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Introduction: The purpose of this study was to investigate the immediate cause of death recorded by home medical care physicians on the death certificates of senile patients who died of pneumonia as a complication, and to examine physician-level factors related to selection of the cause of death.Methods: We used a mail questionnaire survey to conduct a cross-sectional study of members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 470 valid responses were received (response rate: 51.8%). The immediate cause of death was recorded as pneumonia in cases of complication by pneumonia "always" by 95 physicians (20.2%), "often" by 131 (27.9%), "sometimes" by 134 (28.5%), "rarely" by 91 (19.4%), and "never" by 19 (4.0%). Multivariate analysis revealed that female physicians were significantly less likely to record the immediate cause of death as senility (OR: 0.10, 95%CI: 0.01-0.71).Conclusion: The immediate cause of death recorded on death certificates varied in cases of senile patients who died of pneumonia as a complication. The present study also suggested that selection of the cause of death was influenced by the gender of physicians.
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Point-of-care ultrasound (POCUS) as a physical examination was performed using a pocket-sized ultrasound device (pocket echo) for internal medicine outpatients at general hospitals and home care patients. The combination of lectures and hands-on learning was required for technical understanding. Securing time during the consultation was not difficult by determining the protocol and examining for abnormal findings at the specified sites. Cost reduction is desired in order for one pocket echo device to be available for each practitioner.
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Objective: We search valuable information in home medical care settings that impede smooth collaboration among pharmacists, home care physicians, and home care nurses. Methods: We conducted an online survey on 120 physicians and 118 nurses on “areas perceived as overloaded with tasks,” “quality of life (QOL) evaluation of patients,” and “expectations to pharmacists.” We analyzed data using the Mann-Whitney U test and conducted the customer satisfaction (CS) analysis on “stress.” Results: Physicians answered that they had a significantly higher stress on “at night-time/holidays and weekends works” than nurses (p < 0.05). Nurses experienced significantly more stress during “inter-professional collaboration” than physicians (p < 0.01). CS analysis revealed that nurses experienced more stress for items such as “having patients with dementia self-inject correctly,” etc. Both physicians and nurses evaluated QOL items at a high frequency. Majority of physicians and nurses held high “expectations to pharmacists,” particularly for the eight items related to providing information, managing drugs, and making pharmacological judgments. Nurses had significantly high expectations to pharmacists for “management of supplements taken by the patient” (p < 0.01), “explaining drug effects” (p < 0.001), and “explaining the necessity of prescription revision” (p < 0.01). Discussion: Pharmacists should utilize information on physicians and nurses’ stress as well as understand their expectations to pharmacists to facilitate stronger coordination between both professions and contribute to patient care. In particular, many items were found to cause stress, indicating that support for nurses, who have many expectations to pharmacists, needs to be enhanced.
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Objective: We search valuable information in home medical care settings that impede smooth collaboration among pharmacists, home care physicians, and home care nurses. Methods: We conducted an online survey on 120 physicians and 118 nurses on “areas perceived as overloaded with tasks,” “quality of life (QOL) evaluation of patients,” and “expectations to pharmacists.” We analyzed data using the Mann-Whitney U test and conducted the customer satisfaction (CS) analysis on “stress.” Results: Physicians answered that they had a significantly higher stress on “at night-time/holidays and weekends works” than nurses (p < 0.05). Nurses experienced significantly more stress during “inter-professional collaboration” than physicians (p < 0.01). CS analysis revealed that nurses experienced more stress for items such as “having patients with dementia self-inject correctly,” etc. Both physicians and nurses evaluated QOL items at a high frequency. Majority of physicians and nurses held high “expectations to pharmacists,” particularly for the eight items related to providing information, managing drugs, and making pharmacological judgments. Nurses had significantly high expectations to pharmacists for “management of supplements taken by the patient” (p < 0.01), “explaining drug effects” (p < 0.001), and “explaining the necessity of prescription revision” (p < 0.01). Discussion: Pharmacists should utilize information on physicians and nurses’ stress as well as understand their expectations to pharmacists to facilitate stronger coordination between both professions and contribute to patient care. In particular, many items were found to cause stress, indicating that support for nurses, who have many expectations to pharmacists, needs to be enhanced.
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Background: We investigated how individual home care services by nurses, care workers, and therapists at patients' homes are related with the continuation of home medical care service provided by medical doctors.Methods: This research retrospectively analyzed primary insured patients registered with the Japanese long-term care insurance system who had newly started using home medical care service, and whose care level was between 1 and 5 according to national long-term care insurance system claims data. We performed multivariable logistic regression analysis to evaluate patients who used home medical care continuously for >3 months and the utilization of each home care service adjusted for patient age, gender, and care level.Results: A total of 26,590 patients were analyzed. Multivariable analysis revealed that the following home care services were associated with longer continuation of home medical care service compared with home medical care alone: day service (OR, 2.10; 95% CI, 1.98-2.23), home help service (1.91; 1.81-2.01), day care including rehabilitation (1.88; 1.69-2.10), home-visit rehabilitation (1.49; 1.31-1.69), and home-visit nursing (1.23; 1.16-1.31).Conclusions: Our results demonstrated a correlation between utilization of home care services and longer continuation of home medical care from the start. These findings may help medical doctors who provide home medical care service collaborate with other home care services by nurses, care workers, and in-home care therapists.
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Introduction: Although the number of deaths following a diagnosis of senility is increasing in Japan, the criteria of senility are unclear. Therefore, the purpose of this study was to investigate methods to diagnose senility in home medical care.Methods: We mailed questionnaires to 908 members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 535 members (58.9%) responded. Responses of 501 members who selected senility as the cause of death were analyzed. Most doctors considered "continuous care of the patient", "the patient's ADL and gradual decline in oral intake", and "the absence of other critical diseases" to be important when diagnosing senility. The items affecting a diagnosis of senility were "the family's understanding and opinions", "other diseases being medically excluded", and "contribution to the patient's QOL".Conclusion: In home medical care, many doctors consider continuity of care, gradual decline, and the absence of other critical diseases to be important when diagnosing senility. Non-medical aspects, such as the family's opinions and patient's QOL, affected the diagnosis.
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Introduction: We conducted a nationwide questionnaire survey for care managers (CMs) regarding their awareness about the role of pharmacists in home medical care, and objectively analyzed the obtained data using text mining.Methods: Survey targets were CMs belonging to the Japan Care Manager Association (JCMA). A letter of request was mailed to the 47 prefectural branches of the JCMA. Only members of the JCMA who agreed to participate in this survey responded.Results: Responses were received from 206 CMs, 25% of whom had experience as medical professionals and 75% whom had experience as nursing care welfare staff. 90% of the 206 CMs replied "They are necessary" to the question "Are pharmacists necessary for home medical care?". Using text mining to identify the reason for answering "They are necessary", the characteristic keywords from the CMs with experience as medical professionals were "instruction" and "internal use". On the other hand, the characteristic keyword from the CMs with experience as nursing care welfare staff was "consultation".Conclusion: The CMs with experience as medical professionals expected the pharmacists "to demonstrate their expertise to patients, families, and other professionals". On the other hand, the CMs with experience as nursing care welfare staff expected the pharmacists "to provide consultation on information about medications and side effects".
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After we organized a community-based home medical care (HMC) training workshop composed of presentations by welfare and care workers in addition to patients’ family and targeting community pharmacists in collaboration with a regional pharmacy association, we carried out a questionnaire survey to the pharmacists in attendance to take hold on pharmacist’ opinions for the workshop and attitudes for HMC. The participants had a relatively high level of satisfaction regarding the workshop, rating an average of 7.81 out of 10.0. Among the participants, 77.5% had experience of HMC such as visiting pharmacy services at patient’ home, with the most widely practiced activity being “drug administration guidance for patients at home.” However, activities such as “accompany at the time of rounds” and “participation in conferences” were not widely practiced (less than 50% of the most activity) among the participants. Many participants responded that the key factors of HMC were the cooperation system between different professionals and its environmental arrangement. Overall, positive feedback from participants regarding this workshop was reported, through statements such as “I was able to rediscover the need for cooperation in a diverse team with differing job functions” and “the care of patients and their family was important.” We found many opinions that cooperation with other professionals is important in deepening pharmacists’ involvement in HMC, and that this workshop serves as a bridge to establish greater communication between care workers and pharmacists.
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<b>Background: </b>Group practices with multiple physicians are preferred for promoting home medical care, but the explanations to patients and families given by the visiting doctors may differ. That could sometimes lead to confusion in patients and families.<br><b>Methods: </b>We conducted a cross-sectional mail survey of families of Japanese patients who had previously received home medical care. Multivariable adjusted logistic regression for families’ sense of discrepancy between the explanations by doctors in a group practice was performed using eleven explanatory variables including: (1) number of doctors; (2) interval between the doctors’ visits; (3) duration of the doctor’s stay; (4) doctors’ frequent use of technical terminology; (5) doctors’ interruption of family’s talking, etc.<br><b>Results: </b>Among 271 families who were mailed surveys, 227 responded (83.8%). The final sample for the analyses was 139. Responses were divided into two groups: families who had experienced a sense of discrepancy about explanations by different doctors (“Experienced”, 30 families, 21.6%) and those who had not (“Non-experienced”, 109 families, 78.4%). Families’ sense of discrepancy between the explanations by doctors in group practice was significantly associated with a longer time interval between doctors’ visits (OR: 1.103, 95% CI: 1.008–1.208, p = 0.03) and doctors interrupting families while they were talking (OR: 2.559, 95% CI: 1.166–5.615, p = 0.02).<br><b>Conclusions: </b>Visiting doctors need to understand that families may have a sense of discrepancy about explanations given by different doctors. This sense of discrepancy was associated with less frequent doctors’ visits and doctors’ interrupting families while they are talking.
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This study is aimed at reviewing both the rehabilitative program and the role of the home visit physician regarding ALS patients living at home. Seven ALS patients were chosen as subjects for this study. Two of these patients required a mechanical ventilation system and nutritional support such as gastrostomy or central venous infusion, and all patients were found to be totally dependent on their physical care for activities of daily living. Although home visit rehabilitation services were planned for 5 of the patients, it was found that the individual rehabilitation needs of each patient differed depending on the progression of the ALS or the patient's impairment, the level of care that can be given, public support system usage, and the patient's acceptance of their ALS. Cooperation between family members and multidisciplinary care members was essential for effective daily management of the medical and rehabilitation needs of these patients. The home visit physician should provide appropriate care from the viewpoint of the patient's life, based on the decisions of the patient and their family.
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La atención domiciliaria a pacientes terminales es cada día más común en la práctica clínica dentro del ámbito de la atención primaria, que debe enfrentarse al reto de paliar los síntomas de dichos enfermos, en los que en múltiples ocasiones no es posible el uso de la vía oral para administrar un tratamiento efectivo paliativo. La vía subcutánea supone una alternativa eficaz, que permite el uso de gran número de fármacos esenciales en cuidados paliativos, facilita una atención integral en el entorno del paciente y mejora así su calidad de vida. En este caso se hace hincapié en la descripción de la vía subcutánea, así como la técnica para su uso y los fármacos mejor empleados, con el objetivo de facilitar su manejo entre el personal sanitario de atención primaria.
Home medical care of patients with terminal illnesses is more and more frequent in the clinical practice in primary care context. This medical practice copes with the challenge to buffer symptoms, taking into account that oral administration for an effective palliative treatment always is not possible. In this setting, subcutaneous via of drug administration can be a plausible alternative because it permits administer higher number of indispensable drugs than by other administration vias. This advantage makes possible an integrative care of the patients in their environment and, in turn, it enhances their quality of life. The aim of this paper is to facilitate the use of subcutaneous via of drug administration by medical staff in primary care. For this, the foundations of subcutaneous administration as well as the methodology and drugs widely administered by this via are described.
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Home Nursing , Infusions, Subcutaneous , Primary Health Care , Terminally IllABSTRACT
Problem-based learning (PBL) has been recognized as an effective method of medical education in many countries. Because establishing comprehensive PBL is often difficult, we attempted to use clinical clerkship in home medical care as an opportunity for comprehensive PBL education. Both students and teachers benefitted by studying the backgrounds and needs of home medical care patients, discussing various topics, and recognizing and discussing multiple aspects of medicine. Our experiences suggest that this style of learning can be an effective method of PBL education in any medical school and that clinical clerkships in home medical care can easily be adapted for effective PBL with actual patients.