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KMID : 1145820180010020023
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Swallowing Rehabilitation
2018 Volume.1 No. 2 p.23 ~ p.33
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A Phenomenological study on experience of occupational therapist about medical insurance payment related on functional electrical stimulation for rehabilitative dysphagia therapy
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Song A-Young
Oh Young-Ju
Yun Yeong-Sik
Cha Tae-Hyun
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Abstract
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The purpose of this study is to investigate the current state of treatment and the clinical experience of reduce in the number of treatments after the coverage of functional electronical stimulation for rehabilitation dysphagia therapy. Targeting 9 occupational therapists who conducted Dysphagia rehabilitation therapy in Daejeon and Chungcheong area, the conversation was conducted total two times in December 2017 through discussion. Data collection was transcribed through word processor and data analysis was conducted according to Scientific Phenomenology by Giorgi procedure. Clinical experiences felt by the occupational therapists according to the insurance coverage of function of electrical stimulation for rehabilitative dysphagia therapy were derived as 9 semantic units, 7 sub-factors, 5 factors. Composing factors were identified as 1) Decrease of application targets after coverage, 2) Ambiguity of reduction standards, 3) Problems of VFSS results interpretation, 4) Decrease in quality of treatment and 5) duplicity of coping after reduction. Sub-factors were identified as 1) Restriction of application ranges caused by the limitation to central nervous system patients after coverage, 2) Uncertainty of standards to extend the treatments, 3) Reduction results according to subjective evaluation standards by higher level institutions, 4) Different reading results from patient's function, 5) Increase of reuse rate of pads caused by the coverage, 6) Relationship between medical grade and dysphagia insurance payment and 7) Passive responses of medical staffs. Lastly, semantic words were identified as 1) Decrease in the number of treatments due to the restriction of applicable patients, 2) Complaints about the necessity of treatments for non-applicable patients and about the restrictions on the applicable patients, 3) Different VFSS extension standards for each patient, 4) Reduction according to the doctor’s comments about VFSS results of senior institutions, 5) Ambiguity of reading standards about the aspiration findings in VFSS results, 6) Different opinions of occupational therapists and doctors about VFSS interpretation, 7) Difficulty in pad management and increasing use of shortcuts in using pads, 8) Decrease in medical grade and decrease of insurance payment of nursing hospitals, due to the actions to raise the Diagnosis-Related Groups Payment for the reduction of dysphagia and 9) Medical staff’s passive attitudes at the time of coordination application for appeal of reduction. Following results show the current situations of the occupational therapist in the clinical institutions, and based on this, this study is expected to be helpful to suggest the directions for the occupational therapists after the coverage of Functional electrical stimulation for rehabilitative dysphagia therapy.
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KEYWORD
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Functional electrical stimulation for rehabilitative dysphagia therapy, dysphagia, rehabilitative dysphagia therapy, insurance payment, Scientific Phenomenology by Giorgi
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