Journal of Preventive Medicine and Public Health

Brief Report

Primary Healthcare Utilization of Undocumented Migrants in Busan, South Korea: A Retrospective Chart Review of a Free Clinic From 2020 to 2024: Yujin Lee, Hyunjin Moon, Saerom Kim; J Prev Med Public Health. 2026;59(4):421-427. Published online July 9, 2026; DOI: https://doi.org/10.3961/jpmph.26.037

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Abstract Summary PDF Supplementary Material: Objectives
This study examined healthcare utilization patterns and health needs among undocumented migrants attending a free clinic in Busan, South Korea.
Methods
We retrospectively analyzed clinical records from 750 undocumented migrants who made 2111 clinic visits between 2020 and 2024. The primary outcome was the number of clinic visits. Diagnoses were classified using the International Classification of Primary Care, Second Edition. Mixed-effects negative binomial regression, with nationality specified as a random intercept, was used to model visit counts and to assess interaction effects between gender and other variables.
Results
Cardiovascular and endocrine diseases were the most prevalent conditions, with chronic diseases accounting for a substantial proportion of clinic visits. In multivariable analysis accounting for gender-based effect modification (model 2), older age was significantly associated with increased visit frequency (β=0.030; 95% confidence interval [CI], 0.014 to 0.045, p<0.001). The association between chronic disease and visit frequency differed significantly by gender (gender×chronic disease interaction, β=0.488; 95% CI, 0.053 to 0.924, p=0.028). Linear combination testing indicated that men with chronic diseases visited the clinic 1.9 times as frequently as men without chronic disease, whereas chronic disease status showed little association with visit frequency among women.
Conclusions
Undocumented migrants attending the free clinic experienced a substantial burden of chronic disease, and healthcare utilization patterns differed by gender. These findings highlight the need for inclusive healthcare policies and targeted interventions for this population.; Summary

Korean summary
본 연구는 2020?2024년 부산 소재 무료진료소를 방문한 미등록 이주민 750명의 진료기록 2111건을 후향적으로 분석하여 일차의료 이용 양상을 파악했다. 고혈압·당뇨병·이상지질혈증 등 만성질환이 전체 방문 사유의 45.5%를 차지했으며, 혼합효과 음이항 회귀분석 결과 연령이 높을수록 방문 빈도가 증가했고 성별과 만성질환 간 상호작용이 유의했다. 공적 의료보장에서 배제된 미등록 이주민의 의료필요를 파악하는 데에 단일 진료소의 의료이용 분석은 제한적인 정보를 제공할 뿐이며, 한국에서 함께 살아가는 이주민들의 건강과 의료접근성 개선을 위한 학술적 노력이 지속되어야 할 것으로 보인다.

Key Message
This retrospective study analyzed 2111 visits by 750 undocumented migrants attending a free clinic in Busan, South Korea (2020–2024). Chronic diseases—hypertension, diabetes, and lipid disorder—accounted for 45.5% of visit reasons, and mixed-effects negative binomial regression showed that visit frequency increased with age, with a significant interaction between gender and chronic disease. Although analysis of healthcare utilization at a single clinic provides only limited information on the healthcare needs of undocumented migrants excluded from public healthcare coverage, continued scholarly efforts appear warranted to improve the health and healthcare access of migrants living as part of Korean society.

Original Article

Behavioral Segmentation of Integrative Care Use Among Older Adults With Knee Osteoarthritis in a Rural District in Northern Thailand: Kitrawee Jiraratsatit, Wijittra Ubolkam, Kaysorn Sumpowthong; J Prev Med Public Health. 2026;59(4):411-420. Published online June 23, 2026; DOI: https://doi.org/10.3961/jpmph.26.263

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Abstract Summary PDF: Objectives
To identify behavioral segments of integrative care use among older adults with knee osteoarthritis in a rural district in Northern Thailand and to compare these segments according to PRECEDE-related factors and baseline characteristics.
Methods
This analytical cross-sectional study included 302 community-dwelling older adults with primary knee osteoarthritis in Thoen District, Lampang Province, Northern Thailand. Data were collected through face-to-face interviews using a structured questionnaire that assessed demographic and health characteristics, PRECEDE-related factors, and behaviors across 3 care domains: professional medical care, traditional medicine, and community-based medicine. Standardized behavioral domain scores were analyzed using hierarchical cluster analysis, followed by k-means clustering. Differences among segments were examined using chi-square tests, one-way analysis of variance, or Kruskal-Wallis tests, as appropriate.
Results
Three behavioral segments were identified: high engagement (20.9%), intermediate engagement (48.0%), and low engagement (31.1%). The 3 behavioral domains differed significantly across segments (all p<0.001; η²=0.400–0.535). Baseline demographic and health characteristics did not differ significantly among segments. In contrast, significant differences among segments were observed for the total enabling score, access, decision-making, total reinforcing score, social support, and attitude, whereas perceived information showed no significant difference.
Conclusions
Older adults with knee osteoarthritis were not behaviorally homogeneous in their use of professional, traditional, and community-based care. Segment differences were more pronounced for enabling and reinforcing conditions than for perceived information alone. These findings support segment-informed health promotion strategies in primary care and community settings.; Summary

Key Message
This study found three distinct patterns of care use among older adults with knee osteoarthritis in rural Northern Thailand: high, intermediate, and low engagement in professional, traditional, and community-based care. Differences between the groups were more apparent in access, decision-making, and social support than in perceived information. These findings highlight the potential value of tailoring primary care and community-based support to the needs of each group.

Perspective

Towards Mental Health Equity: Task Shifting Strategy to Overcome Barriers in Primary Healthcare Services in India: Suganya Panneerselvam, Senthilkumar Ramasamy, Sanjana Agrawal; J Prev Med Public Health. 2025;58(5):548-551. Published online June 13, 2025; DOI: https://doi.org/10.3961/jpmph.25.144

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Abstract Summary PDF: Mental illness remains among the top 10 causes of the global burden of disease. According to the National Mental Health Survey of India, 10.6% of adults exhibit mental disorders. India ideally requires 3 psychiatrists per 100 000 population, yet the current ratio is only 0.7 per 100 000. The country thus faces an urgent need to strengthen mental health infrastructure and expand training programs. Vulnerable groups—particularly residents of rural and remote areas, women, and older adults—are disproportionately affected by this situation. Individuals with mental illness often suffer in silence, enduring human rights violations, stigma, and discrimination. India’s National Mental Health Programme seeks to ensure the availability and accessibility of minimum mental health care for all, with a focus on the most vulnerable and underserved populations. The World Health Organization recommends task shifting or task sharing to improve access and deliver healthcare services in remote areas. Community Health Officers (CHOs) and Accredited Social Health Activists use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders. CHOs then ensure continuity of care through regular follow-up, bridging the gap between diagnosis and ongoing treatment. This practice significantly augments the effectiveness of community-level mental health interventions. Integrating mental health into primary health care should facilitate earlier detection and treatment of mental health disorders.; Summary

Key Message
Mental illness remains among the top 10 causes of the global burden of disease. Stigma associated with these disorders exacerbates the problem, leading to social discrimination. The Ayushman Bharat initiative is a transformative step towards strengthening India’s healthcare system. CHOs and ASHAs use community-based assessment checklists to identify individuals at risk of communicable, non-communicable, and mental health disorders within their communities. This task-shifting approach empowers local communities and fosters participation, reducing disease burden and offering a sustainable, effective model.

Original Articles

Prognostic Scoring Model for the Transition From Acute to Chronic Non-specific Low Back Pain in Primary Health Care Units in Indonesia: Djoko Kuswanto, Riva Satya Radiansyah, Dwinka Syafira Eljatin, Muhammad Nazhif Haykal, Rumman Karimah, Ratri Dwi Indriani, Zain Budi Syulthoni, Erna Furaidah, Andiva Satrio Rinaldi, Hafira Nushifa Putri, Jessica Felina Adi, Anak Agung Bagus Wirayuda; J Prev Med Public Health. 2025;58(4):422-430. Published online April 12, 2025; DOI: https://doi.org/10.3961/jpmph.24.581

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Abstract Summary PDF Supplementary Material

Objectives
Non-specific low back pain (NSLBP) is a prevalent health issue that can progress from acute to chronic, resulting in prolonged disability and diminished quality of life. This study aimed to develop a prognostic scoring model to predict the transition from acute to chronic NSLBP in primary care settings.
Methods
This prospective cohort study enrolled 112 adults with acute NSLBP from primary health care units in Indonesia. Participants were assessed at baseline and at a 3-month follow-up visit. Bivariate and multivariable analyses were conducted to identify significant predictors of chronicity. A scoring system was then developed based on the final logistic regression model.
Results
Three factors were found to be significant predictors of the transition to chronic NSLBP: age above 30 years, low education level, and moderate to severe pain intensity. The prognostic scoring model demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.705, 70.8% sensitivity, and 62.5% specificity at the optimal cut-off score of 2.5.
Conclusions
This simple prognostic scoring model can help clinicians identify patients at high-risk of developing chronic NSLBP. Early identification of at-risk patients could guide targeted interventions to prevent chronicity. Further validation in diverse populations is necessary to confirm the broader applicability of this model.

Summary

Key Message
This prospective cohort study developed a prognostic scoring model to predict the transition from acute to chronic non-specific low back pain (NSLBP) in primary care settings in Indonesia. The study identified three significant predictors: age above 30 years, low education level, and moderate to severe pain intensity, which formed a simple scoring system with good discrimination ability (AUC = 0.705, sensitivity 70.8%, specificity 62.5%). This practical tool enables clinicians to identify high-risk patients early and implement targeted interventions to prevent chronicity in primary healthcare settings.

Citations

Citations to this article as recorded by

The Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study
Giustino Varrassi, Maria Dolma Gudez-Santos, Magdi Hanna, Magdalena Kocot-Kępska, Antonio Montero Matamala, Marco Antonio Narvaez Tamayo, Serge Perrot, Jose Luis Aguilar, Omar Al Hamad, Lu’i Al-Husinat, Raad Al-Khafaji, Abdallah Allam, Ezio Amorizzo, Nadi
Pain and Therapy.2026; 15(1): 175. CrossRef

Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings: Sun-Jin Jo, Hyeon Woo Yim, Hyunsuk Jeong, Hoo Rim Song, Sang Yhun Ju, Jong Lyul Kim, Tae-Youn Jun; J Prev Med Public Health. 2015;48(5):257-263. Published online September 21, 2015; DOI: https://doi.org/10.3961/jpmph.15.009

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Abstract PDF

Objectives
Although the prevalence of depressive disorders in South Korea’s general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities.
Methods
Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated.
Results
The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2), with major depressive disorder 5.4% (95% CI, 2.1 to 8.7), dysthymia 1.1% (95% CI, 0.0 to 2.6), and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5). Among the 26 patients with depressive disorder, 19 patients were newly diagnosed.
Conclusions
As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

Summary

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The role of gender differences in the outcome of juvenile social isolation: Emphasis on changes in behavioral, biochemical and expression of nitric oxide synthase genes alteration
Soroush Bijani, Fatemeh Sadat Kashfi, Sadaf Zahedi-Vanjani, Keivan Nedaei, Ali Sharafi, Ali Kalantari-Hesari, Mir-Jamal Hosseini
Heliyon.2024; 10(7): e28964. CrossRef
Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization
Lana Alhalaseh, Karim Alsawalha, Mohammed Qussay Al-Sabbagh, Farah Al-Khaleefa
Psychology, Health & Medicine.2023; 28(6): 1503. CrossRef
Prevalence of depressive disorders in a primary care setting in Ho Chi Minh City, Vietnam: A cross-sectional epidemiological study
Ho Nguyen Yen Phi, Truong Quoc Tho, Bui Xuan Manh, Tran Anh Ngoc, Pham Thi Minh Chau, Nguyen Trung Nghia, Tran Trung Nghia, Huynh Ho Ngoc Quynh, Nguyen Tien Huy, Ngo Tich Linh, Pham Lê An
The International Journal of Psychiatry in Medicine.2023; 58(2): 86. CrossRef
Mental illness in patients with end-stage kidney disease in South Korea: a nationwide cohort study
Min-Jeong Lee, Eunyoung Lee, Bumhee Park, Inwhee Park
Kidney Research and Clinical Practice.2022; 41(2): 231. CrossRef
Prevalence of depressive symptoms in urban primary care settings: Botswana
Keneilwe Motlhatlhedi, Keneilwe Molebatsi, Grace N. Wambua
African Journal of Primary Health Care & Family Medicine.2021;[Epub] CrossRef
Psychiatric comorbidities among endometrial cancer survivors in South Korea: a nationwide population-based, longitudinal study
Jaesung Heo, Mison Chun, Young-Taek Oh, O Kyu Noh
Journal of Gynecologic Oncology.2019;[Epub] CrossRef
The prevalence of suicidal ideation and depression among primary care patients and current management in South Korea
Yoon-Joo Choi, Weon-Young Lee
International Journal of Mental Health Systems.2017;[Epub] CrossRef

Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications: Young-Hoon Gong, Seok-Jun Yoon, Hyeyoung Seo, Dongwoo Kim; J Prev Med Public Health. 2015;48(4):188-194. Published online July 23, 2015; DOI: https://doi.org/10.3961/jpmph.15.020

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Abstract PDF

Objectives
The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea.
Methods
This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited.
Results
Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance.
Conclusions
Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

Summary

Citations

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Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
Sanghyun Cho, Ji-Yeon Shin, Hyun Joo Kim, Sang Jun Eun, Sungchan Kang, Won Mo Jang, Hyemin Jung, Yoon Kim, Jin Yong Lee
Journal of Korean Medical Science.2019;[Epub] CrossRef

Comparative Study

Differences in Medical Care Utilization Rates of the Disabled and the Non-disabled with Ambulatory Care Sensitive Conditions.: Sang Jun Eun, Jee Young Hong, Jin Yong Lee, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2006;39(5):411-418.

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Abstract PDF: OBJECTIVES
The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78~0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16~1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44~0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16~1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69~19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.; Summary

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