Medical Treatment, Duty to Work, and Political Education. Functions of Soviet “Prophylactoria” and “Care Homes for STD Patients” in Germany

In the 1920s, so-called prophylactoria were established in the USSR. In these institutions, sex workers with sexually transmitted diseases (STDs) were treated. After the end of World War II, care homes for patients with STDs were established in the Soviet Occupation Zone of Germany (SOZ). These institutions were also intended to treat people suffering from STDs. This article compares these two types of medical institutions. Sources from the State Archive of the Russian Federation in Moscow, the German Federal Archives in Berlin and the City Archive Zwickau were used. The analysed sources were evaluated by using the historical-critical method. The prophylactoria were novel institutions that combined education and medical treatment of people with STDs. Similar strategies were followed in the care homes for STD patients. In both institutions, the sick persons had to follow a regular daily routine and work every day. The political indoctrination served to educate 'socialist personalities'. Nevertheless, various differences can be found between the facilities: the length of stay was different. The women in Soviet prophylactoria were cared for there for up to 2 years. However, the standard duration of stay in the care homes for STD patients was 3-6 months. The prophylactoria had a long-term programme not only to treat sick women but also to reeducate them. The aim was to enlighten and integrate them into the new Soviet society. The care homes for STD patients had a short-term programme of combating venereal diseases. Their main goal was to treat patients with STDs as quickly as possible, while education was an additional measure. Whether both institutions were successful in educating and treating these patients can hardly be assessed from today's perspective.

Objectives: While health literacy is recognized as a crucial determinant of health outcomes, research on its disparities among individuals visiting different types of primary medical institutions remains limited. This study aimed to examine the association between health literacy and the type of medical institution individuals primarily visited.Method: Using data from the Korea Health Panel Survey, this study analyzed the Health Literacy (HLS-EU-Q16 score) in relation to the type of medical institution visited. Furthermore, the study examined the difference in the primary source used to acquire medical information across institution types. Sub-analyses were also conducted based on age and the presence of chronic disease.Results: Among the 5,361 participants, women represented the majority of visitors to all groups (p<.0001). Older individuals were more likely to visit all types of medical institutions, but this tendency was less pronounced for Korean Medicine Clinics/Hospitals (KMC) (p=0.0002). Visitors to KMC showed an even distribution in education level; conversely, visitors to Public Health Centers/Clinics (PHC) tended to have a lower education level (p<.0001). The mean household annual income of KMC visitors was higher than that of other groups, while the income of PHC visitors was lower (p<.0001). The HLS-EU-Q16 score was significantly higher among visitors to KMC compared to other institutions (p=0.0003). Visitors to PHC relied mainly on television, whereas other visitors primarily utilized search engines for medical information.Conclusions: Health literacy varies by the type of medical institution visited. Further research is needed to understand the reasons for this variation and to improve health literacy across different healthcare settings.

Background/AimsThe utilization of endoscopic retrograde cholangiopancreatography (ERCP) is variable and largely dependent on a patient’s age, sex, and region. Herein we analyzed the publicly available Health Insurance Review and Assessment (HIRA) database with the aim of understanding the current status and trend of ERCP use in Korea.MethodsBetween 2013 and 2017, information regarding ERCP was acquired from the HIRA database using the procedural codes of the Korean Standard Classification of Disease. We analyzed the annual number of patients according to age in 10-year increments, sex, type of medical institution, and administrative division.ResultsThe total number of patients and number of patients undergoing ERCP per 100,000 people increased from 40,516 and 78.6 in 2013 to 47,027 and 91.3 in 2017, respectively those aged 70 years accounted for the highest number, and the increase was the most prominent in those aged 80 years or older. Men underwent more ERCPs than women, except in younger patients (<40 years). Most ERCPs were performed at tertiary and general hospitals; however, the ratios between the two types of institutions were different according to the procedure. There were different patterns of patients associated with each procedure according to the administrative division. Therapeutic ERCP was performed more frequently than diagnostic ERCP.ConclusionsMost procedures in Korea were therapeutic, and the increase in patients was most prominent in those aged 80 years or older. The utilization of ERCP increased markedly and varied depending on age, sex, type of medical institution, and region.

BackgroundMany countries agree with the horizontal equity that medical resources should be allocated according to medical needs, regardless of income. Although the short-term equity index calculated through cross-sectional data doesn't reflect the dynamics of individual income and medical use, it can be supplemented by the long-term equity index using panel data. Koreans tend to choose expensive but highly specialized services without considering their medical needs because they are free to choose service providers. This study aims to empirically examine how the patterns of outpatient medical use that are not based on medical needs differ in terms of short- and long-term equity for each type of medical institution.MethodsUsing Korea Health Panel Survey(2014-2018), the equity of outpatient medical use(number of visits, medical expenses) of 10,244 people was measured by type of medical institution (tertiary general hospital, general hospital, hospital, clinic, and dentist). Wagstaff&van Doorslaer(2000)’s tool and Jones & Lopez-Nicolas(2004)’s tool were used to calculate the short and long-term horizontal equity index(HI), and mobility index(MI) to compare short and long-term inequity.ResultsIn tertiary general hospitals and dentists, there were short and long-term pro-rich inequalities(HI > 0, p < 0.05). As a result of comparison, long-term inequality was greater in the number of visits (MI < 0), while inequality was easing in the long-term in medical expenses(MI > 0) in tertiary general hospitals. In dentists, long-term inequality was less than short-term inequality in both the number of visits and medical expenses (MI > 0).ConclusionsThe short-term equity index is likely to underestimate or overestimate inequity in our society, so a long-term perspective is needed. Inequality patterns for each type of medical institution should be considered in healthcare reforms for fair distribution of medical resources.Key messages• Short-term equity index differs from the long-term equity index in outpatient medical use.• The pattern of short and long-term equity indices may differ by type of medical institutions.

There is an urgent need for more systematic investigations into how image inspection and primary treatment for low-risk prostate cancer vary by type of medical institution. To investigate disparities in imaging inspections and first-line treatment depending on the type of medical institution for low-risk prostate cancer using the Japan Study Group of Prostate Cancer database. Data on patients with low-risk prostate cancer diagnosed between 2016 and 2018 from a nationwide database of the Japan Study Group of Prostate Cancer were used. Among these databases, patient and tumor characteristics, image inspections for diagnosis, and first-line treatment at clinics, community hospitals, and university hospitals were compared statistically. This analysis included patients with low-risk prostate cancer at clinics (n = 89), community hospitals (n = 1259), and university hospitals (n = 671). The three facilities had no significant differences in the performance of computed tomography scans, bone scintigraphy, and magnetic resonance imaging scans. Active surveillance was less performed in clinics and university hospitals, compared with community hospitals. Androgen deprivation therapy was significantly more common, but curative treatments, including radiation and prostatectomy, were less performed in clinics. Curative radiation was significantly more common, but androgen deprivation therapy was less performed in university hospitals. Our study analyzed data on low-risk prostate cancer obtained from a Japanese multi-institutional registry and showed differences in first-line treatment options by type of medical institution.

Background: Over the past two decades, population aging and the introduction of the new postgraduate medical education program in 2004 have impacted on the geographic maldistribution of physicians in Japan. The purpose of this study was to evaluate recent changes in physician distribution across municipalities from 1996 to 2012 using Gini coefficients and to clarify the impact of the new medical education program on physician distribution.Methods: We extracted the number of physicians classified by type of medical institution and municipal bodies. Gini coefficients were calculated using both population and demand for medical services. We calculated the contribution ratio (CR) of maldistribution within each type of medical institution to the whole maldistribution using Rao’s method. In addition, we calculated the incremental difference in Gini coefficients between 2002 and 2010, and calculated the CR of the incremental Gini coefficient difference for each medical institution type using Seki’s method.Results: Both Gini coefficients decreased from 1996 to 2002, and increased after 2006. The CR of other hospitals increased from 2004. The incremental difference in the Gini coefficient using demand between 2002 and 2010 was 0.012, and the CR of each type of medical institution was -25.1% (university hospitals), 131.0% (other hospitals) and -5.9% (clinics).Conclusions: Our analysis showed that the geographic maldistribution of physicians has worsened since the introduction of the new postgraduate medical education program, and the CR of maldistribution in other hospitals was high. Our study suggested that new medical resource distribution policies should be discussed to improve maldistribution.

Purpose: There is an urgent need for more systematic investigations into how imaging inspection and primary treatment for low-risk prostate cancer vary by type of medical institution. To investigate disparities in imaging inspections and first-line treatment depending on the type of medical institution for low-risk prostate cancer using the Japan Study Group of Prostate Cancer database. Methods: Data on patients with low-risk prostate cancer diagnosed between 2016 and 2018 from a nationwide database of the Japan Study Group of Prostate Cancer were used. Among these databases, patient and tumor characteristics, image inspections for diagnosis, and first-line treatment at clinics, community hospitals, and university hospitals were compared statistically. Results: This analysis included patients with low-risk prostate cancer at clinics (n = 89), community hospitals (n = 1259), and university hospitals (n = 671). The three facilities had no significant differences in the performance of computed tomography scans, bone scintigraphy, and magnetic resonance imaging scans. Active surveillance was less performed in clinics and university hospitals, compared with community hospitals. Androgen deprivation therapy was significantly more common, but curative treatments, including radiation and prostatectomy, were less performed in clinics. Curative radiation was significantly more common, but androgen deprivation therapy was less performed in university hospitals. Conclusions: Our study analyzed data on low-risk prostate cancer obtained from a Japanese multi-institutional registry and showed differences in first-line treatment options by type of medical institution.

BackgroundSchizophrenia is a recurrent, debilitating disease that is rarely curable. Rapid intervention after the first episode of schizophrenia has been shown to positively affect the prognosis. Unfortunately, basic data is scarce on first-episode schizophrenia in Korean patients making it difficult to create a comprehensive list of risk factors for relapse. This study aims to investigate the demographic characteristics and institutional factors of patients with first-episode schizophrenia in order to identify risk factors for relapse.MethodsData from the Health Insurance Review & Assessment Service (HIRA) was used for this study to represent the Korean patient population. To identify factors affecting relapse, we explored gender, age, geographic location, medical benefits, type of medical institution, type of medication used, medication adherence, and the severity of symptoms. Data analysis was performed using the Cox proportional hazard model.ResultsThe number of patients diagnosed with first-episode schizophrenia in Korea over a 2-year period was 4567 of which 1265 (27.7%) patients experienced a relapse during the observational period. Factors affecting relapse included age, type of medical institution, type of medication used, medication adherence, and type of treatment (inpatient or outpatient) after the initial diagnosis, which varied depending upon the severity of symptoms.ConclusionsIt was found that environmental and institutional factors as well as the type of medical treatment were crucial in determining whether patients with first-episode schizophrenia subsequently relapsed. The results of this study can be utilized as source material for directing therapeutic interventions and improving mental health policies in the future.

Background: Information asymmetry between physicians and patients is one of the most unique characteristics of health care. But as consumerism spreads in health care sector, health care consumers are searching comparative information about quality and cost of providers from many information sources. Providing comparative information to health care consumers not only makes consumers choose hospital rationally, but also invigorates the health care market by providers' competition. However there are few studies regarding information searching behavior of health care consumers, then this study is carried out. Methods: The purpose of this study is to understand the information searching behavior of health care consumers based on their characteristics and the types of medical institutions. For this purpose, 313 spinal patients' data of 11 medical institutions (university hospital, spine specialized hospital, clinic) located in Seoul were collected by self-administered surveys. Results: The results of this study are as follows: 1) t-test/analysis of variance analysis showed that according to various characteristics of health care consumers and the types of medical institutions, the level of information searching of each source and the amount of information searching and searching outcomes are statistically different. 2) Regression analysis showed that influence on searching outcomes are statistically different according to the level of information searching of each source and searching content and the amount of information searching has positive effects on searching outcomes. Conclusion: The significance of this study is to provide empirical basis for establishment of health care policy reflecting information needs and preference of health care consumers.

Background The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard.Methods In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency. Results Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41 min per day, reduce clinical service time by 25 min per day, and extend rest time by 70 min per day, while the quality indicators were all meeting the targets.ConclusionBy employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives.

BackgroundPalliative care has become a key medical field worldwide. Although research relating to adult palliative care is well-established, less is known about children’s palliative care (CPC). Therefore, this study investigated the knowledge, attitude and behavior of pediatric healthcare workers (PHWs) regarding CPC and analyzed the influencing factors for the implementation and development of CPC.MethodsA cross-sectional survey of 407 PHWs was carried out in a Chinese province from November 2021 to April 2022. The questionnaire consisted of two parts: a general information form and questions on the knowledge, attitude and behavior of PHWs about CPC. Data were analyzed using t-test, ANOVA and multiple regression analysis.ResultsThe total score of the PHWs’ knowledge, attitude and behavior about CPC was 69.98, which was at a moderate level. PHWs’ CPC knowledge, attitude, and behavior are positively correlated.The most important influencing factors were working years, highest education, professional title, job position, marital status, religion, grade of hospital (I, II or III), type of medical institution, experience of caring for a terminally ill child/kinsfolk and total hours of CPC education and training received.ConclusionsIn this study, PHWs in a Chinese province had the lowest scores on the knowledge dimension of CPC, with moderate attitude and behavior and various influencing factors. In addition to professional title, highest education and working years, it is also worth noting that the type of medical institution and marital status also affected the score. Continuing education and training of PHWs in CPC should be emphasized by the administrators of relevant colleges and medical institutions. Future research should start with the above-mentioned influencing factors and focus on setting up targeted training courses and evaluating the post-training effects.

PMS73 - BRIGHT FUTURE FOR THE USE OF BIOSIMILAR INFLIXIMAB: EVIDENCE-BASED ANALYSIS USING HEALTHCARE CLAIM DATABASE

We aimed to investigate Krebs von den Lungen 6 (KL-6) assay results in a clinical laboratory to better understand patient population and test utilization. We investigated serum KL-6 test results in Korean adults by the type of medical institution visited between October 2019 and December 2021. Overall, 7,677 KL-6 tests were performed in 5,527 Korean adults (3,627 men and 1,900 women) with a median age of 68.3 years (interquartile range 59.6 - 75.8). The median KL-6 level in 507 patients who visited health promotion centers was lower than the other 5,020 patients who visited other types of medical institutions (196 U/mL vs. 588.0 U/mL, respectively, p < 0.05). Increased KL-6 levels (≥ 500 U/mL) were observed in 0.8% of patients who visited health promotion centers and in 57.1% of patients who visited other types of medical institutions. This study will help to understand patient populations and test utilization for KL-6 in clinical laboratories in Korea.

Understanding the factors influencing patient satisfaction is essential for improving healthcare services. However, the diverse elements affecting patient satisfaction at medical institutions make it impractical and inefficient to enhance all factors simultaneously. The purpose of this study is to analyze the factors influencing patient satisfaction based on the Patient Experience Survey and to identify key predictors ranked by importance for efficient application in clinical and hospital settings. A total of 69 562 survey responses were obtained from the Korean Medical Service Experience Survey conducted between 2019 and 2023. Patients satisfying the following specific conditions were extracted and categorized based on the type of medical institution (clinic or hospital) and care modality (outpatient or inpatient): outpatients visiting a clinic (N = 26 349), outpatients visiting a hospital (N = 9861), and inpatients admitted to a hospital (N = 1617). For each category, factors influencing the patients' overall satisfaction with their medical experience and their intention to recommend the hospital or clinic were analyzed. To assess the magnitude and importance of these factors, Spearman's rank correlation analysis and a regression tree model were used. The study also compared whether key predictive factors of patient satisfaction differed by medical institution type (clinic vs. hospital) and care modality (outpatient vs. inpatient), as well as by the specific patient satisfaction outcome measure (overall satisfaction vs. intention to recommend). The analysis revealed that patient satisfaction was determined by different factors depending on the outcome measure. For overall satisfaction, the most significant predictor was satisfaction with treatment outcomes, while for intention to recommend, the most influential factor was the convenience of the medical facility. These findings were consistent across medical institution types (clinic or hospital) and care modalities (outpatient or inpatient). The attitude of healthcare providers (doctors or nurses) also emerged as a key predictor of patient satisfaction, though its importance varied depending on the type of medical institution and care modality. Satisfaction with treatment outcomes and convenience of the medical facility were the most important predictor of overall satisfaction and intention to recommend, respectively. These findings reinforce that prioritizing the clinical effectiveness of care-rather than focusing solely on service-related features-is essential for achieving high patient satisfaction. Because of utilizing a large-scale dataset and identifying predictors ranked by importance, this study is expected to contribute effectively to decision-making processes regarding the future development and improvement of healthcare institutions.

ObjectivesTo evaluate the population structure of environmental bacteria and fungi in three different types of medical institutions and the potential risks due to antibiotic resistance during the coronavirus disease 2019 (COVID-19) pandemic.MethodsOne hundred twenty-six environmental surface samples were collected from three medical institutions during the COVID-19 pandemic. A total of 6,093 and 13,514 representative sequences of 16S and ITS ribosomal RNA (rRNA) were obtained by amplicon sequencing analysis. The functional prediction was performed using the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States tool based on the Greengenes database and the FAPROTAX database.ResultsOn environmental surfaces in three medical institutions during the COVID-19 pandemic, Firmicutes (51.6%) and Bacteroidetes (25%) were the dominant bacteria, while Ascomycota (39.4%) and Basidiomycota (14.2%) were the dominant fungi. A number of potential bacterial and fungal pathogens were successfully identified by the metagenomic approach. Furthermore, compared with the bacterial results, the fungi showed a generally closer Bray Curtis distance between samples. The overall ratio of Gram-negative bacteria to Gram-positive bacteria was about 3:7. The proportion of stress-tolerant bacteria in medical institutions A, B and C reached 88.9, 93.0 and 93.8%, respectively. Anaerobic bacteria accounted for 39.6% in outdoor environments, 77.7% in public areas, 87.9% in inpatient areas and 79.6% in restricted areas. Finally, the β-Lactam resistance pathway and polymyxin resistance pathway were revealed through functional prediction.ConclusionWe described the microbial population structure changes in three different types of medical institutions using the metagenomic approach during the COVID-19 pandemic. We found that the disinfection measures performed by three healthcare facilities may be effective on the “ESKAPE” pathogens, but less effective on fungal pathogens. Moreover, emphasis should be given to the prevention and control of β-lactam and polymyxin antibiotics resistance bacteria during the COVID-19 pandemic.