Terminal Care on Remote Islands without Doctors / 日本プライマリ・ケア連合学会誌

Toshima archipelago is a series of remote islands in southern Japan with a population of about 700. There is a nurse on every island, but a doctor only visits each island twice a month. Faced with this challenging and isolated environment, we cooperated with the executive branch of the Toshima region to improve the telemedicine system and provide terminal care to patients with end-stage cancer. The system still has limitations, but we improved cooperation with the administrative agencies on behalf of the islands' inhabitants to enable patients to receive palliative care on their home island.

An Opinion Survey on Purchasing Nonprescription Drugs over the Internet in Remote Islands / 医薬品情報学

<b>Objective: </b>The revised Pharmaceutical Affairs Act that came into force in June 2009 prohibits the sale of nonprescription drugs via mail.  However, as a provisional measure, regular users and inhabitants of remote islands who do not have access to pharmacies or drug stores are allowed to purchase nonprescription drugs via mail until the end of May 2013.  This study involves a survey on the purchasing of nonprescription drugs by Internet-illiterate inhabitants of the remote Goto Islands, Nagasaki Prefecture, Japan.<br><b>Methods: </b>Our process began with the distribution of questionnaires via mail to inhabitants of the remote Goto Islands, of whom 3,819 were randomly selected.  The responses were sent between January 22 and February 26, 2011.  We analyzed problems presented by 522 inhabitants who were Internet-illiterate.<br><b>Results: </b>The results revealed that 57.3% of the respondents living on large islands—with pharmacies, drug stores, and pharmacists— (e.g., Fukueshima) and 85.3% of respondents living on small islands scattered around large islands—with none of the abovementioned amenities— (e.g., Maeshima) were Internet-illiterate.  Additionally, a majority of the respondents (more than 80%) felt no need to purchase nonprescription drugs over the Internet.  However, considering that a handful of these inhabitants do, or will at some time need to purchase nonprescription drugs over the Internet, we strive to establish an optimal system for supplying medications to these Internet-illiterate inhabitants.<br><b>Conclusion: </b>Community pharmacists need to establish close relationships with the Internet illiterate (particularly those living on small islands) and promote the overall appropriate use of medicinal products.

Can Screening Invitations from Primary Care Physicians Increase Participation in Cancer Screenings on Remote Islands? / General Medicine

<b>Background:</b> Gastric and colorectal cancers are the leading cause of cancer-related deaths in Japan. In an attempt to control such cancer-related deaths, gastric and colorectal cancer screenings (GCSs) are readily available in Japan. Despite this, the rate of participation has been lower than expected. Previous studies have reported that some intervention tools can improve participation in cancer screenings and others cannot. Such studies conducted in rural areas are quite rare.<br><b>Methods:</b> The subjects were residents of Kozu Island. All subjects were aged 40 and over. In the clinical setting, primary care physicians (PCPs) handed their patients a screening invitation, in an attempt to improve participation in GCSs. We examined participation trends before and after this intervention. In addition, we administered questionnaires to examine subjects' reasons for attendance and relevant characteristics of the subjects.<br><b>Results:</b> Following the intervention, participation in GCSs did not significantly improve in the short term. In 2011, the number of participants in gastric cancer screening was 173 (22.1%) and was not significantly different from the 2010 results (P=0.80). Furthermore, the number of participants from year to year (2005-2011) was not significantly different (P=0.07). In addition, the number of participants in colorectal cancer screening was 145 (16.5%) and was not significantly different from the 2010 results (P=0.65). Moreover, the number of participants from year to year (2005-2011) was not significantly different (P=0.17). 172 out of 211 (82%) participants submitted the questionnaire. Results taken from the questionnaires showed that our screening invitation influenced non-elderly people (49.5±3.9 vs. 56.4±6.5, P=0.04) and first-attendance people showed a significant tendency for more gastrointestinal symptoms (4 vs. 2, P=0.03).<br><b>Conclusion:</b> On the whole, the screening of invitations from PCPs did not improve participation rates in GCSs in the short term. However, we believe that screening invitations can influence non-elderly people, and this intervention can be effective in increasing the numbers of gastrointestinal-symptomatic people attending for the first time (first-attendance people).