Search

Background Patients' perceptions of care tend to correlate with the quality of care provided. Different health care systems and service environments may show different associations between types of usual source of care (USC) and overall service quality assessment. We attempted to analyze this association as a benefit of having a USC. Methods This study used the 2012 Korea Health Panel data version 1.1 as representative national household survey data. The total number of subjects aged 18 years or more was 12,708. The number of subjects in the final analysis was 10,665. Multiple logistic regression analysis was used to assess the association between types of USC and overall health care service quality. The main outcome variable was users' ratings of the quality of health care service. Results People having a usual doctor (n=1,796) were more likely to positively assess the quality of health care they received than those not having a USC (n=7,920; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.20-1.60) or with those having only a place as a USC without a usual doctor (n=949; OR, 1.29; 95% CI, 1.05-1.58) after adjustment for demographic characteristics and health-related variables. Conclusion People having a usual doctor rated overall health care service quality as high, which might be due to benefits of primary care attributes related to usual doctors. Further studies are needed to elucidate the causal relationship. This finding implies that health policies encouraging people to have a usual doctor are needed in Korea.

Background: A usual source of care (USC) is related to longitudinal and personalized services, which are attributes of primary care. Patient-centered communication, an important element of patient-centered care, helps physicians understand health problems from a patient’s point of view. We analyzed the association between USC and patient-centered communication.Methods: Data from the Korea Health Panel 2018 were used in the analysis. Patient-centered communication scores were obtained by combining the four communication-related questionnaire items. Usual source of care types were categorized based on responses to two questionnaire items: no USC, a place without a regular doctor and with a regular doctor. Multiple logistic regression analysis was used to adjust for confounders.Results: Good communication rate was higher for those with a regular doctor (71.8%) than for those with no USC (61.8%) or a place only (61.5%). Those with a regular doctor had better communication (odds ratio, 1.49 for individuals with poor/moderate health, and 2.08 for those with good health) than those without a USC after adjusting for confounders. In terms of communication, no difference was observed between individuals with no USC and those with a place only.Conclusion: Having a regular doctor promotes communication between patients and doctors. Good communication may be a mediator between having a regular doctor and related beneficial outcomes. Better communication by having a regular doctor, along with several other benefits identified in previous studies suggests the need for a health policy that encourages individuals to have regular doctors.

Background Despite various anti-smoking policies, the smoking rate in adults is still high in Korea. Doctors’ advice is known to increase the smoking cessation success rate. However, few studies have reported the effect of having a usual source of care (USC) on receiving smoking cessation advice. Objective To determine the effect of USC on receiving smoking cessation advice. Methods We performed multiple panel logistic regression analyses to identify the effect of having a USC on the rate of receiving a doctor’s smoking cessation advice using 2009, 2012 and 2013 datasets from the Korea Health Panel database. Only people who responded to questions regarding a USC and smoking cessation advice were analysed. Eventually, 5243 observations were included in the final analysis. Results A higher percentage of people with a USC received smoking cessation advice from doctors (58.4% in 2009, 64.0% in 2012 and 59.6% in 2013) than those not having a USC (28.6% in 2009, 37.5% in 2012 and 34.8% in 2013). The odds ratios (ORs) of receiving smoking cessation advice in people with a USC were higher than those of people without a USC after performing multiple panel logistic regression analysis with random effects (OR: 2.24; 95% confidence interval: 1.90–2.63). Conclusions Having a USC increased the odds of receiving a doctor’s smoking cessation advice in Koreans. The results of this study suggest that a health care policy that encourages having a USC is useful in receiving more smoking cessation advice in a Korean population.

Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study. Among adults with diabetes, those with RD accounted for 41.0%. The older the age group and the higher the Charlson comorbidity index score, the higher the percentage of adults with diabetes had RD. Even for those with RD, coordination of care was very poor (positive answer: 27.1%). After adjustment for confounding variables, those having (vs. not having) a RD (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35–0.94), especially those whose RDs delivered good comprehensiveness of care (OR, 0.47; 95% CI, 0.26–0.84) or worked at a primary care clinic (OR, 0.43; 95% CI, 0.22–0.81), and those whose longitudinal relationship with a RD was 5 years or less (OR, 0.45; 95% CI, 0.22–0.91) were less likely to have ED visits within the last year. In conclusion, health care policies that promote having a RD who delivers high-quality primary care could decrease unnecessary ED visits by diabetic adults. This can partly reduce ED overcrowding in Korea., Graphical Abstract

Background There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. Methods The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. Results The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. Conclusion This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization., Graphical Abstract

Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i.e., primary care) physician as a USC with experience of emergency department (ED) visits and hospitalization within a year. After adjusting for cofounding variables including Charlson comorbidity index scores, those having a primary care physician as a USC remained associated with a decrease in an experience of ED visits (OR: 0.61, 95% CI: 0.40-0.93) and hospitalization (OR: 0.69, 95% CI: 0.49-0.96), compared to those not having a usual physician. Health policies that promote having a primary care physician as a USC could decrease unnecessary experience of ED visits and hospitalization by adults with hypertension. This can partly reduce ED overcrowding and avoidable hospitalization in Korea.

To ascertain the association between primary care quality and self-rated health status.A cross-sectional study using the Korean primary care assessment tool (K-PCAT). The K-PCAT is a validated tool based on the definition of primary care in Korea, consisting of 5 domains and 21 items providing a total primary care quality score. Data were collected from patients of family physicians working at nine private clinics as their usual source of care. The main outcome measure was self-rated health status.Data were analyzed for 531 study participants. Bivariate analysis of socio-demographic variables of patients, who participated in this study as primary care quality assessors, revealed that those with high self-ratings of health tended to have higher household incomes and more frequent exercise. Those with high self-ratings of health had higher total primary care scores than those with low self-ratings of health, as determined through bivariate analysis (P0.01). After being adjusted for age, sex, the number of diseases being treated, education years, household income, smoking status, alcohol intake and the frequency of regular exercise, the total primary care score was found to be positively associated with good health.Primary care quality, as assessed by the K-PCAT, was positively associated with good self-rated health status.

Countries with historically unlimited patient choice of medical provider, such as Korea, have been promoting rational health care pathways. Factors related to the length of doctor-patient relationship (DPR) for enhancing primary care in those countries should be studied. Participants were patients who had visited their family practices on six or more occasions over a period of more than 6 months. Five domains (21 items) of the Korean Primary Care Assessment Tool (first contact, coordination function, comprehensiveness, family/community orientation, and personalized care) and general questions were administered in the waiting rooms. From seven practices, the response rate was 83.7% (495/591). The older the age, the lower the income, the shorter the duration of education, the more the number of diseases the patients had, and in provincial cities rather than in Seoul, the longer length of DPR ( ≥ 4 yr) was shown. The long-term DPR was associated with total primary care quality score (upper [ ≥ 71.4] vs lower [ < 71.4], OR, 1.74; 95% CI, 1.10-2.76), especially with coordination function (OR, 1.01; 95% CI, 1.00-1.02), being adjusted for confounding variables. Strengthening the coordination function may have to be the first consideration in primary care policy in countries like Korea.

Background Usual source of care (USC) is one of the hallmarks of primary care. We aimed to examine the status of having a USC and its patient-related sociodemographic factors among Korean adults. Methods Data were obtained from the 2012 Korea Health Panel survey. Panel participants were selected for the study who were aged 18 years or older and who replied to questionnaire items on having a USC (n = 11,935). Results Of the participants, 21.5% had a usual place and 13.9% had a usual physician. Reasons for not having a USC were seldom being ill (66.1%), the preference to visit multiple medical institutions (27.9%), and others. The private community clinic was the most common type of usual place (57.0%). In patient-reported attributes of care provided by a usual physician, the percentages of positive responses for comprehensiveness and coordination were 67.2% and 34.5%, respectively. By institution type, primary care clinics showed the lowest percentage (32.8%) of positive responses for coordination. Adjusted odds ratios of having a usual physician were 3.77 (95% confidence interval, CI: 3.75–3.79) for those aged 65 years or older (vs. aged 18–34 years), 1.31 (CI: 1.30–1.31) for females (vs. males), 0.72 (CI: 0.72–0.73) for unmarried people (vs. married), 1.16 (CI: 1.16–1.16) for college graduates or higher (vs. elementary school graduate or less), 0.64 for the fifth quintile (vs. the first quintile) by household income, 1.53 (CI: 1.52–1.54) for Medical Aid (vs. employee health insurance) for type of health insurance, and 4.09 (CI: 4.08–4.10) for presence (vs. absence) of a chronic diseases. Conclusions The proportion of Korean adults who have a USC is extremely low, the most influential factor of having a USC is having a chronic disease or not, and Korean patients experience much poorer health care coordination than do patients in other industrialized countries. The findings of this study will give insight to researchers and policy makers regarding the potential facilitators of and barriers to promoting having a USC in the general Korean public.

Purpose: In this study, we evaluated the effects of training for survival prediction of terminally ill patients in terms of medical professionals’ confidence, accuracy and knowledge of survival prediction. Methods: Twenty-nine participants completed a self-administered questionnaire where they scored their confidence, accuracy and knowledge of survival prediction before and after the training session. T he training was provided in July 2009 at a university hospital located in Gyeonggi province, Republic of Korea. The p articipants were instructed by a professor of family medicine specialized in hospice palliative medicine to predict survival of a case using the palliative prognostic score and objective prognostic score. The training was provided in th e form of a PowerPoint presentation for 40 minutes. Results: Participants’ confidence in survival prediction significantly increased from 4.00±1.73 (mean±SD) (0∼10, visual analogue scale) to 5.83±1.71 after the training (P＜0.001). Before training, participant ’s level of confidence significantly correlated with their age (P=0.04). The training significantly improved the correlation between the confidence level and the number of terminal cancer patients who m they have experienced (P=0.005 before training, P=0.017 after training). Participant ’s accuracy in survival prediction also significantly improved from 14 of 29 (48%) to 27 of 29 (93.1%) (P ＜0.001). The change in knowledge of survival prediction was too small to be statistically analyzed. Conclusion: After training, the confidence and accuracy scores significant ly improved. Further study with a greater number of participants is needed to generalize this finding. (Korean J Hosp Palliat Care 2012;15:155-161)Key Words: Prognosis, Education, Attitude

Objective. To compare patient’s assessment of primary care of medical institutions by structural type. Design. Cross-sectional study. Setting. Primary care clinics where family physicians work in South Korea (nine private clinics, three health cooperative clinics, three public health center clinics and five teaching hospital clinics). We collected data by questionnaire survey from April 2007 to June 2007. Participants. Study subjects were patients who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. Main outcome measures. Scores in each domain of primary care, evaluated by the Korean Primary Care Assessment Tool. Results. A total of 968 subjects were surveyed. The median of primary care average scores was the highest (78) in health cooperative clinics, the second in teaching hospitals clinics, the third in private clinics and the lowest (62) in public health center clinics. When compared with private clinics, the odds ratio for having a high primary care average score was 2.1 (95% confidence interval 1.3– 3.3) for health cooperative clinics, and 0.55 (95% confidence interval 0.34 – 0.88) for public health center clinics. Conclusion. Among medical institutions where family physicians work in South Korea, health cooperative clinics showed the highest primary care average score, and public health center clinics the lowest. To reinforce primary care in South Korea, where medical service delivery systems are only loosely established, health cooperative clinics could serve as an alternative.

The metabolic syndrome is known to sometimes exist in the presence of normal aminotransferase levels. The purpose of this study was to determine the lowest sex-specific level of alanine aminotransferase associated with the metabolic syndrome in a nationwide, representative Korean population. We analyzed data from adults 20 years and older (n = 3405) assessed in the Third Korean National Health and Nutrition Examination Survey (2005). Participants were divided into 4 groups according to the quartiles of alanine aminotransferase levels for each sex. Logistic regression modeling was performed after adjustment for age, body mass index, waist circumference, smoking, ingested alcohol amount, and physical activity. Alanine aminotransferase level groups 3 and 4 in women (or =15 IU/L) and group 4 in men (or =27 IU/L) were significantly associated with the metabolic syndrome compared with the lowest alanine aminotransferase groups (16 IU/L in men,11 IU/L in women). In men, the odds ratio (95% confidence interval) of the metabolic syndrome was 2.71 (1.31-5.63) for alanine aminotransferase group 4 (or =27 IU/L). In women, odds ratios were 1.69 (1.02-2.80) and 2.06 (1.23-3.43) for alanine aminotransferase groups 3 (15or = alanine aminotransferase19 IU/L) and 4 (or =19 IU/L), respectively. High-normal alanine aminotransferase levels (or =27 IU/L in men,or =15 IU/L in women) were strongly associated with the metabolic syndrome in Korean adults.

Background The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. Methods This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. Results Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 ± 0.60, after 2.73 ± 0.72), 'timeline' (before 2.82 ± 0.68, after 3.18 ± 0.73), 'positive verbal reinforcement' (before 2.24 ± 0.56, after 2.61 ± 0.90), and the total score (before 21.70 ± 2.62, after 23.39 ± 3.13) (P < 0.05). Conclusion Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

Introduction Several in vitro studies have suggested the effects of adipokines and insulin resistance on breast cancer cell proliferation and survival. However, little is known about the clinical significance of these findings. Methods We examined associations between breast cancer recurrence and adiponectin, leptin, insulin resistance, and metabolic syndrome (MetS) in a cohort of 747 patients from 2001 to 2004. Results Adjusted hazard ratios showed an inverse trend across the quartiles for serum adiponectin concentration in estrogen receptor (ER)/progesterone receptor (PR) -negative patients (P for trend = 0.027) but not in ER/PR-positive patients. Compared to the highest quartile for adiponectin level, the lowest quartile showed a hazard ratio of 2.82 (1.03 to 7.68). Homeostasis model assessment for insulin resistance (HOMA-IR) showed a positive trend for recurrence in the ER/PR-negative group (P for trend = 0.087) and a negative trend in the ER/PR-positive group (P for trend = 0.081). Leptin did not show any associations (P for trend >0.05). A linear trend was observed with the number of components of MetS in ER/PR-negative patients (P for trend = 0.044). This association disappeared when adjusted for adiponectin and HOMA-IR. Conclusions Adiponectin and HOMA-IR have prognostic significance in breast cancer recurrence and interventions related to these factors may protect against recurrence in ER/PR-negative patients. These findings were not observed in the case of ER/PR-positive patients. Further evaluation of these insignificant associations is needed because it might be biased by adjuvant chemotherapy or other confounders.

Background It is important to know the current level of primary care performance in order to evaluate and plan for desirable health policy. We tried to compare patient's assessment of primary (family physician, general practitioner, internist, pediatrician, and general surgeon) and non-primary (the other specialties) care physicians. Methods Study subjects were physicians of primary care clinics in Seoul. The study subject evaluators were Seoul citizens who were selected by a list-assisted random digit dialing sampling method and who had visited their primary care clinic on six or more occasions over a period of more than 6 months as a usual source of care. The modified version of the Korean Primary Care Assessment Tool was used for the evaluation of primary care performance. The data were collected with the aid of a computer-assisted telephone interview system from June 29 to July 22, 2009. Results The data on 260 individuals were used for analysis. The mean scores of primary and non-primary care physician group were respectively 1.19 and 0.85 in the comprehensiveness domain, 1.00 and 0.83 in the coordination domain, 1.54 and 1.31 in the family/community orientation, and 1.24 and 0.99 as an average of 3 domains above. The scores in the comprehensiveness domain and the average of 3 domains were significantly higher in the primary than in the nonprimary care physician group. Conclusion Primary care physicians showed superior performance compared to non-primary care physicians in comprehensiveness domain and in the average of comprehensiveness, coordination, and family/community orientation domains.

Objectives. To develop a tool for assessing the performance of primary care services in South Korea from the patient’s perspective and to test the validity of the tool under the conceptual framework of the recently developed definition of primary care in Korea. Design. Item development for questionnaire and a cross-sectional survey for tool validation at 16 primary care clinics. All family physicians included in this study were required to have practiced at their current clinic for at least 2 years. Participants. A nine expert panel was assembled for tool development and patients (or guardians) who had visited their primary care clinic on six or more occasions over a period of more than 6 months participated in the survey. Main outcome measures. Scores corresponding to each domain of primary care. Results. A total of 722 effective data sets were used for the analysis. Five items were eliminated from the preliminary 30-item tool after expert discussions at two seminars. Another four items were eliminated by principle component analysis. For each of the four domains (comprehensiveness, coordination function, personalized care, and family/community orientation), tests of scaling assumptions were well satisfied by all Likert-scaled measures. On the other hand, ‘first contact’ turned out to be a composite domain with five independent single-item scales. Conclusion. The Korean primary care assessment tool (version 1) consists of four multi-item scales and one composite scale. Widespread application of this tool will provide an empirical basis for the measurement, monitoring and continuous improvement of primary care in South Korea.

장 승 훈·신 승 수·김 혜 영·임 현 우· 박 보 영· 김 재 우·박 인 규·김 영 환·이 계 영·이 경 수·이 종 목·황 보 빈· 백 상 현·김 진 환·성 낙 진·이 상 현·황 승 식·김 수 영·김 열·이 원 철·성 숙 환 | 한림대학교 의과대학 호흡기-알레르기내과, 아주대학교 의과대학 호흡기내과, 국립암센터 폐암센터 영상의학과, 가톨릭대학교 의과대학 예방의학교실, 국립암센터 국제암대학원대학교, 서울대학교 의과대학 서울대학교병원 흉부외과, 호흡기내과, 건국대학교 의과대학 내과, 성균관대학교 의과대학 영상의학과, 국립암센터 흉부외과, 호흡기내과, 순천향대학교 부천병원 영상의학과, 충남대학교 의과대학 영상 의학과, 동국대학교 의과대학 가정의학과, 국민건강보험 일산병원 가정의학과, 인하대학교 의과대학 예방의학과, 한림대학교 의과대학 가정의학과, 국립암센터 암검진사업과, 가톨릭대학교 의과대학 흉부외과

The present study analyzed serum IgG subclass antibody reaction to major antigenic bands of Clonorchis sinensis to investigate improvement of its serodiagnosis. Of the four subclass antibodies, IgG1 and IgG2 antibodies were produced but not specific, IgG3 antibody was least produced, and IgG4 antibody was prominent and specific. The serum IgG antibody reaction to any of 43-50, 34-37, 26-28, and 8 kDa bands was found in 65.5% of 168 egg positive cases while IgG4 antibody reaction was found in 22.0% of them. The positive rates of IgG and IgG4 antibodies were directly correlated with the intensity of infection. All of the sera from heavily infected cases over EPG 5,000 showed positive reaction for specific IgG and IgG4 antibodies. The specific serum IgG4 antibody disappeared within 6 months after treatment. The bands of 35 kDa and 67 kDa cross-reacted with IgG antibodies but not with IgG4 antibodies in sera of other trematode infections. The present findings suggest that serum IgG4 antibody reaction to 8 kDa band is specific but not sensitive. Any method to increase its sensitivity is required for improved serodiagnosis.

Yu-Il Kim, MD·Jee Young Hong, MD·Kyoungwoo Kim, MD·Eurah Goh, MD·Nak-Jin Sung, MD Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Department of Family Medicine, Kangwon National University Postgraduate College of Medicine, Chuncheon, Korea

Background: Management of hypertension has been performed mainly in primary care institutions, but hypertension control in population is still unsatisfactory. This study was aimed at finding a strategy to improve health promotion activities in patients with hypertension by exploring the association between health behaviors and quality of primary care. Methods: April to June in 2007, a questionnaire survey of the patients who has a family physician as a usual source of care was conducted for the development of the Korean Primary Care Assessment Tool (KPCAT). In this study, a usual source of care was defined as a physician of the persons who had visited their primary care clinic on six or more occasions over a period of more than 6 months. Of the data collected from 9 private clinics (3 in Seoul and 6 at small cities), cases of the patients who marked on having hypertension were selected. The associations between levels of quality of primary care and socio-demographic characteristics or health behaviors were analysed by Student t-test and chi-square test. Controlling socio-demographic variables, the association between quality of primary care and health behaviors was examined by multiple logistic regression analysis. Results: Among the patients (n = 602) of 9 private clinics who has a family physician as a usual source of care, those who marked on having hypertension were 134. Among 5 domains of the KPCAT, the highest domain in score was personalized care (71.7/100), and the lowest domain in score was coordination function (49.7/100). In patients who gave total average (69.2/100) or more in total primary care score, after adjustment with age, sex, income, education, and duration, odds ratio to have a normal BMI (

Department of Family Medicine, The Catholic University of Korea School of Medicine, Seoul, Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Department of Social and Preventive Medicine, Hallym University College of Medicine & Health Services Research Center, Chuncheon, Department of Family Medicine, Ilsan Hospital, Dongguk University College of Medicine, Goyang, Department of Family Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Incheon, Korean Primary Care Research Group, Seoul, Korea

Abdominal pain is one of the most common symptoms we encounter in primary care clinics, and the patients being hospitalized for abdominal pain account for 5-6% of all the inpatients. Careful history taking and physical exams are always necessary for the diagnosis of patients having abdominal pain, because their problems may be transient and insignificant but also can be severe. For the elderly patients, common causes of abdominal pain are unspecific abdominal pain, functional disease, constipation, kidney stone, urinary tract infection, inflammatory bowel disease, biliary tract disease, acute appendicitis, diverticulitis, abdominal aortic aneurysm, peptic ulcer, intestinal obstruction, mesenteric ischemia, malignant tumor, gastroenteritis, etc. and myofacscial pain can also be the cause. We treated an elderly female patient who had suffered severe abdominal pain due to myofascial pain syndrome of the iliopsoas muscle undiagnosed for over 3 years. Therefore we report this case with review of several literatures.

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.

Background: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method wil l be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. Methods: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. Results: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. Conclusions: The PWTT has a negative correlation with the SBP of the patien ts who received vasopressor infusion.