당뇨질환자의 통합의료서비스 이용 결정요인

Abstract

Background: Recently, conventional medicine has further developed forms of integrative medicine by developing interfaces with other systems of medicine, including traditional, complementary and alternative medicine. Patients with chronic diseases have begun to expect the new health care models which integrate both modalities. Thus there is an increasing number of research studies on integrative approaches. However, the use of integrative health service of patients with Diabetes Mellitus has not been studied yet in Korea.

Objectives: The objective of this study was to understand the prevalence of the use of integrative approaches, managing diseases with both use of western medicine and complementary and alternative medicine among patients with diabetes mellitus. Then, this study determined the influencing factors related to Integrative Health Services use and the health benefits perceived by the patients.

Methods: The design of the study was descriptive cross-sectional, and data were collected using a 30-items questionnaire. The subjects were three hundred sixty patients with diabetes mellitus who visited to "A" University Hospital in Seoul, Korea. Data were analyzed using 'SPSS Statistics 18.0 Network Version(on release 18.0.1 of PASW Statistics)' program. Various statistical methods were used for analyze the data to obtain a profile for participants and the methods most frequently used by users of integrative health services. Logistic regression analysis was employed to determine the predicting variables of integrative health care use and health benefit perceived.

Results: Complementary and alternative medicine used 92% among patients with diabetes mellitus. The prevalence of the use of Integrative Health Services was 67.4%. Results of logistic regression analysis revealed that the variables significantly related with integrative health services use were age, marital status, duration of the disease, and medical pluralism as a new approach for managing chronic diseases. Another results of logistic regression analysis found that the variables related to the perceived health benefits from integrative health service uses were 'subjective perception of constitutional changes' and "subjective perception of glucose level control'. Conclusions: The use of integrative health services is highly prevalent in patients with diabetes mellitus. This study gives some understanding of the impetus among the patients with chronic diseases for seeking integrative health services. Knowing that the patient is using both western medicine and CAM should alert physicians to the possibility that care may be lacking, the patient is dissatisfied with the results of their treatment, or is experiencing problems with self-care and thus seeking help outside the conventional sources of care. In the hospital care of the patients, therefore, the use of integrative health services is a clinical marker to identify patients in need of improved chronic disease care.|이 연구는 질병의 치유와 건강증진을 목적으로 기존의 서양의료와 보완대체의료를 병행하고 있는 만성질환자들에 있어 통합의료서비스이용에 영향을 미치는 요인과 건강이익, 즉 바람직한 치료결과에 관련된 결정요인을 확인하고자 수행하였다. 이러한 통합의료서비스이용이 건강이익으로 이어지는 상관성을 통해 환자 중심적 관점에서 통합의료서비스가 나아갈 방향성을 제시하는 것이 이 연구의 궁극적 목적이었다.

연구의 자료 수집을 위해 2011년 3월 21일부터 약 2주간 서울에 소재한 A병원 외래를 방문한 환자 대상으로 설문을 하였으며, 혈당조절 등의 “건강이익”에 대한 객관적 치료결과 확인이 가능한 당뇨질환자를 대상으로 하였다. 대상자에게 연구의 취지를 설명하고 참여의사를 질문한 뒤 연구자가 직접 또는 연구자로부터 사전교육을 받은 설문요원 1인이 해당 외래에서 1:1 면담을 하였으며 설문요원이 설문지를 작성하였다. 설문지의 총수는 360부였으나 완성도가 미흡한 47부를 제외하였으며, 실제로 분석에 이용된 설문지의 총수는 313부로 회수율은 86.9%였다.

이 연구에 사용된 조사 도구와 설문 항목은 총 30문항이며 인구사회학적 특성 7문항, 질병과 의료행태에 관한 특성 11문항, 의료서비스 관련하여 4문항, CAM이용특성에 관하여 8문항으로 구성하였다. 이 연구를 위하여 수집된 자료는 SPSS Statistics 18.0 Network Version(on release 18.0.1 of PASW Statistics) 프로그램을 이용하여 통합의료서비스 이용에 대한 결정요인과 건강이익(health benefit), 즉 치료결과에 관련된 요인을 분석하였다.

이 연구의 주요결과는 다음과 같다. 우선 응답한 대상자는 총 313명으로 이중에서 보완대체의료 이용률은 92.0%였다. 보완대체의료 이용시점을 기준으로 '진단을 받고나서부터(발병즉시)'와 '치료과정 중부터' 이용을 시작한 군을 통합의료서비스 기간으로 가정한 최병희(2010)연구와 동일기준을 적용하였으며 그 결과, 통합의료서비스 이용률은 67.4%였다.

통합의료서비스 이용 결정에 영향을 미치는 요인의 Linear Logistic Regression분석 결과, 인구사회학적 요인으로 나이에서는 ‘50대’ 에서와(p<0.05), ‘유배우자’에서 유의한 결과가 확인되었으며(p<0.05), 질병특성에서는 ‘치료기간이 만성기’에서 통계적으로 유의하였다(p<0.001). 현재의 치료만으로는 만족하지 못하는 ‘의료다원’주의 신념을 가진 군에서 통합의료서비스 이용의 결정 요인으로 유의하였다(p<0.001).

당뇨환자의 통합의료서비스이용과 건강이익과의 Linear Logistic Regression분석 결과는, 환자의 질병에 대한 주관적 인식에서 ‘건강상태가 좋다’는 군(p<0.01)과 ‘건강에 관심이 높다’는 군, ‘질병통제 수준이 높다’는 군에서 유의하였으며(p<0.05), 통합의료서비스이용이 ‘혈당조절효과’와 ‘체질이나 면역체계’에 변화가 있었다는 구체적 효과항목을 선택한 군 또한 높은 관련성이 확인되어(p<0.001) 통합의료 이용 후 주관적 치료의 효능감이 관계되어 있음을 알 수 있었다.

대상자들의 통합의료서비스 이용이 당뇨질환관리에 있어 건강이익에 대한 주관적 인식 수준이 높다는 사실은 만성질환자 관리과정에서 객관적 지표 활용이 치료의 효율성 증대에 영향을 미칠 수 있음을 시사한다. 또한 통합의료 서비스이용이 체질변화에 있어 주관적 효능을 인지한바 한국의 문화적 측면의 용어 활용이 또한 병원에서의 치료상담에 있어 활용이 필요함을 시사한다.

대부분의 환자들은 정통 서양의료에 부정적 인식과 함께 환자의 이익(benefit)을 가장 수준 높은 상태로 될 수 있도록 하기 위해 통합의료서비스를 끊임없이 선택하고 경험한다. 이제는 우리사회가 의료의 다양성을 받아들이기 위한 노력이 필요한 바, 이 연구를 통해 환자의 본질적 속성에 내재된 특성이 통합의료서비스이용 결정요인과 건강이익으로 이어지는 관계성이 유의하게 확인한 것은 매우 의미 있는 결과라 할 수 있다.; Background: Recently, conventional medicine has further developed forms of integrative medicine by developing interfaces with other systems of medicine, including traditional, complementary and alternative medicine. Patients with chronic diseases have begun to expect the new health care models which integrate both modalities. Thus there is an increasing number of research studies on integrative approaches. However, the use of integrative health service of patients with Diabetes Mellitus has not been studied yet in Korea.

Objectives: The objective of this study was to understand the prevalence of the use of integrative approaches, managing diseases with both use of western medicine and complementary and alternative medicine among patients with diabetes mellitus. Then, this study determined the influencing factors related to Integrative Health Services use and the health benefits perceived by the patients.

Methods: The design of the study was descriptive cross-sectional, and data were collected using a 30-items questionnaire. The subjects were three hundred sixty patients with diabetes mellitus who visited to "A" University Hospital in Seoul, Korea. Data were analyzed using 'SPSS Statistics 18.0 Network Version(on release 18.0.1 of PASW Statistics)' program. Various statistical methods were used for analyze the data to obtain a profile for participants and the methods most frequently used by users of integrative health services. Logistic regression analysis was employed to determine the predicting variables of integrative health care use and health benefit perceived.

Results: Complementary and alternative medicine used 92% among patients with diabetes mellitus. The prevalence of the use of Integrative Health Services was 67.4%. Results of logistic regression analysis revealed that the variables significantly related with integrative health services use were age, marital status, duration of the disease, and medical pluralism as a new approach for managing chronic diseases. Another results of logistic regression analysis found that the variables related to the perceived health benefits from integrative health service uses were 'subjective perception of constitutional changes' and "subjective perception of glucose level control'. Conclusions: The use of integrative health services is highly prevalent in patients with diabetes mellitus. This study gives some understanding of the impetus among the patients with chronic diseases for seeking integrative health services. Knowing that the patient is using both western medicine and CAM should alert physicians to the possibility that care may be lacking, the patient is dissatisfied with the results of their treatment, or is experiencing problems with self-care and thus seeking help outside the conventional sources of care. In the hospital care of the patients, therefore, the use of integrative health services is a clinical marker to identify patients in need of improved chronic disease care.