[Prefectural health administration's view on otorhinolaryngological care in medical rural areas].

In a previous study, we investigated otorhinolaryngological care by the general practitioners in medical rural areas and demonstrated that a close relationship between general practitioners and otorhinolaryngologists was necessary. In the present study, a survey of prefectural health administration's views on otorhinolaryngological care in medical rural areas was performed. A questionnaire for otorhinolaryngological care in medical rural areas was sent to the divisions of health administration in the 47 prefectures of Japan. Of these prefectures, 46 (97.9%) responded. About 80% of respondents have medical rural areas, and the otorhinolaryngological care is inadequate in most areas. General practitioners of internal medicine or surgery are primarily demanded in about 75% of the prefectures. Otorhinolaryngological care in medical rural areas has never been considered in most prefectures. Because the need for otorhinolaryngological medical care will increase, prefectural health administrations need to pay more attention to otorhinolaryngological care in medical rural areas, and a close relationship between general practitioners, otorhinolaryngologists, and the administration should be established.

[Otorhinolaryngological medical care by the general practitioners in rural areas].

In the present study, a survey of otorhinolaryngological medical care by the general practitioner, including the relationship between general practitioners and otorhinolaryngologists in rural areas was carried out. A questionnaire for otorhinolaryngological medical care by the general practitioners was sent to 326 hospitals with less than 100 beds where non-otorhinolaryngological doctors who had graduated from Jichi Medical School were working. Of these hospitals 164 (50.4%) responded. Most respondents said that they had about 3 or 4 patients with otorhinolaryngological disease per month. The distance between most hospitals and the nearest otorhinolaryngologists was within one hour by available transportation facilities. About 70% of the respondents were provided with simple otorhinolaryngological instruments, such as an aural speculum, a nasal speculum and a head mirror. The most frequent otorhinolaryngological diseases which they treated were vertigo, allergic rhinitis and upper respiratory infection including acute tonsillitis and pharyngolaryngitis. Only 10 to 20% of the general practitioners had otorhinolaryngological training. We found several problems in otorhinolaryngological medical care in rural areas. Patients with otorhinolaryngological disease seek otorhinolaryngological care at the nearest medical facility where general practitioners with inadequate otorhinolaryngological experience examine patients with inadequate otorhinolaryngological instruments. Therefore, a close relationship between general practitioners and otorhinolaryngologists should be developed and the quality of otorhinolaryngological medical care should be raised in rural areas.