시각장애인을 위한 의료서비스 필요측정도구 개발 및 적용 = Development and Application of Health Needs Assessment Tools for the Visually Impaired Persons in Korea

다국어 초록 (Multilingual Abstract)

This study aims to develop the health needs assessment tool for the visually impaired persons and to apply it to assess the health needs of the disabled dwelling in Seoul, Korea. This study used consensus methods to develop health needs assessment tools. First of all, panel was composed. It was consisted of six ophthalmologists who had an experience in medical practice more than 10 years and low vision therapy. One specialist was chosen in the panel to make a draft of health needs assessment tools composed of four main categories: medical intervention and operation, assistive devices, rehabilitation therapy, and regular follow-up. The drafts were reviewed by each of panel members respectively and discussed openly by consensus meetings, letters, and telephone conversations. Each panel member repeated the consensus process until they reached agreement on health needs assessment tools for the visually impaired persons. Using randomized stratified systematic sampling method for adjusting sex, age, and districts, 311 registered persons with disabilities who lived in Seoul were chosen and medical specialists investigated all subjects with the developed tools.
The results are as follows;First, the panel developed health needs assessment tool. It was composed of 2 parts: flow charts for understanding tool and assessment standards consisted of 4 main categories. Second, there was a significant level of unmet need in all 4 categories of the medical intervention and operation(unmet need: 54.5%), assistive devices(55.6%), rehabilitation therapy(85.0%), and regular follow-ups(63.9%). In particular, unmet need for rehabilitation therapy was highest. The results showed that medical under-utilization of the persons with visual impairment could aggravate their general health conditions and disabilities. Besides, it was found that the disabled had unmet needs for health care. Therefore, health needs assessment tools would help us to estimate health states of the disabled and to provide appropriate medical services to the disabled. It is meaningful as a quantitative methodology for measuring unmet needs in health care of the disabled. Health needs assessment should be performed regularly to all persons with disability. Health authority should provide appropriate health services with the disabled according to the result of health needs assessment. However, in-depth studies to modify tools, especially to improve the validity and the reliability, are necessary.

국문 초록 (Abstract)

장애인 등록 이후 재가 장애인의 의료서비스 필요 및 미충족필요의 규모를 측정하기 위한 도구로서 의학적 처치 및 수술, 보장구, 재활치료, 정기적 추후관리 등 4개 영역이 포함된 시각장애 필요측정도구를 개발하였다. 개발된 필요측정도구를 이용하여 서울지역 일부 장애인을 대상으로 시험 적용해 본 결과 다음과 같은 결론은 얻었다. 조사대상 장애인 중 의학적 처치 및 수술은 36.1%에서 필요하였고 그 중 45.5%만이 적절하였다. 보장구는 29.5%에서 필요하였고 그 중 55.6%가 적절하였다. 재활치료는 32.8%가 필요하였고 적절률은 15.0%에 불과하여 가장 심각한 문제로 나타났다. 정기진료는 100%가 필요했으며 그 중 36.1%만이 적절한 관리가 이루어지고 있었다. 의학적 처치 및 수술, 보장구, 재활치료, 정기진료 중에서 부적절 판정을 하나도 받지 않은 최종 적절성은 18.0%(미충족필요: 82%)에 불과하였고, 대체적으로 적절한 치료를 받지 못하고 있었으며 그 중 저시력 재활치료는 가장 적절률이 낮아 시각장애인 의료서비스 제공에 문제가 있음을 알 수 있었다.

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