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Background: Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors. Methods: Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year. Results: At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P<0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, P = 0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups. Conclusion: While the educatinal material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population. [ABSTRACT FROM AUTHOR]

Background: Recently there has been a growing interest in healthcare quality control in Korea. We examined the association between patient factors and quality indicators of diabetic care among Korean adults with diabetes. Methods: We obtained a sample of 335 adults aged 20 or older diagnosed with diabetes from the 2005 Korean National Health and Nutrition Examination Survey. Patient factors were divided into two categories: socioeconomic position and health-related factors. Quality indicators for diabetes care were defined as receiving preventive care services for diabetes complications (e.g., fundus examination, microalbuminuria examination, diabetes education) and diabetes-related clinical outcomes (e.g., HbA1c, blood pressure, LDL-cholesterol). We performed multiple logistic regression analyses for each quality indicator. Results: We found that people with lower education levels or shorter duration of diabetes illness were less likely to receive preventive care services for diabetes complications. Women or people with longer duration of diabetes were less likely to reach the glycemic target. Obese diabetic patients were less likely to accomplish adequate control of blood pressure and LDL-cholesterol. Conclusions: Several factors of patients with diabetes, such as education level, duration of illness, gender, and obesity grade are associated with the quality of diabetes care. These findings can help inform policy makers about subpopulations at risk in developing a public health strategy in the future. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population. Methods: We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors. Results: Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence. Conclusions: Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose: To describe development of the Standard Hospice & Palliative Care Education Program in Korea, a basic training program for hospice & palliative care professionals, and to report preliminary results from the 2008-2009 demonstration project at 2 sites that support its effectiveness. Method: We developed the Standard Hospice & Palliative Care Education Program, consisting of 19 modules, under the initiative and financial support of the Ministry of Health, Welfare, and Family Affairs. We adapted the train-the-trainer model and benchmarked the EPEC (Education in Palliative and End-of-life Care) course. In order to evaluate the effectiveness of the program, session evaluation, pre-post test of knowledge, and overall course evaluation were assessed by participants. Results: The demonstration program included a total of 105 participants. Overall rating by participants was 4.1 for relevance and usefulness of program contents (range, 4.1–4.2; 1 = strongly disagree, 5 = strongly agree) and 4.1 for the trainer's teaching skills (range, 4.0–4.2). Participants demonstrated significant improvement in their knowledge on the pre-post test for 6 of the 17 modules, and reported that they had gained confidence in their ability to perform palliative care practices (overall mean ratings, 4.0, range; 3.6–4.3; 1 = very low, 5 = very high). Overall evaluation of the program was very high (very satisfied or satisfied; 86%). Conclusion: Development of the Standard Hospice & Palliative Care Education Program was successful, and its preliminary effectiveness was shown by the demonstration program. Comments on our experience in Korea would be helpful to efforts in other countries, particularly those with limited resources for hospice and palliative care. [ABSTRACT FROM AUTHOR]

Background: Clinical effectiveness of Helicobacter pylori eradication in gastric cancer survivors after endoscopic resection of early gastric cancer (EGC) was recently established in a randomized controlled trial. We aimed to establish long-term cost-effectiveness in gastric cancer survivors after endoscopic resection of EGC. Materials and Methods: A Markov model was constructed to compare the costs and outcomes of the two intervention strategies: (1) eradicate H. pylori after complete resection of EGC by endoscopy (2) do not eradicate. Estimates for variables in the model were obtained by extensive review of published reports. Analyses were made from the Korean public healthcare provider’s perspective. Results: Base-case analysis indicated H. pylori eradication costs less (US$ 29,780 vs. US$ 30,594) than no eradication, and save more lives (mean life expectancy from eradication: 13.60 years vs. 13.55 years). One-way and three-way sensitivity analyses showed the robustness of the cost-effectiveness results. Conclusion: In this selective population with very high risk of developing gastric cancer, H. pylori eradication should be considered for reimbursement with priority to prevent subsequent cancer and also reduce health care cost. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. METHODS: Cohort study of a 3% random sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. RESULTS: In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. CONCLUSIONS: Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs. [ABSTRACT FROM AUTHOR]