Our clinic is a home care clinic located in Sapporo City, and we began providing dermatology house calls by a full-time dermatologist. We retrospectively investigated the actual situation of 300 consecutive new patients during the first six months. The most common underlying conditions among them were sequelae of cerebral infarction, intractable neurological diseases, and dementia, while the most common dermatological conditions were eczema/dermatitis, skin mycosis, and pressure ulcers, in that order. It was possible to achieve stable profits within two months from the start of house calls. It has been reported that over 70% of home care patients have skin diseases. While there is significant demand for house calls by dermatologists, the reality is that not many medical institutions provide comprehensive dermatology house calls due to profitability and other issues. It is strongly desired that the medical fee system be reviewed in accordance with social needs.

When visiting patients at home, I encounter cases where further examination at a hospital seems necessary, yet I am compelled to continue home medical care without fully understanding the patien’s condition. Therefore, during house calls, I used point-of-care ultrasound (POCUS) to assess the patient’s condition and decide whether to refer them to a hospital or continue home care. The appropriateness of the decision was evaluated as follows: a referral to a hospital was considered appropriate if it led to a thorough examination; it was deemed inappropriate if no thorough examination was needed. For home care, it was considered appropriate if the patient remained at home and inappropriate if the patient was subsequently referred to a hospital. Among the home-bound patients whom I initially determined needed a referral to a hospital for further examination, after undergoing POCUS, 73% were able to continue living at home without being referred. This group included patients who were cured or went into remission while remaining at home, as well as those who received end-of-life care at home as planned.

Purpose : This study aimed to determine the medications currently prescribed for hyperactive delirium in terminal cancer patients in home care settings.

Methods : This study aimed to determine the medications currently prescribed for hyperactive delirium in terminal cancer patients in home care settings.

Results : Sixty-seven out of 401 participants were included in the analysis. The survey results showed that the most commonly prescribed first-line drugs for patients who could receive oral medications were risperidone (96%) and quetiapine (90%). For those who did not respond to first-line treatments, the type of antipsychotic was changed, or a benzodiazepine was added (including diazepam suppositories, 67%; intravenous midazolam, 61%). For patients who could not receive oral medications, haloperidol injection (72%) and midazolam injection (63%) were selected.

Conclusions : This study revealed the current treatment for terminal delirium in home care settings. It is necessary to develop a systematic approach to the treatment of delirium that considers the unique characteristics of home care.

Background : At the end stage of medical home care, the place of death is usually either at home or in a hospital. However, it does not always align with the patient’s wishes. Therefore, we are still seeking solutions to this issue.

Objective : The purpose of this study was to investigate and identify the patient-related factors that influence the place of death in home medical care.

Method : We conducted research involving 1,101 deceased patients who were under our clinic’s medical care.

Results : Of those, 735 patients died at home or in a nursing care facility, while 366 patients died in a hospital at the end of life. The total number of hospitalizations during the last year of life was significantly higher for patients who died in a hospital compared to those who died at home. The odds ratio for hospital death was 14, indicating a strong association between hospitalization and death in a hospital setting. Conversely, factors such as residence type (nursing care facility), nursing care level, and cancer had odds ratios of less than 1, suggesting these factors were associated with a higher likelihood of dying at home rather than in a hospital.

Conclusion : By understanding the patient-related factors that influence the place of death, we may be able to provide better medical care that aligns with a patient’s wishes or advance care planning, which could improve the quality and efficiency of home care.

Sedation may be necessary to manage difficult-to-treat pain in terminally ill cancer patients. The purpose of this study was to investigate the status of sedation for cancer patients receiving home care. We aimed to clarify the relationship between the use of sedatives during the dying phase of terminally ill cancer patients at our hospital and the duration of home care, and to report on the implementation rate of sedation and its actual status.