Review of Japan Society of Health Support Science
Online ISSN : 2188-2924
ISSN-L : 2188-2924
Current issue
Displaying 1-9 of 9 articles from this issue
  • Shinya MATSUDA, Genki MURAKAMI, Kenji HAYASHIDA
    2023 Volume 8 Pages 1-10
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    Using the DPC data of Fukuoka Prefecture, we examined the relationship between the admission and discharge routes of elderly patients in acute care hospitals and the scores of B items of the Severity of a Patient’s Condition and Extent of a Patient’s Need for Medical/Nursing Care. In this study, it was suggested that the B item score may be related to the decision of the discharge destination. If it is evaluated to be difficult to return home from the item B scores at the time of admission, it will be possible to start the discharge coordination other than home from the time of admission. In addition, by using the scores of B items and the score of each check item as link information at the time of admission and discharge, it is possible to continuously provide appropriate nursing care, ADL care, and rehabilitation care. Currently, the Ministry of Health, Labor and Welfare is considering developing a medical information infrastructure. B-item scores should be included in discharge summaries scheduled for enrollment. In addition, it may be appropriate to evaluate the preparation of summaries that include such B-item information based on medical fees and long-term care fees schedule.

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  • Shinya MATSUDA, Keiji MURAMATSU, Kei TOKUTSU
    2023 Volume 8 Pages 11-24
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    Using the receipts (national health insurance and medical insurance for the elderly aged 75 or over) of one municipality in eastern Japan, we examined the implementation status of the “outpatient services that use medical resources intensively” indicated by the government. As a result of examining the difference in the appearance rate of the diagnosis of injury and disease between the receipt for which the medical information provision fee I is calculated and other receipts, it was observed that a high percentage of cases were calculated for Medical Information Provision Fee I in the case of serious injuries such as malignant tumors, chronic renal failure, and endocardiosis, for example. This suggests that referrals are being made appropriately for injuries and illnesses that exceed the scope of treatment of the medical institution of family doctor. In addition, looking at the changes over time in the use of medical services by patients for whom the Medical Information Provision Fee I was calculated, it seems that such patients intensively use medical resources such as hospitalization, pathological examinations, and diagnostic imaging management additions. Based on the above analysis results, it was considered desirable to construct an evaluation system focusing on the intra-hospital consulting department such as radiological department for “outpatient services that use medical resources intensively”.

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  • Shinya MATSUDA, Keiji MURAMATSU, Kei TOKUTSU
    2023 Volume 8 Pages 25-38
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    A web-based opinion survey was conducted on the function of primary care physicians during the period is from April 1, 2022 to May 31, 2022. Invitation letters to participate in the survey were sent to 27,707 facilities, and valid responses were received from 1,286 (4.6%). By age group, 60-69 years old accounted for 33%, followed by 50-59 years old(32%) and 40-49 years old (17%). In terms of primary care physician functions, they evaluated “referral of patients to other medical institutions”(89%) as the most important function, followed by “preparation of primary physician opinions for the Long Term Care Insurance”(85%), and “acceptance of patient referrals from other medical institutions”(84%), “Vaccination” (82%), “Specific health checkup”(71%), “Home visit” (70%). Comparing these results with the responses to things that are “currently being done” or that “have been done’ in the past”, the percentages were almost the same for most of the items. In response to the question, “Do you think you are fulfilling the function of a primary care physician?”, 79% of the respondents answered that they “perform adequately” and “relatively fulfill the function.” Regarding the evaluation of primary care physician functions in medical fees, overall, 36% responded that they preferred the lump-sum payment, and 57% of respondents preferred the fee-for-service payment. From the results of this analysis, it can be concluded that many physicians consider themselves to be performing the primary care function. This is different from the recognition of the fiscal authorities and the public. It is considered that the urgent task in the future is to examine the cause of this perception gap.

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  • Shinya MATSUDA, Genki MURAKAMI, Kenji HAYASHIDA
    2023 Volume 8 Pages 39-49
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    As the population ages, acute and chronic medical needs, and medical care and long term care are becoming more complex. There is an urgent need to develop an evaluation method that responds to this situation.

    We consider that the Severity of a Patient’s Condition and Extent of a Patient’s Need for Medical/Nursing Care will become a standardized way of comprehensively assessing this complex situation. Therefore, in this study, we targeted users of post-acute medical and long term care service providers in the Kyushu region, mainly Fukuoka Prefecture, using the values of each item of the Severity of a Patient’s Condition and Extent of a Patient’s Need for Medical/Nursing Care and the prevalence rate of major injuries and illnesses. We categorized the facilities into 5 groups by the Cluster analysis using above mentioned information. and compared the state images of the users. The five groups differed in the scores of A and B items of the Severity of a Patient’s Condition and Extent of a Patient’s Need for Medical/Nursing Care, as well as the prevalence rate of injuries and illnesses.

    This result suggests the possibility of categorizing facilities using the Severity of a Patient’s Condition and Extent of a Patient’s Need for Medical/Nursing Care, and of evaluating the nursing care load in different types of facilities in a unified manner.

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  • Shinya MATSUDA, Keiji MURAMATSU, Haruki MATSUMOTO
    2023 Volume 8 Pages 51-60
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    Based on the projected future population by region in Japan published by the National Institute of Population and Social Security Research (estimated in March 2013) and the published data of the Ministry of Health, Labor and Welfare’s patient survey and long-term care insurance business report, we have developed tools for estimating the number of inpatients and outpatients, and the number of users by level of care required (including volume stratified by service type). In this study, by analyzing these tools combined with the standardized receipt ratio (SCR) published by the Cabinet Office, we have showed it is possible to plan medical and long term care measures for the chronic phase that match the characteristics of each region.

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  • Shinya MATSUDA
    2023 Volume 8 Pages 61-72
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    【Objective】 In Japan, the issue of elderly people visiting multiple facilities is a topic of debate. This issue is also important when considering the role of family doctors. In this paper, we use medical and nursing care data from a municipality in western Japan to analyze the current situation and related factors and discuss the role of family doctors.

    【Materials and methods】 The data was generated using medical receipts (National Health Insurance and Medical Care Insurance for the Elderly) and long term care insurance receipts from one local government (prefectural level) in western Japan. Using this database, the number of medical institutions and dispensing pharmacies where subjects aged 65 and over visited as outpatients, the number of days of outpatient visits, and the types and number of illnesses diagnosed, as well as the total number of months nursing care insurance services were used were calculated.

    【Results】 The main results of the multivariate analysis on the number of outpatient visits are as follows (numbers are multiple regression coefficients).

    ・There was a statistically significant difference in outpatient visits and the number of days of outpatient visits, with both being higher in urban medical areas A and B and lower in medical area G, which is a mountainous region.

    ・Concerning the impact of illness or injury on the number of outpatient visits, the number of institutions visited was higher for those with eye disease (1.06), ear disease (0.68), skin disease (0.57), spinal disorders (0.42), malignant tumors (0.64), and cerebrovascular disease (CVD) (0.44).

    ・Concerning the impact of illness or injury on the number of days of outpatient visits, the number of days of outpatient visits was higher for those with schizophrenia (9.6), mood disorder (4.1), eye disease (6.7), ear disease (5.4), skin disease (6.4), lower limb joint disorders (9.6), spinal disorders (9.5), osteoporosis (5.0), renal failure (4.0), and dementia (4.9).

    ・Those who use long term care insurance have a lower use of medical institutions (-0.48).

    【Discussion】 In urban areas with abundant medical resources, it is natural for elderly patients who have a chronic internal medicine disease and a family doctor specializing in internal medicine to go to clinics that specialize in dermatology, ophthalmology, otolaryngology, orthopedics, or other specialties for their injuries or illnesses. Therefore, if there are attempts to restrict such visits, it is clear that patients will be dissatisfied. In light of this situation, the immediate challenge in urban areas is to create a system of family doctors that functions as a network. On the other hand, in mountainous areas with scarce medical resources, the reality is that “internal medicine clinics and other facilities already function as family doctors in a general practitioner role.” Therefore, in such areas, the strengthening of the general practitioner function should be incorporated into the framework of lifelong training for doctors.

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  • Shinya MATSUDA, Keiji MURAMATSU, Ning LIU, Ryutaro MATSUGAKI, Kei TOKU ...
    2023 Volume 8 Pages 73-80
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    Purpose: In order to examine the medical needs of elderly people requiring long-term care (LTC) in an unstable state who are “occasionally hospitalized or admitted”, we investigated the utilization status of medical and LTC services, and prevalence of major injuries among short stay users of health care facilities for the elderly..

    Data and methods: Medical and long-term care insurance (LTCI) receipts from 34 secondary health care regions in Japan were consolidated on an individual basis. Using this database, medical and LTCI service utilization and prevalence of major injuries were examined from one month before short stay service use to 11 months after use.

    Results: After 11 months, the utilization rate for short stay service was around 20%, but on the other hand, the number of institutional care users was increasing. The short stay users suffered from multiple chronic diseases such as hypertension, diabetes, cerebrovascular disease, heart failure, and dementia. As a result, the cumulative mortality rate per year is as high as about 20%. This situation requires care management putting more importance on clinical aspect. Around 80% used outpatient care. This figure suggested that their chronic diseases were managed by primary care physicians.

    Discussion: Looking at the short stay users over time, the cumulative mortality rate over one year was around 20%, and the transition rate to institutional care was 20%. In addition, many of the users suffer from multiple chronic diseases, and it was thought that active medical management by their primary care physicians was necessary to maintain their home life..

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  • Shinya MATSUDA, Keiji MURAMATSU, Ning LIU, Kenji FUJIMOTO, Yumi NOMOTO
    2023 Volume 8 Pages 81-92
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS

    Purpose: The regional healthcare concept issued in 2018 aims to increase the amount of home medical care. However, the amount of home medical care is affected by various factors such as the state of medical and long term care services in each region, human resources, and living environment. It is practical to consider how home medical care should be based on these regional characteristics. Therefore, in this analysis, we conducted an ecological study on the factors related to the amount of home-visit medical care using medical care-related data by secondary medical care area.

    Method: Using SCR (standardized claim-data ratio) published on the Cabinet Office “Economic, Financial and Living Index ‘Visualization’ Portal Site” and “Regional Differences in Medical Care Provisions”, Ministry of Health, Labor and Welfare, Long Term Care Insurance Business Status Report, and the data of the number of specific facilities in the Japan Medical Association Regional Medical Information System, we created a data set for each secondary medical area, and performed correlation analysis and covariance structure analysis between variables.

    Results: In the secondary medical area, where a large amount of home-visit medical care is provided, a large amount of outpatient medical care, home-visit nursing, home care services, and many emergency home visits and emergency care conferences are held. Furthermore, in areas where the capacity of specific facilities such as facilities for the elderly with care services is large, the amount of home-visit medical care provided was large. A significant negative correlation was observed between the amount of home-visit medical care provided and admission to nursing homes, but no significant correlation was observed for long-term care beds. Based on the above results, we constructed a model between variables and conducted a covariance structure analysis. As a result, the amount of care provided by nursing homes and inpatients was negatively related to the amount of medical care provided by home visits. There was a significant positive correlation between the medical care support system, the emergency response system, and the amount of housing for the elderly with services.

    Discussion: In order to promote home visits, it is first necessary to have medical institutions such as clinics and visiting nursing service. In addition, the results of this analysis show that home medical care is substitutable for institutional long-term care services, and that it is important to have homes that are easy to receive long-term care, such as specific facilities, in order to increase the amount of care provided.

    Conclusion: In order to promote home medical care, it is important not only to improve medical and long term care services, but also to improve the living environment to promote it.

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  • Shinya MATSUDA, Keiji MURAMATSU, Ning LIU, Ryutaro MATSUGAKI, Kei TOKU ...
    2023 Volume 8 Pages 93-102
    Published: 2023
    Released on J-STAGE: January 17, 2025
    JOURNAL FREE ACCESS
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