Regional disparities of community medicine for acute stroke in Japan and solution strategy

Abstract

Background and Purpose: The current status of community medicine for acute stroke was investigated to clarify regional disparities in medical practice in Japan. Methods: Questionnaires concerning the current status of medical practice for acute stroke was sent to members of the Japan Stroke Association and the Miyagi Stroke Association. Results: The first batch of questionnaires asked about the presence of secondary medical service areas with problems. The response rate was 61.4% (81/132), covering all prefectures. Among 329 secondary medical service areas, 32 (9.7%) and 90 (27.4%) lacked hospitals with round-the-clock tissue plasminogen activator (t-PA) therapy and thrombectomy, respectively. These regional disparities were considered due to a shortage of stroke physicians in these areas, and effective method to resolve this problem was combining with medical support systems in other secondary medical service areas. Responses to the second batch of questionnaires asking about row numbers in secondary medical service areas were received from 32 prefectures (68.1%). t-PA therapy was not performed in 21 of 174 areas (12.1%), and thrombectomy in 53 of 145 areas (36.6%). Differences among prefectures and those among secondary medical service areas in a prefecture were evident. Conclusion: The government should play a central role in taking measures to establishing the collaboration system and improving emergency transportation systems to reduce regional disparities in medical treatment and care for patients with acute stroke in Japan.