Journal of Preventive Medicine and Public Health

Original Articles

Knowledge, Attitudes, Barriers and Uptake Rate of Influenza Virus Vaccine Among Physicians in Jordan: A Multicentric Cross-sectional Study: Munir Abu-Helalah, Tarek Rashad Gharibeh, Mohammad Al-Hanaktah, Hussam Alshraideh, Raghad Mahmoud Darweesh, Maria Alshurman, Lekaa Ja’far Al Mughrabi F, Yaqeen Ja’far Al Mughrabi F, Neveen Ghanem; J Prev Med Public Health. 2025;58(5):484-495. Published online June 3, 2025; DOI: https://doi.org/10.3961/jpmph.24.776

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Abstract Summary PDF Supplementary Material: Objectives
Seasonal influenza poses significant global health challenges, with healthcare professionals (HCPs) particularly vulnerable due to frequent exposure to infected patients. Influenza vaccination is a proven method to reduce morbidity and mortality. Despite recommendations by health authorities, vaccination uptake among HCPs remains suboptimal globally and within Jordan. This study aimed to assess knowledge, attitudes, barriers, and influenza vaccine uptake among physicians in Jordan.
Methods
A cross-sectional study was conducted from March 2023 to June 2023 involving 389 physicians from Ministry of Health facilities across Jordan. A structured and validated questionnaire was used to collect demographic data, vaccination history, and insights guided by the health belief model. Multivariate logistic regression analyses were performed to identify predictors of vaccine uptake and patient vaccination practices.
Results
The influenza vaccination rate during the 2022-2023 season was 47%. Vaccination uptake was associated with factors such as age, geographic location, professional designation, and training. Vaccinated physicians demonstrated better knowledge and more favorable attitudes toward vaccination. Common barriers included misconceptions about personal risk, concerns over vaccine efficacy, and forgetting to vaccinate. Physicians who received training were more likely to recommend vaccination to patients.
Conclusions
The low vaccination rate among Jordanian physicians highlights the need for targeted educational interventions and policies to address misconceptions and barriers. Improving influenza vaccination uptake among HCPs is critical to enhancing patient confidence, reducing transmission, and improving public health outcomes.; Summary

Key Message
"Despite recommendations by health authorities, vaccination uptake among HCPs remains suboptimal in Jordan and globally. This study aimed to assess knowledge, attitudes, barriers, and influenza vaccine uptake among physicians in Jordan. A cross-sectional study was conducted from March 2023 to June 2023 involving 389 physicians from the Ministry of Health, Jordan. The influenza vaccination rate during the 2022-2023 season was 47%. Common barriers included misconceptions about personal risk, concerns over vaccine efficacy, limited training, and forgetting to vaccinate. The low vaccination rate among Jordanian physicians highlights the need for targeted educational interventions and policies to address misconceptions and barriers."

Probability of Early Retirement Among Emergency Physicians: Jaemyeong Shin, Yun Jeong Kim, Jong Kun Kim, Dong Eun Lee, Sungbae Moon, Jae Young Choe, Won Kee Lee, Hyung Min Lee, Kwang Hyun Cho; J Prev Med Public Health. 2018;51(3):154-162. Published online May 17, 2018; DOI: https://doi.org/10.3961/jpmph.18.079

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Objectives
Early retirement occurs when one’s job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction.
Methods
A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram.
Results
Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors.
Conclusions
To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

Summary

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Special Article

How to Improve Influenza Vaccination Rates in the U.S.: Byung-Kwang Yoo; J Prev Med Public Health. 2011;44(4):141-148. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.141

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Abstract PDF

Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities.

This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.

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English Abstracts

A Study of Factors Related to Korean Physicians' Trust in the Government: On the Target for Board Members of Physicians' Associations.: Sunhee Lee, Gunmo Yang, Juhyun Seo, Juhye Kim; J Prev Med Public Health. 2010;43(5):411-422.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.411

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Abstract PDF

OBJECTIVES
This study aims to investigate the factors related to Korean physicians' trust in the government. METHODS: We used structured questionnaires that were composed of multidimensional scales for each of the various categories. RESULTS: The recognition levels of trust of the government by Korean physicians were not high, and they ranged from 3.6 to 4.8 for ten scales. The factors related to trust in the government were categorized into seven factors on the basis of a factor analysis. On the regression analysis, a positive relationship was found between "the individual propensity to trust" and trust in the government, while a negative relationship was found between "the recognition level regarding the government as an authoritarian power" and trust in the government. "Confidence about participation in the policy process" as internal efficacy and "belief in governmental ability and motivation toward public demand" as external efficacy also showed a strong positive relationship with trust in the government. CONCLUSIONS: From these results, we can draw the conclusion that making efforts to improve the recognition level of trust in the government among physicians is an important policy task. To increase the trust level, participation of physicians in the policy process in various ways and open communication between the physicians'associations and the government should be facilitated.

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The Relationship between Trust in Healthcare System and Health Examination Participation
Baek-Geun Jeong, In-Kyoung Hwang, Hae-Sook Sohn, Kwang-Wook Koh, Tae-Ho Yoon, Jeong-Hun Lim
Journal of agricultural medicine and community health.2010; 35(4): 395. CrossRef

Certificate Education for Geriatric Physician: Satisfaction and Feasibility.: Sung Chun Lee, Hwa Joon Kim, Hyung Joon Park, Jong Lull Yun, Chang Yup Kim, Ok Ryun Moon, Soong Nang Jang; J Prev Med Public Health. 2008;41(1):10-16.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.10

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OBJECTIVES
Korea faces a number of challenges to meet demands in the area of geriatric professional medicine in a country with a rapidly ageing population. We evaluated the satisfaction and feasibility of the current education certification for geriatric physicians. METHODS: Geriatric physicians who were deemed qualified by the Korean Geriatrics Society during the period of 2001 to 2005 (n=2,200) were asked to complete structured questionnaires sent to them by mail about their satisfaction of and need for certificates of education, as well as their opinions on their geriatric specialty training. A total of 419 physicians responded. Descriptive analysis and hierarchical regression were performed to rate the respondents.satisfaction, the characteristics of the need for clarity and utility in education certification, and the characteristics of their patients. RESULTS: Although most respondents were satisfied with their education certification, those who had more elderly patients, aged 65 or older, and those who had more cognitively impaired patients, rated their education as significantly lower than did other physicians. Both groups expressed the need for more the comprehensive care and assessment concerning of their education. Multiple regression analysis indicated that satisfaction with geriatric physician qualification was associated with a physician's age, specialty, and percentage of elderly patients. CONCLSIONS: This study suggests that the current system of education certification is limited in terms of feasibility and physician satisfaction.

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Soong-Nang Jang, Sung-il Cho, Ichiro Kawachi
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Physician Factors Associated with the Blood Pressure Control among Hypertensive Patients.: So Young Kim, In Sook Cho, Jae Ho Lee, Ji Hyun Kim, Eun Jung Lee, Jong Hyock Park, Jin Seok Lee, Yoon Kim; J Prev Med Public Health. 2007;40(6):487-494.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.487

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Abstract PDF

OBJECTIVES
Little is known about the physician-related factors that are associated with the management of hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. METHODS: We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do. Forty-one physicians completed the survey (response rates: 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the selfreported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center's information system. We compared the physicians' perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians' antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physicianrelated factors. RESULTS: The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients' control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensinconverting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI: 1.17-1.48). CONCLUSIONS: Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians' overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician' awareness regarding the management of patients with hypertension are needed.

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Eboni G. Price-Haywood, Sarah Amering, Qingyang Luo, John J. Lefante
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Jeung-Hee Kim, Weon-Young Lee, Yeon-Pyo Hong, Wang-Seong Ryu, Kwang Je Lee, Wang-Soo Lee, Donald E. Morisky
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The Levels of Psychosocial Stress, Job Stress and Related Factors of Medical Doctors Practicing at Local Clinics.: Moon Kuk Kang, Yune Sik Kang, Jang Rak Kim, Baek Geun Jeong, Ki Soo Park, Sin Kam, Dae Yong Hong; J Prev Med Public Health. 2007;40(2):177-184.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.177

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Abstract PDF

OBJECTIVES
This study was conducted to investigate the levels of psychosocial stress, job stress and their related factors among medical doctors practicing at local clinics. METHODS: A survey using a self administered questionnaire was administered to 1,456 doctors practicing at private clinics via post for 2 months (2006. 1 - 2006. 3). Psychosocial stress, job stress,demographic factors, job related factors and health related behaviors were investigated. Among the eligible study population, the respondents were 428 doctors (29.4%). RESULTS: The average scores of psychosocial stress and job stress were 2.19 and 3.13, respectively. The levels of psychosocial stress and job stress were statistically lower in older respondents, those who worked shorter or who were more satisfied with their job, and those with higher socioeconomic status. The level of psychosocial stress was related with smoking status, drinking status and exercise. The level of job stress was related with smoking status and exercise. In multiple linear regression analysis using psychosocial stress as a dependent variable, age, working hours per day, job satisfaction and perception on socioeconomic status were significant independent variables. In analysis using job stress as a dependent variable, age, working hours per day and job satisfaction were significant independent variables. CONCLUSIONS: Stress affects the doctor-patient relationship, productivity and overall health level of people. Therefore, it is important to manage and relieve the stress of doctors. It is suggested that more advanced studies on stress level and related factors and ways to improve the stress and health related behaviors of medical doctors should be conducted.

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Keon Kim, Sunhwa Lee, Yoon Hee Choi
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Yunesik Kang
Journal of Preventive Medicine and Public Health.2010; 43(5): 445. CrossRef
The Work Related Psychosocial Factor and Disease among Health Professional
Sang Baek Koh
Journal of the Korean Medical Association.2010; 53(6): 467. CrossRef
Job Satisfaction, Subjective Class Identification and Associated Factors of Professional Socialization in Korean Physicians
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Original Articles

Smoking Status and Smoking Cessation Activity among Physicians in a Community.: So Yeon Ryu, Ki Soon Kim, Myung Gun Kang, Hyung Cheol Park, Jin Sun Kim; Korean J Prev Med. 2003;36(3):271-278.

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Abstract PDF: OBJECTIVES
The purposes of this study were to assess the smoking status, knowledge and attitude related to smoking and smoking cessation activity of the physicians in a community, and to identify their predictors of smoking cessation activity. METHOD: All physicians employed by various health facilities in a community were surveyed using a structured questionnaire. Of the physicians surveyed, 523 (69.6%) returned completed questionnaires. RESULTS: The smoking rate of physicians was 29.3% (34.2% in males, 3.6% in females) and the knowledge and attitude scores to smoking were 22.5+/-2.4 and 65.4+/-6.9, respectively. The self-efficacy score was 3.4+/-1.0 and the smoking cessation activity score was 65.4+/-6.9. The smoking cessation activity was statistically significant with working place, specialty, knowledge and attitude to smoking and self-efficacy. In stepwise multiple regression, smoking cessation activity was predicted by doctors' working place, specialty, attitudes related to smoking issues, and self-efficacy of counseling knowledge and skills. CONCLUSION: Physicians need to participate routinely and actively in smoking cessation activity. For doctors to effectively counsel and intervene in patients regarding smoking cessation, it is essential to integrate education on smoking cessation intervention into curricula in formal education and to offer continuing education including smoking cessation intervention.; Summary

A Study on Service Characteristics of Directors of Health Centers in Korea.: Jae Won Yoo, Ok Ryun Moon, Sang Yi Lee, Chul Woung Kim, Sang Gu Yi; Korean J Prev Med. 1998;31(4):786-800.

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Abstract PDF: This study has attempted to show general characteristics of health centre directors who have served the post of directorship during the last 40 years. Of 3,000 such health centre directors, information on about 2,500 directors was collected. While average length of service for health center directors has increased, that of vacancy period has decreased. Rural areas have a shorter average length of service than the urban area. Rural areas have twice longer length of vacancy period per health center. Kangwon-do has the longest average length of vacancy period since 1980(2.79 months/year), and Daejeon has the shortest length of vacancy period(0.21 months/year). Chung-buk has no physician directors. The civil servant's rank for the directorship has promoted from the fifth level to the fourth level since 1990. A comparison between the physician director and non-physician director was made as follows : First, the proportion of physician directors had maintained rather high before 1980s ; 62.5% in 1963, 78.3% in 1970, 70.4% in 1980. It decreased to 44.1% in 1990 and 47.6% in 1997. Instead, non-physician directors has abruptly increased since 1980s(12.4% in 1980, 55.4% in 1990 and 50.8% in 1997). Second, physician directors mainly locate in the urban area(58.0% in 1997), but non-physician directors mainly in the rural area(67.2% in 1997). Third, since 1980, the average length of service for physician directors and for non-physician directors has become similar. Fourth, the mean age of physician directors is 45.1 years, and that of non-physician directors 55.7 years. The latter is 10 years older than the former.; Summary

Analysis of influencing factors on self-employed physician's income.: Woong Sub Park, Han Joong Kim, Myong Sei Sohn, Eun Cheol Park; Korean J Prev Med. 1998;31(4):770-785.

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Abstract PDF: This study describes the relation of physician's income and price of medical service and social welfare through microeconomic view, reviews the literature of influencing factor on physician's income, and it describes general distribution of physician's income, and analyzes influencing factor of physician's income. A total of 844 persons responded to the mail survey, through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study, and the unit of analysis is a physician. To examine the change of average income per month, multiple regression was used to test the change according to physician's characteristics, demographic characteristics, scale of clinic(or hospital), average intensity of ordinary work, and specialty. The major findings of this study are as follows; 1. As for self-employed physicians, the difference of average income per month among specialties was 4,850,000won, but the difference was 6,020,000won under the control of control variables, and average income per month was significantly higher for physicians who had sick-beds than physicians who had no sick-beds. 2. The number of average out-patients per month and number of nurses and nursing aides significantly positively associated, but the number of physician significantly negatively associated with average income per month. In conclusion, the number of out-patient and number of nurses and nursing aides is the major influencing factor, and the difference of average income per month among specialties existed in self-employed physicians. So this study suggests basic hypothesis that the price of medical service and supply of physician by specialties are not pertinent. Being a cross-sectional study, this study can not suggest causal explanations. In the future, further study is needed for causal explanations.; Summary

The Difference in Attitude toward Medical Care between Patients and Physicians.: Myung Geun Kang, Jong Ku Park, Han Joong Kim, Myong Sei Sohn, Dal Rae Kim; Korean J Prev Med. 1998;31(3):516-539.

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Abstract PDF: The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilizers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's alpha coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care- preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a university hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demand side such as the development and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be necessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.; Summary

A study on a hospital services evaluation method b physician survey.: Won Gi Jhang, Ok Ryun Moon; Korean J Prev Med. 1996;29(4):815-830.

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Abstract PDF: A physician survey was done by mailing for the purpose of performing hospital services evaluation and ranking. A slightly over one thousand samples were drawn from the list of professional societies, and 324 physicians(about 32 percent) replied. This study has focused on developing easy and simple method to evaluate hospital services, and providing patients with useful information. Hospital service structure and process were evaluated without outcome evaluation, because it is difficult to obtain reliable data regarding health services outcome indicators. Clinical specialty was targeted to evaluate, and three specialties were chosen, that is obstetrics & gynecology, cardiology, and proctology. Among 16 structural indicators, four indicators were finally chosen in each specialty by respondent specialists. And then using these indicators, structural score was calculated for study hospitals. For process evaluation, physicians were requested to nominate five most famous hospitals. The nomination score and structural score were summed up to produce final score and hospital ranking. This method is very easy to conduct rather than other hospital services evaluation methods prevailing in Korea. And it is more useful for patients to choose hospitals, according to his/her own purpose, because it gives high ranking hospitals with specific clinical specialty.; Summary

Distribution af active physicians and their working areas after 10 years of graduation.: Seung Hum Yu, Tae Yong Sohn, Hyohn Joo Oh; Korean J Prev Med. 1996;29(3):429-438.

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Abstract PDF: The geographical distribution of active physicians who graduated from medical schools before 1985 were studied. Those who had emigrated, hold non-medical jobs, are in the military service, or work as public health physicians and resident staff were excluded from the study. A total of 27,728 physicians were analyzed. Our studies have shown a relationship between the location of the medical schools from the which the physicians have graduated and the geographical regions in which they practice. A statistically significant number of physicians are working near the medical colleges from which they have graduated. That is, those who had graduated from medical schools located in the southern area of the country are presently working in the same region. This relationship was shown to be especially significant for older physicians and female doctors, who work around the area of the medical colleges from which they graduated.; Summary

Geographical distribution of physician manpower by specialty and care level.: Seung Hum Yu, Sang Hyuk Jung, Byung Yool Cheon, Tae Yong Shn, Hyohn Joo Oh; Korean J Prev Med. 1993;26(4):661-671.

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Abstract PDF: In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.; Summary

A study on the practice variations according to physician characteristics.: Eun Kyeong Jeong, Ok Ryun Moon, Chang Yup Kim; Korean J Prev Med. 1993;26(4):614-627.

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Abstract PDF: It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount(total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners(GP), 107 regular family physicians(FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites(urban-rural). Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.; Summary

Recognition and attitude to fundtional division between physicians and pharmacists of practising physicians and pharmacists in Taegu city.: Moo Sik Lee, Nung Ki Yoon, Suk Kwon Suh, Jae Yong Park; Korean J Prev Med. 1993;26(1):1-19.

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Abstract PDF: Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered failure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is successful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical insurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician preferred pros and 17.7 percent cons ,but 38 percent of practicing pharmacist preferred pros and 45.5 percent cons. And pharmacist know better the content of functional division between physician and pharmacist, practicing emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist preferred generic name (44.0%, 89%) mostly, but physician preferred brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the governmental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the government should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.; Summary

Impact of increasing the level of copayments on the number of physician visits.: Ki Hong Chun, Hang Jung Kim; Korean J Prev Med. 1992;25(1):73-87.

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Abstract PDF: The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in nuniU rs of physician visits, to explain charac teristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program.. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor pule.; Summary

An analysis of the physician productivity in general hospitals.: Jung Un Lee, Ki Hyo Lee, Ok Ryun Moon; Korean J Prev Med. 1991;24(3):400-413.

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Abstract PDF: The purpose of this paper is to identify factors affecting the optimum mix of required inputs and other relevant factors which account for the variation in physician's productivity in general hospitals, and to find out their implications for the efficient health planning and management. An extended version of Cobb-Douglas production function and cross sectional data of one day patient census from all general hospitals in Korea in 1988 were used in the analysis. Main results of the analysis and their implications could be summarized as follows ; (1) The production function for physician's inpatient service shows the evidence of economies of scale, but the production function for physician's outpatient and adjusted-patient service, which combines both out- and inpatient service, shows that of dis-economies of scale. (2) The physician's role for production for all service is smaller than auxiliary personnel's, which imply that more intensive utilization of nurses, nursing aides and other auxiliary personnel is desirable for improving general hospital productivity. (3) In case of physician's inpatient and adjusted-patient service, nurses is recommended for the efficient operation of general hospitals. (4) The factor of hospital beds plays the leading role among required inputs in the production for physician's in- and adjusted-patient service. (5) The physician's productivity of general hospitals in rural area is lower than that in urban area. And the productivity of teaching hospitals is lower than that of the other hospitals. Further analysis was made in physician production function based upon the size of hospitals, namely those hospitals below 250 beds and those above. Explained variances by the factor of hospital beds was significantly increased in the case of those hospitals above 250. A more detailed and thorough investigation is needed for verifying factors influencing physician's productivity in general hospitals in Korea.; Summary

A study on the productivity of physicians operating clinic in Kyeongsangnamdo.: Jeong Ho Kim, Kwi Won Jeong, Jin Ho Chun, Chae Un Lee, Ki Taek Pae, Kong Hyun Kim, Hae Rim Shin, Hyung Jong Park; Korean J Prev Med. 1991;24(2):171-180.

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Abstract PDF: Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionnaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The major results were as follows. First, physicians were more prevalent 35~44 group (38.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization, city (78.0%) in geographical location. Age group of 35-54 and specialist were more prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p<0.001). Second, daily outpatient load of all physician were 77.1 persons on average. Age group of 35~44 had the most outpatient load (90.3 persons) among all age group, 6~10 years group (94.2 persons) in years of duration of practice, 11 hours per day group (83.4 persons) in working hours per day. Specialists had more outpatient load (82.6 persons) than general practitioners (61.1 persons) and physicians in cities had more (80.2 persons) than physicians in counties (66.3 persons). Daily average outpatient load of physicians were significantly different by their age, speciality, number of assistants and years of practice (p<0.001) and working location (p<0.05), but not significantly different by working hours per day of physician (p>0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factorsnumber of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.; Summary

Physician Utilization and its Determinants in Rural and Urban Slun Areas.: Jin Hee Lee, Kee Ho Ko, Yong Sik Kim, Jung Ae Rhee; Korean J Prev Med. 1988;21(2):404-418.

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Abstract PDF: The household survey was performed in a urban slum and a rural Chonnam areas to measure the level of illness and medical care utilization and to find the determinants of physician utilization. The data revealed that age-adjusted prevalence rates of acute and chronic diseases were much the same in both areas ranged between 10.0 to 11.3%. But medical care utilization was more frequent in urban slum than in rural area. The facility of the first medical contact was also different. Some personal and disease related variables including disease severity and activity restricted day were significantly, but somewhat differently by area, associated with physician utilization pattern. When applying Anderson model, the medical need factors explained 42.2 and 40.4% of physician utilization in urban slum and in rural areas respectively, while the enabling factors explained 18.0 and 12.2% and the predisposing factors explained 17.1 and 8.9% correspondingly.; Summary

Projection of Physician Manpower Supply in Korea.: Seung Hum Yu, Woo Hyun Cho, Yong Ho Lee, Byung Yool Cheon; Korean J Prev Med. 1988;21(1):61-69.

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Abstract PDF: In this study, the number of physicians presently living in Korea thoroughly estimated by several means and, on this bases, their productivity and level of supply were estimated. The results were as follows : First, the number of physicians who did not notify the Korea Medical Association in May 1987 were 10,110, including 4,093 emigrant physicians(40.5%), 861 military medical officers, 745 public health doctors, and 107 decreased physicians. A total of 1,330 physicians could not be identified by any effort. Second, among the 34,897 registered physicians as of May 1987, 29,933(85.8%) were residing in Korea, 4,115 physicians(11.8%) had emigrated to other countries, and 849 physicians(2.4%) were decreased. Practicing physicians defined as those in Korea who were not retired, serving in the military, or completing residencies or internships, comprised 78.6%(27,414 physicians) of the total number of registered physicians. Third, it is estimated that in the year 2000 the number of registered physicians, physicians residing in Korea, and practicing physician will be 75,040, 64,038 and 57,655, respectively and these are increases of 115.0%, 113,9%, and 110.3%, respectively, compared to 1987. Fourth, the population physician ratio will be 759 to one physician in the year 2000. Fifth, the productivity of physicians, as calculated by relative values defining the productivity of 35 to 44 year-old male physicians as 10, will increase 110.7% in the year 2000 compare to that of 1987, and this increment is almost the same level as that of physicians supply. From the results of the present analysis of physicians manpower and supply projection, it can be recognized that the development of a regular notification system is necessary in order to identify precisely the number of physicians. Also a policy a physician supply is essential in order to adjust in advance the number of physicians, otherwise there will be surplus to the medical demand.; Summary

English Abstracts

Mortality among Medical Doctors Based on the Registered Cause of Death in Korea 1992-2002.: You Cheol Shin, Jae Heon Kang, Cheol Hwan Kim; J Prev Med Public Health. 2005;38(1):38-44.

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Abstract PDF: OBJECTIVE
To compare the mortality rate of Korean medical doctors to that of the general Korean population for the period 1992-2002. METHODS: The membership records of the Korean Medical Association were linked to the 1992-2002 death certificate data of Korea's National Statistical Office using 13-digit unique personal identification numbers. The study population consisted of 61, 164 medical doctors with a follow-up period of 473, 932 person-years. Standardized mortality ratios (SMRs) were calculated to compare cause-specific mortality rates of medical doctors to those of the general population. RESULTS: We confirmed 1, 150 deaths at ages from 30 to 75 years from 1 January 1992 to 31 December 2002. The SMR for all-cause of death was 0.47 (95% CI : 0.44~0.50). The SMRs for smoking-related diseases such as cerebrovascular accidents and chronic obstructive pulmonary disease were smaller than the SMR of all-cause of death. However, the SMRs for colorectal and pancreatic cancers were not significantly lower than those of the general population. Transport accidents and suicides accounted for 72% (94 of 131) of external causes of death. The SMR for suicide was 0.51 (95% CI : 0.38~0.68). CONCLUSIONS: The mortality rate of South Korean medical doctors was less than 50% that of the general population of South Korea. Cause-specific analysis showed that mortality rates in leading causes of death were lower among medical doctors although differences in mortality rates between medical doctors and the general population varied with the causes of death. These health benefits found among medical doctors may be attributable to the lower level of health damaging behaviors (e.g., lower smoking rates) and better working conditions.; Summary

Factors Influencing Antibiotics Prescribing of Primary Health Physicians in Acute Upper Respiratory Infections.: Nam Soon Kim, Soong Nang Jang, Sun Mee Jang; J Prev Med Public Health. 2005;38(1):1-8.

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Abstract PDF: OBJECTIVES
To explore the factors influencing antibiotics prescription by primary health physicians for acute upper respiratory infections (URI). METHODS: We performed a survey of 370 primary health physicians randomly sampled in April, 2003. The questionnaire consisted of a prescription on the scenario of acute bronchitis case, along with opinions and reasons for prescribing antibiotics on URI. RESULTS: We found that 54.7% of the physicians prescribed antibiotics on the example case of acute bronchitis which is known as not needing antibiotics. Female physicians and ENT physicians had a greater tendency to prescribe antibiotics. The factors influencing antibiotics prescription on URI were the belief about the effectiveness of antibiotics, preference for their own experiences rather than clinical guidelines, perception of patients' expectations, and perception of competitive environment. The prescription of antibiotics in the example case was affected by how much they usually prescribe antibiotics (OR=2.400, 95% CI=1.470-3.917) and the physicians who thought that antibiotics were helpful for their income prescribed antibiotics more than others (OR=6.773, 95% CI=1.816-25.254). CONCLUSION: These findings demonstrated that the false belief on the effectiveness of antibiotics, patient's expectation of medication and fast relief of symptoms, and perception of competitive environment all affected the physicians' prescription of antibiotics on URI. It may help to find barriers to accommodate scientific evidence and clinical guidelines among physicians and to specify subgroups for education about appropriate prescription behaviors.; Summary

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