Use of In-Home Services of the Public Long-Term Care Insurance System by Elderly Foreign Residents in Osaka City: Care Managers’ Perception / 国際保健医療

Objectives  This study investigated the use of In-home services of the Public Long-Term Care (LTC) Insurance System by foreign residents in Osaka city to serve this population better.Methods  Using information from the WAMNET database, questionnaires were sent to 1,800 care managers (CMs) affiliated with 1,106 In-home Care Support Office and Community General Support Centers in Osaka city (1-4 CMs/site), and collected between February and early March 2011. The data collected were analyzed quantitatively, focusing on descriptive statistics. And fisher’s exact tests were used to evaluate the relationship between the Japanese communication skills and age, sex, and family structure.Results  We obtained answers from 460 CMs (collection rate 25.6%). The total number of foreign residents covered under the service by CMs was 590, and we analyzed the valid data of 312 foreign user’s information.   Home-Visit LTC and Day Care for LTC were most frequently used. 34.3% of CMs had difficulty communicating in Japanese, there was a higher proportion of people who had difficulty in communication with older age group (p<0.05), and noticed that nearly 60% faced economic hardship. Conclusion  Our results suggest that careful communication is required with older age groups. This indicates that there may be difficulties in communication and understanding the clients’ needs, which are necessary to create care plan and to ensure optimal utilization of the services. And it is possible to reduce the service required user charge due to the insufficient economic status. The support system should be strengthened to address communication and economic difficulties faced by foreign users of In-home services, from the standpoint of the service fairness.

Questionnaire Survey for Care Managers Regarding Their Awareness about the Role of Pharmacists in Home Medical Care: Objective Analysis Using Text Mining / 日本プライマリ・ケア連合学会誌

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".

Actuación de estudiantes de enfermería en la creación de proyectos / Nursing students activities in projects' development

Resumen:

Introducción/Objetivo: por medio de los proyectos, la gestión del cuidado y del servicio requiere un abordaje multifactorial y multidisciplinario, en donde el profesional de enfermería visualiza a la persona de forma integral, utiliza las herramientas y crea alianzas con otras disciplinas para generar nuevas opciones de atención. El objetivo es presentar los resultados del proyecto de investigación 421-B0-249 Sistematización e impacto de los proyectos elaborados en el curso de Gerencia en Enfermería, de la Escuela de Enfermería (Universidad de Costa Rica. 2005-2009).

Método: esta investigación se enmarcó dentro de los elementos que establece la investigación documental. Se realizó la revisión de proyectos, de los informes de docentes que imparten el curso de gerencia, el material publicado y las entrevistas a informantes claves.

Resultados: se logró encontrar que ocho se implementaron realizando cambios en la infractructura y en la dotación de personal. La evidencia es que la mayoría de ellos genera cambios muy significativos en las instituciones, como la capacitación en temas sobre paro cardiaco, el proceso de enfermería y en investigación, la restructuración en departamentos, las ubicaciones de los centros de salud en riesgo y la generación tanto de líneas de investigación como la creación de nuevas áreas de atención.

Discusión: en términos generales se puede decir que la propuesta de aprendizaje de elaborar proyectos en el curso de gerencia en enfermería guarda una estrecha coyuntura con el contexto laboral donde trabajara el enfermero o enfermera egresada de la escuela de Enfermería de la Universidad de Costa Rica.

Conclusiones: el o la profesional en enfermería es idóneo/a como responsable de formular proyectos para la gestión del servicio y la gestión del cuidado, pues posee un gran conocimiento de diversas temáticas y propone las bases necesarias para lograr generar nuevas opciones de atención. Este es un escenario más de la actuación de enfermería que aporta conocimiento y genera seguridad en el ejercicio profesional. En los proyectos que están vigentes no se visibiliza o reconoce que fue propuesto por las y los estudiantes.

Abstract:

Introduction/Purpose: by means of projects, care and service management requires a multifactor and multidisciplinary approach so that nursing professionals can see a person from an integral point of view, use available tools, and create alliances with other disciplines in order to produce new care options. Our aim was to present the results of the research project 421-B0-249 systematization and impact of projects developed in a course on Nursing Management, School of Nursing, University of Costa Rica. 2005-2009.

Methods: we carried out an investigation based on documental research methods. Projects, teaching reports by academic staff in nursing management, published materials and interviews with key informants were reviewed.

Results: eight projects were found to be implemented through changes in infrastructures, involving staffing. Most of them were found to result in very significant changes in institutions, for example training on topics such as cardiac arrest, nursing process and nursing research, department reorganization, localization of healthcare at risk, and development of research lines and new healthcare areas. Discussion: in general terms, the training proposal to develop projects in a nursing management course is closely linked to the working settings of nurses being trained in University of Costa Rica School of Nursing.

Conclusions: nurses are suitable professionals to develop projects on service and healthcare management because they have a solid knowledge of various topics and apply the foundations required to create novel healthcare options. This is an additional scenario in nursing actions to provide knowledge and promote safety in nursing work. The fact that a specific project was suggested by students is not visible or recognizable in on-going projects.

Case Manager's Understanding of Care Management for Terminal Cancer Patient in Home / 日本プライマリ・ケア連合学会誌

<b>Purpose</b>: The present study was conducted to elucidate the gap in awareness of experience of care management and the actual work of being responsible for this field by spotlighting on the attributes of of case managers and who are in charge of care management of terminal cancer patients at home.<br><b>Methods</b>: Anonymous individual style questionnaire investigation was conducted against a target of 443 care managers.<br><b>Results</b>: 70.3% had experience being in charge of terminal cancer patients and there was a significant difference in that this was found in those of more than 5 years of experience and among those of full timer status. As for experience in regard to those with or without experience being in charge by basic type of job, there was not much significant difference.<br>As for awareness regarding being in charge of terminal cancer patients, those who felt “I want to avoid it”, remained in 25% and found more in non-fulltimers (P<0.05). As for those who thought that “health care providers are more suited to be in charge”, this was found in 70% of health care providers and 40% in welfare related individuls (P<0.05) and a significant difference was noted. As for awareness of “should not depend on specific profession and should be done fairly among professions and which was found in 80% of those who have less than 5 years among care support specialist profession and hence compared to those with more than 5 years, it was many, and a significant gap was found. Regarding need of education and training about care management of terminal cancer patients, 95% agreed there is.<br><b>Conclusion</b>: Approximately 70% of all had experience with terminal cancer patients and particularly, among those with over 5 years as care support specialist, it became clear that full timers were in charge. However, about awareness of being in charge of care management, it became clear that there was an positive attitude toward who takes in charge without being restricting to specific individuals and not selecting by number of years of experince as care managers nor by basic job types. Therefore, it can be concluded that opportunity for education and training about care management of terminal cancer patients and consolidating education environment for self training is important.

Community Care: A Team Based Approach to Managing Chronic Lung Disease

Patients with COPD represent the ideal target population which stands to benefit from the Integrated Care Pathway (ICP) model of care. They are generally older and many suffer comorbid conditions which share common causative links to cigarette smoking. Hence their combined medical and social complexities represent a great challenge for the solo physician, whether in specialty or primary care, to deliver care comprehensively, consistently and efficiently. Effective management of patients with COPD thus requires the co-ordinated efforts of the hospital and the community to integrate care across the care continuum. In the COPD ICP Team approach, the execution of care is based on 5 interdependent tenets: (1) Every patient has a primary care physician; (2) Every patient’s care should be delivered as a set, rather than individual components; (3) Every patient has a single health record; (4) Every care process must represent value to the patient; (5) Every patient must be helped to navigate care, and supported to remain in care. Of note is the care is supported by care managers, communication links for tracking response to therapy, IT support, and equipment support.

Cognition and Practice on Medical Information Protection of Iudustrial Health Care Manager of Small and Medium Sized Enterprises / 대한산업의학회지

OBJECTIVES: This research aimed to know the actual condition and problems of medical information protection at a workplace with the target of industrial health care managers of small and medium-sized enterprises. METHODS: A self-administered questionnaire was given to industrial health-care managers of 216 enterprises from March 15 to May 17, 2010. The questionnaire was produced by referring to the Act on Personal Information Protection of Public Institutions, etc. This research evaluated agreement of cognition and practice according to 10 items of medical information protection using kappa and cross-analysis of significant factors between cognition and practice of medical information protection and general characteristics. RESULTS: Cognition about medical information protection appeared to be 85.4-97.1% and its practice appeared to be 44.1-95.3%, so practice was lower than cognition. In addition, the agreement of cognition and practice appeared significantly low (kappa 0.082-0.387). The practice of medical information protection tended to be lower when the managers were older and held a higher job title. Health examination results were being delivered only to workers except for an employer (94.2%), but there were many industrial health-care managers who felt discomfort about their work in group occupational health-care systems (58.1%). CONCLUSIONS: The practice of protecting medical information by industrial health-care managers was clearly lower than the cognition. Therefore, introduction of educational programs about personal information protection and provision of an independent place for group occupational health care service is urgent. In addition, in order to use the health examination results conveniently in group occupational health services, an institutional complement is necessary.

An Attitude Survey for Nursing Care Managers on Acupuncture and Moxibustion Therapy in Nursing Care Plans / 全日本鍼灸学会雑誌

[Purpose]To investigate the present use of medical expenses for acupuncture and moxibustion, and judo and massage therapies under the health insurance system in contracted nursing care plans prepared by nursing care managers.<BR>[Methods]The subjects were 75 nursing care service providers who were registered in a certain municipally (B City) with an aging index of 27.7%. We investigated the experience and use of medical expenses for acupuncture and moxibustion therapy through a mail survey. The survey period was from July 10 to July 31 in 2006. The collection rate was 57.3%(43out of 75 nursing care service providers). We used simple adding, the Kruskal-Wallis test, factor analysis (principal factor method) and path analysis.<BR>[Results]In simple adding, there were 3,535 total care receivers, 11.5%of the total aged population in B City. Users who took acupuncture and moxibustion therapy were 2.5%of the total care receivers in nursing care plans. However, 10 people could not take acupuncture and moxibustion therapy due to their economic conditions. Nine out of 41 nursing care service providers (22.0%) had users who could not take acupuncture and moxibustion therapy because their healthcare facilities would not sign the written informed consent. In factor analysis (principal factor analysis), "experience and recognition of acupuncture and moxibustion therapy using medical expenses"was extracted as the first principal component. In pass analysis, it can be explained that nursing care managers who planned acupuncture and moxibustion therapy using medical expenses had recognized that the therapy would maintain the capabilities for activities of daily living (ADL) and quality of life (QOL) of the users.<BR>[Conclusion]When nursing care managers planned acupuncture and moxibustion therapy for maintenance of ADL and QOL in their care services using medical expenses, they were considered to have recognized that the therapy would keep the users'ADL and QOL.

Job Analyses of Health Care Managers in Group Health Care System / 예방의학회지

For developing the Group Health care system, health managers' job structure were analysed in the aspects of content, amount, and process. As a trial research, data were collected by a standardized job analysis table to 6 doctors, 40 nurses, and 11 industrial hygienists of Group Health Care System. Health care managers were performing complex and intellectual jobs such as health education for workers, managing health care, conference as well as more simple jobs like as filling diary. Especially, job was consisted of general job and health care management job in the proportion of 1:2.18. The major general job were data management related with the health statistics, and major health care management jobs were managing health care, health counselling, environmental management of working sites. Each specific jobs were required differentiated intellectual capacity, creativity, autonomy, psychic stress, and physical work; most respondents perceived that health care management jobs should require more inputs than general jobs Additionally job satisfaction and perceived need on specific job items were analysed. Results of this research, suggested through the field experiences in working sites, should be considered for improving the Group Health Care System.

Perception, Attitude and Praetical Behavioral Change of Industrial Health Care Manager toward Group Health Care System / 대한산업의학회지

To evaluate the change of perception, attitude and practice toward Group Health Care Systerl for small and medium industries, a survey using self-administered questionnaire was conducted to a part of industries in Inchon area, in year 1992 and 1993. major dependent variables were perception, attitude, and practical behavioral change related with Croup Health Care System ; these variables were measured by 3-point Likert like scale. 47 industries were used in analysis. Psrception of year 1993 was higher (1.25) than that (1 34) of 1992. Attitude of yeal. 1993 was also slightly higher (1.46) than that (1.43) of 1992. Both data indicated positive attitude. Practice of year 1993 was slightly lewer (0.86) tHan that (0.90) of 1992, but its change didn't have any statistical significance. In year 1992, major determinants of perception, attitude and behaviral change were sex and age of industrial health care manager ; they had positive efffct upon perception and practice. In yeal. 1993, it was sex of health care manager; it had influenced upon practice. Both year 1992 and 1993, perception was higher and attitude was more positive. In the case of higher perception or positive attitude, practice was active accordingly. To accelerate the behavioral change of health care manager, it is necessary to eaucate them continuously.