriorated in spouses of patients with parkinsonism.
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Patients' perspectives of family medicine according to the physician's identity and role as a primary-care specialist need to be investigated. This study was conducted to investigate the perceived quality of the primary care of family medicine clinics as assessed by patients in a community setting.
Patients (or their guardians) visiting nine community family medicine clinics were surveyed using the Korean Primary Care Assessment Tool from April 2014 to June 2014. The scores of the Korean Primary Care Assessment Tool domains were compared according to the clinics' designation (or not) as 'family medicine' and the patients' recognition (or not) of the physicians as board-certified family medicine specialists.
A total of 196 subjects responded to the questionnaire. They assessed the community clinics' quality of primary care as moderate to high. Of the clinics, those that were not designated as family medicine scored higher than those that were designated as family medicine (P<0.05). The group of patients that recognized a clinic as that of a board-certified family medicine specialist awarded higher scores than the non-recognition group in the domains of coordination function and personalized care (P<0.05).
The moderate to high scores for the community family medicine clinics' quality of primary care are encouraging. It seems that patients' recognition of the family physician's role and of the physician-patient relationship has a significant influence on their assessment of the quality of primary care.
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Alcohol use disorder (AUD) affects not only an individual's health but also their family. This study was conducted to examine effects of a spouse's AUD on family functioning and family communication.
We conducted a cross-sectional study using data from 890 participants (445 couples) in a Korean family cohort in primary care. Participants with Alcohol Use Disorders Identification Test in Korea scores of 8 or greater were classified into an AUD group. Family functioning was classified into three groups (balanced, midrange, and extreme) using the Family Adaptability and Cohesion Scale (FACES)-III questionnaire, and then reclassified into two groups (appropriate and extreme groups) for binominal analyses. Family communication was classified into three groups (high, moderate, and low) using the Family Communication Scale, FACES-IV, and also reclassified into two groups (good and poor).
There was no significant difference in adaptability and cohesion between both male and female participants with a spouse with AUD and participants with a spouse without AUD. Using multivariate logistic regression to adjust for potential confounders, there was no significant difference in family type and communication between the two groups in males. However, there was a significant decrease in family communication (odds ratio, 2.14; 95% confidence interval, 1.29 to 3.58) in females with a spouse with AUD compared to females with a spouse without AUD, even after adjusting for the participant's own AUD.
In females, family communication is significantly worse when spouses have AUD. This suggests that a husband's alcohol consumption has negative effects on his wife's family communication.
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Research is important for the development of family medicine as a professional field in primary care. The aim of this study was to suggest directions for the development of family medicine research by analyzing research trends in original papers published in the Korean Journal of Family Medicine (KJFM) and international journals.
We investigated original research papers published in KJFM and 4 international journals from August 2009 to July 2010. Analysis was conducted according to research topics, authors, methods, participants, and data sources.
'Clinical research' was the most common research topic in both the KJFM (88.3%) and international journals (57.3%); however, international journals had more studies in other domains ('education and research,' 'health service,' and 'family medicine'). More authors other than family physicians participated in international journals than in the KJFM (58% and 3.3%, respectively). Most studies were 'cross-sectional' in KJFM (77.0%) and international journals (51.5%): however, the latter had more 'qualitative' studies, 'cohort' studies, and 'systematic reviews' than the former. The largest study population was 'visitors of health promotion center' in the KJFM and 'outpatients' in international journals. Most of the study sources were 'survey' and 'medical records' in both.
There were limitations of diversity in the papers of the KJFM. Future investigation on papers of other than family medicine journals should be planned to assess research trends of family physicians.
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Practitioners of family medicine are essential to primary care practices in Korea. Resident training staffs in Korean family medicine departments have a crucial role in producing well-trained family physicians. This study assesses the aspects of satisfaction and difficulties of Korean family medicine resident training staffs.
We surveyed the resident training staffs of various Korean family medicine departments using an online survey tool. The survey used in this study was modified from previously used questionnaires. Respondents rated items using a five-point Likert scale and a 0-10 visual analogue scale.
The response rate was 43.9% (122/278). The mean satisfaction score with regard to current family medicine residency programs was 7.59 out of 10. Resident training staffs found the administrative aspects of their role to be the most difficult. There were considerable differences in the reported difficulties of resident training according to the differing characteristics of each staff member, including age, sex, type of hospital, number of staff members, role as chief, and duration of staff. Most respondents (91.9%) cited a need for faculty development programs.
Korean family medicine resident training staffs need faculty development programs for the improvement of resident training. For the strengthening of core competencies among resident training staffs, faculty development programs or courses should be designed and implemented in Korea.
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Recently, importance of family meals has been emphasized at home and abroad, and several journals reported that family meals had a big impact on children's development. In this paper, we would like to report the relationship between family meals and depressive symptoms in children.
This study was based on questionnaires distributed to 162 5th and 6th graders of one elementary school in the area of Daegu, Korea, in July, 2010. The questionnaire was about general characteristics, family characteristics, and quantity/quality of family meals. Family functions and depressive symptoms in children were evaluated with Smilkstein's family APGAR (adaptability, partnership, growth, affection, and resolve) score (FAS) and Kovac's Children's Depression Inventory (CDI).
In one-way analyses of variance, there was no significant difference in FAS and CDI according to general and family characteristics (P > 0.05). CDI was significantly lower in the group having more frequent family meals (P < 0.05). Higher FAS and lower CDI was seen in the group having more conversation and better atmosphere during meals (P < 0.05). There were no significant differences in FAS and CDI according to the number of participants, duration, and watching television during meals (P > 0.05).
The frequency of family meals, having more conversation and better atmosphere during family meals predicted less depressive symptoms in children.
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The Family Adaptability and Cohesion Evaluation Scale (FACES) III using the circumplex model has been widely used in investigating family function. However, the criticism of the curvilinear hypothesis of the circumplex model has always been from an empirical point of view. This study examined the relationship between adolescent adaptability, cohesion, and adolescent problem behaviors, and especially testing the consistency of the curvilinear hypotheses with FACES III.
We used the data from 398 adolescent participants who were in middle school. A self-reported questionnaire was used to evaluate the FACES III and Youth Self Report.
According to the level of family adaptability, significant differences were evident in internalizing problems (P = 0.014). But, in externalizing problems, the results were not significant (P = 0.305). Also, according to the level of family cohesion, significant differences were in internalizing problems (P = 0.002) and externalizing problems (P = 0.004).
The relationship between the dimensions of adaptability, cohesion and adolescent problem behaviors was not curvilinear. In other words, adolescents with high adaptability and high cohesion showed low problem behaviors.
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The purpose of this study was to examine the levels of occupational stress and physical symptoms among family medicine residents and investigate the effect of subscales of occupational stress on physical symptoms.
A self-administered questionnaire survey of 1,152 family medicine residents was carried out via e-mail from April 2010 to July 2010. The response rate was 13.1% and the R (ver. 2.9.1) was used for the analysis of completed data obtained from 150 subjects. The questionnaire included demographic factors, resident training related factors, 24-items of the Korean Occupational Stress Scales and Korean Versions of the Wahler Physical Symptom Inventory.
The total score of occupational stress of family medicine residents was relatively low compared to that of average workers. The scores of 'high job demand', 'inadequate social support', 'organizational injustice', and 'discomfort in occupational climate' were within the top 50%. Parameters associated with higher occupational stress included level of training, on-duty time, daily patient load, critical patient assigned, total working days, night duty day, sleep duration, and sleep quality. The six subscales of occupational stress, except for 'Job insecurity', had a significant positive correlation with physical symptom scores after adjustment had been made for potential confounders (total score, r = 0.325 and P < 0.001; high job demand, r = 0.439 and P < 0.001).
After the adjustment had been made for potential confounders, the total score of occupational stress and six subscales in family medicine residents showed a significant positive correlation with physical symptom scores.
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In reporting results of case-control studies, odds ratios are useful methods of reporting findings. However, odds ratios are often misinterpreted in the literature and by general readers.
We searched all original articles which were published in the Korean Journal of Family Medicine from 1980 to May 2011 and identified those that report "odds ratios." Misinterpretation of odds ratios as relative risks has been identified. Estimated risk ratios were calculated when possible and compared with odds ratios.
One hundred and twenty-eight articles using odds ratios were identified. Among those, 122 articles were analyzed for the frequency of misinterpretation of odds ratios as relative risks. Twenty-two reports out of these 122 articles misinterpreted odds ratios as relative risks. The percentage of misinterpreting reports decreased over years. Seventy-seven reports were analyzed to compare the estimated risk ratios with odds ratios. In most of these articles, odds ratios were greater than estimated risk ratios, 60% of which had larger than 20% standardized differences.
In reports published in the Korean Journal of Family Medicine, odds ratios are frequently used. They were misinterpreted in part of the reports, although decreasing trends over years were observed.
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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was developed to improve the reporting of observational studies. We aimed to evaluate the quality of reporting in cohort studies and case-control studies among observational studies published in the Korean Journal of Family Medicine.
We searched for cohort studies and case-control studies published as original articles in the Journal of the Korean Academy of Family Medicine during the period January 1992 through December 2009. The main outcome measures were the number and proportion of cohort studies and case-control studies that reported each of 22 checklist items of STROBE.
We identified a total of 84 articles, of which 46 articles were cohort studies and 38 were case-control studies. Concerning methods, study designs (10%), bias (13%), study size (0%), statistical methods (12-c and 12-e items, 0%; 12-d item, cohort study, 6%) have been poorly reported. Of results, participants (5-6%), descriptive data (14-b item, 5%), and funding (1%) among other information have been poorly reported.
The degree of adherence the STROBE recommendations was relatively low in cohort studies and case-control studies published in the Korean Journal of Family Medicine. An effort to improve the reporting of observational studies by application and recommendation of the STROBE statement is required.
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This study proposed a desirable direction for the future development of the Korean Journal of Family Medicine (KJFM) by comparing with the overseas SCI journals, Family Medicine (FM) and The Journal of Family Practice (JFP) based on the statistical viewpoints.
All of the original articles published in KJFM from January 1981 to June 2011, FM from January 1998 to June 2011, and JFP from January 1978 to June 2011, were reviewed and compared in terms of content, data size, research design, and statistical method.
Of 3,226 total original articles, KJFM published 1,549, FM 322, and JFP 1,355, respectively. Both JFP and KJFM mainly focused on biomedical topics (67.2% and 61.7%), while FM focused on education (55.9%). Most of the studies in three journals used the data size of between 100 to 300 cases. The most frequently used research design was cross-sectional, FM 66.8%, JFP 58.4%, and KJFM 72.4%, respectively. The statistical methods in KJFM were gradually diversified.
The quality of the original articles in KJFM has been improved over the years, but still has conducted based on the relatively weak research designs. Under the circumstances that the higher ranked SCI journals demand the prospective design and large size of data, and most researchers in Korea could not use the large scaled prospective data, we need to collaborate to accumulate the small sized data sets and try to make a registry. More refined statistical method such as a propensity score matching analysis for retrospective data could be an alternative.
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The family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care.
In 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis.
Total 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals.
Evaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.
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Recently, a revised telehealth legislation that allows direct doctor to patient teleconsultation was proposed in Korea. However, there have been some debates. This study aimed to examine the attitude of primary care physicians towards telehealth.
A questionnaire asking attitude towards telehealth and revised telehealth legislation was self-administered to 1,988 registered members of Practitioners Council of Korean Academy of Family Medicine. A total of 218 complete responses by family physicians were included in the study.
Large proportion (60.6%) of participants disagreed to the main clause of revised telehealth legislation, which allowed doctor to patient teleconsultation. Participants tended to expect that negative outcomes are more likely to occur than positive outcomes after the enforcement of the revised telehealth legislation. Around 50% of participants had an intention to adopt telehealth just as soon (4.6%) or afterwards (45.4%). The majority of participants suggested that; primary care clinic as the most appropriate telehealth facility (75.4%); patients with low accessibility to medical care (74.3%) as the best target of telehealth service; and tele-radiology (61.9%) or tele-pathology (41.3%) as the most applicable medical field for telehealh service. Around 89% of participants suggested telehealth service fee to be similar or higher than current medical consultation fee.
The majority of family physicians participating in this study were not in favor of the revised telehealth legislation. However, the majority of the participants had an intention to adopt telehealth to their practice and held clear opinion about practical aspects of telehealth.
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Attending conferences is important for doctors and residents in family medicine. Nevertheless, departments of family medicine at many hospitals find it difficult to hold regular conferences. Holding joint videoconferences between Family Medicine Departments of several hospitals through a videoconferencing system could solve this problem. Therefore, Family Medicine Departments of Seoul National University Hospital, Seoul National University Bundang Hospital, and Kangwon National University Hospital decided to hold regular joint videoconferences via a videoconferencing system. Eighty-one joint videoconferences were held from April 1 to October 29, 2010. PowerPoint slideshows were transferred to the other two locations in the same resolution as presenter's monitor. Image and voice of the speaker were transferred in real time and in acceptable quality. Joint videoconferences are feasible, satisfactory and useful for medical education, especially when individual family medicine departments are small and lack resources to hold face-to-face conferences. We expect that more family medicine departments will choose to participate in implementing similar joint videoconferencing systems in the future.
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