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Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.
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<b>Introduction</b> : The appropriate size of the regional coverage area for primary care in Japan has been unclear. The aim of this study was to determine the geographical distribution of primary care clinics for elderly ambulatory diabetic patients.<br><b>Methods</b> : Using an insurance claims database, we extracted data of patients aged 75 years and older requiring ambulatory diabetic care in May 2010 in Ibaraki prefecture. The geographical distance from each municipal office to the clinics was analyzed.<br><b>Results</b> : A total of 17,717 data points were extracted from the database. Data points that could not be mapped due to coding errors were eliminated, resulting in 17,144 (96.8%) data points that were ultimately analyzed. The median [25th-75th percentile] geographical distance was 5.5 [2.3-9.9] km. The distance was not related to municipal population, aging rate, or area size.<br><b>Conclusion</b> : The coverage area for diabetic care in this primary care setting was estimated. For most elderly ambulatory diabetic patients, clinics are distributed within a 10-km radius area. Further investigation is needed to clarify primary care coverage areas that result in the most efficient use of medical resources.
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<b><i>Abstract</i></b><br><b>Introduction</b> : There are few reports of long-term medical support activities in disaster areas. We analyzed drug-related data using medical records and prescriptions obtained during the long-term medical support of patients impacted by the Great East Japan Earthquake, which occurred on March 11, 2011.<br><b>Methods</b> : Using medical records and prescriptions, the dispensing frequency of each drug was calculated and usage trends of the top three most frequently dispensed drugs are described here. All data was collected from March 26, 2011 onwards after the medical support activity commenced.<br><b>Results</b> : In the first week of data acquisition, a total of 166 patients visited the medical support team (median 48.5, range 14-166). Following that, the number of patients decreased with a median of 24 people per day (range 0-47). The number of prescriptions for common cold medication was the highest, followed by antihypertensive and anti-allergic medications, respectively. The usage of antihypertensive drugs and common cold medications decreased over time, whereas anti-allergic medications were prescribed on a continuous basis.<br><b>Conclusion</b> : Disaster medical support teams should not only be prepared to support the acute phase but also long-term phase, which depends heavily on the restoration of local medical services. The earlier the intervention to provide support, the greater the likelihood that the disaster medical support team will require to provide treatment for both acute and chronic illness.
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<b>Objective</b> : To analyze and reveal the contents of medical questionnaires distributed to nationwide general practice outpatients prior to their initial medical consultations.<br><b>Method</b> : An observational study was conducted, based on questionnaire format. Sample questionnaires were collected from 85 hospitals registered with the Japan Primary Care Association.<br><b>Results</b> : No standard format was found among the samples. A4 size forms (210 mm×297 mm) averaging 19.7 questions were in the majority, accounting for 68%. The distribution frequency of questionnaires reported by research cooperation centers listed 28 items (31.8%) concerning medical history, 19 items (21.6%) related to lifestyle, and 7 items (8.0%) referring to social and reproductive status.<br><b>Conclusion</b> : This research assessed the qualitative value of medical questionnaires used in General Practice Clinics in Japan. The results indicate the nature of the medical information required by physicians prior to medical consultation.
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<b>Background:</b> When analyzing regional disparities in healthcare resources, hospital accessibility is given little consideration. We surveyed accessibility from residential districts to medical institutions using GIS (Geographic Information System) and estimated Gini coefficient for each hospital distribution.<br><b>Methods:</b> The subjects were 2,688 census mesh blocks ( “<i>Cho</i>-<i>cho</i>-<i>aza</i>” ) and 109 hospitals in Tochigi prefecture. The number of hospitals located within the road distances of 5 km, 10 km and 15 km from the geometrical center of each block was calculated using GIS. The Gini coefficient of each hospital per 100 residents was calculated among the regions located within 5 km, 10 km and 15 km from the geometrical center of the census mesh block.<br><b>Results:</b> The population of each block was 748±1,067 (mean±SD), and the road distance to the nearest hospital from the center of each block was 4.3±4.5 km. The number of census mesh blocks with distances from the center of each block to the nearest hospital within 5 km, 5-10 km, 10-15 km and more than 15 km were 1909 (71.0%), 561 (20.9%), 139 (5.2%) and 79 (2.9%) respectively. The number of hospitals located within 5 km, 10 km and 15 km were 3.3±4.7, 8.3±8.6 and 14.4±11.4. Gini coefficients were 0.65, 0.52 and 0.43.<br><b>Conclusion:</b> When analyzing regional disparities in healthcare resources, it is necessary to take into account not only the number of physicians and beds, but also accessibility. Gini coefficient is useful to estimate geographical distributions, and can be used as an indicator for improvement projects for hospitals.
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Background: Physician shortage affects mortality at the city level in Japan. The medical administrative district (MAD) covering the area (town, city, etc.) in which the patients live and is the unit responsible for recruiting doctors. The number of physicians or changes in this number in each MAD varies. The relationship between the number, or the change in number, of physicians and the mortality in each MAD has been unclear. <br>Methods: We designed a descriptive study using publicly-available national statistics. In all 358 MADs in Japan, we analyzed the relationship between the changes in the number of physicians (total, clinic, and hospital) from 2000 to 2005 and the standardized mortality ratio (all causes of death, cancer, heart disease, and stroke). <br>Results: In MADs, the number of physicians and mortality are not related, nor are changes in number of physicians and mortality. Further investigation including factors associated with mortality is needed. <br>Conclusion: In MAD, there is no relationship between the number of physician and the mortality, between the change in number of physician and the mortality. Further investigation is needed including factors associated with mortality.
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Owing to shortages of primary-care physicians, increasing their numbers has been recognized as an urgent issue in Japan and other countries. However, it is unclear which factors in medical education influence the decision of residents to go into primary care. We investigated the factors associated with residents' choosing to practice primary care.<br>Of 281 randomly selected medical facilities designated as residency training hospitals, 137 facilities answered. Self-administered questionnaires were completed by 724 residents in the third or fourth postgraduate year. Responses were compared between residents who intended to choose a career in primary care (n=175, 24.2%) and residents who intended to choose a career in other specialties (n=549, 75.8%).<br>In addition, for residents who had intended during their undergraduate years to enter a non-primary-care specialty (n=442, 61.1%), responses were compared between those who now intended to go into primary care (n=33, 7.5%) and those who did not (n=409, 92.5%).<br>Residents who had planned during their undergraduate years to choose a career in primary care (adjusted odds ratio [95% confidence interval]: 9.85 [6.24-15.5]), residents who were working as primary-care physicians at the time of the survey (7.58 [4.92-11.7]), and residents who wanted to enter rural practices in the future (2.24 [1.36-3.68]) were significantly more likely to plan to choose a career as a primary-care physician in the future.<br>Residents who had worked at a rural practice during residency training were significantly more likely to change their career plans from other specialties to primary care (crude odds ratio [95% confidence interval]: 2.18 [1.05-4.49]). Exposure to a rural practice during residency training may affect residents' career plans.<br>Integrating rural primary-care practice into residency training may help increase the number of primary-care physicians in the future.
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<b>Objectives</b> : To determine factors related to peoples' preference for visiting home-doctors when experiencing new health problems.<br><b>Method</b> : A questionnaire survey was conducted of people receiving annual health checkups in municipalities in the vicinity of Jichi Medical University Hospital. We surveyed personal characteristics, test equipment, having of a home-doctor, and answers to an assumed scenario (asking about willingness to visit a home-doctor in case of getting certain health problems).<br>According to the responses to the scenario, we divided the subjects into two groups (a home-doctor group: visiting a home-doctor; and a specialist group: not visiting a home-doctor) and statistically compared the two groups.<br><b>Results</b> : In the analytic sample of 1,829, the home-doctor group numbered 1,097 individuals (60%) and the specialist group numbered 732 individuals (40%). The home-doctor group statistically had more home-doctors than the specialist group (adjusted odds ratio, 95% confidence interval: 2.47, 2.00-3.05).<br>More home-doctors in the home-doctor group had test equipment than home-doctors in the specialist group: Gastrointestinal test equipment (gastroscopy, colonoscopy, or ultrasonography) (adjusted odds ratio, 95% confidence interval: 1.39, 1.06-1.83).<br><b>Conclusion</b> : We revealed two factors relating to the preference for visiting home-doctors: First, those people had home-doctors, and, second, the home-doctors had test equipment.
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Because of drastic changes in community health care in Japan, increasing emphasis has been placed on medical undergraduate education in community health care.The number of medical school introducing community-based clinical training is increasing.Therefore, effective clinical training in community health care should be developed. This study examined the effects of the location and subjects of training on students' evaluations and impressions of community-based clinical training.<BR>1) Self-administered questionnaires were completed by 499 fifth-year students taking part in community-based clinical training.The main items were the locations and subjects of training and the students' evaluations and impressi ons of training. The associations between these items were analyzed.<BR>2) A total of 96.8% of the questionnaires were analyzed. The students who trained only in clinics were slightly but not significantly more likely to have positive impressions of and to have given higher evaluation scores to training than were other students.<BR>3) Students who participated in health education for healthy persons or patients or both were significantly more likely to answer that“the training program was enjoyable, ”“the preceptors were enthusiastic, ”and“I spent more time with the preceptors.”On the other hand, the students who took part in inpatient care were significantly less likel y to answer that“the training program was enjoyable”or that“the training program is needed.”<BR>4) Students who studied 1 to 4 of the 11 subjects were significantly less likely than were students who studied 8 to 11 subjects to answer that“the preceptors were enthusiastic”and were less likely than were students who studied 5 to 7 subjects to answer that“the training was meaningful.”<BR>5) Students who studied few subjects during training might have negative feelings about community-based clinical training.The experience of health education might have a positive effect on students.On the other hand, the experience of inpatient care probably has a negative effect.
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We conducted a questionnaire survey of all sixth-year students at 10 Japanese medical schools asking their opinions on the necessity of experience in community-based learning (CBL) programs. We developed a detailed questionnaire to examine students' experiences in CBL and their opinions of its necessity using the students' reports from CBL by Delphi process. After excluding data from 1 medical school because of a low response rate, we analyzed data from 659 students (response rate, 75%). The necessity of each item in the required programs, except “seeing labor in medical facilities, ” was more likely to be recognized by students who had experienced the item than by students who had not experienced it. The differences between experiencing and nonexperiencing students in recognizing necessity were greatest for “conversation with patients in their homes, ” “seeing physicians' consultation or referral to other medical institutions, ” “observing nurses work in the outpatient clinic, ” and “participation in conferences with various professional staff.” These results suggest that medical students can recognize the significance and meaning of CBL through experience.
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Education in community medicine has become increasingly important. At Jichi Medical School, community-based clinicalclerkships began in 1998. This study examined the effects of a standardized program for medical facilities and clerkshipcontents introduced in 2001. A self-administered visual analogue scale questionnaire was given to 308 fifth-yearmedical students to examine their opinions about this program, community medicine, and the future. Results from beforeand after the introduction of the standardized program were compared. After the program had been introduced, significantlymore students agreed that the clerkship program was “meaningful” and should be continued. Furthermore, significantly more students agreed that “physicians enjoy working in the community, ” “talking with people, patients, and public officials is not difficult, ” and “ I will become a general physician or a specialist in the future.” These resultsshow that the standardized program is effective for education in community medicine.
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We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.
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In Japan, it is necessary to develop the community medicine (community health care) because of the current of the medical practice. Since 1998, the community-based clinical clerkship (the two weeks' program) has been introduced to the all 5-grade medical students in Jichi Medical School. The aim of this program is to learn not only the knowledge and skill for the community medical practice, but also the attitude included the pleasure, enjoyment and worth to do it. The program contains as many activities of the community medicine as possible other than the out-patient or the in-patient managements. The most of medical students give good evaluation to the program. After the program, many of the medical students became to have the motivation to work in the rural area. In the undergraduate medical education, a community-based clinical clerkship will be more necessary in terms of the development of the community medicine.
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To determine the background of aged people who need bathing assistance, we analyzed data of the Survey on Demand for Health and Welfare Services of Japan as of 1997. The survey covered 21, 723 persons aged 65 years or older, and 1, 193 caregivers who provide care to persons 65 years or older throughout Japan. The main parameters were aged people's sex, age, marital status, health condition, degree of bed rest, and needs of care in daily life; relation between caregivers and aged people; life with care giver; job; family composition; use of home care services; demand for home care services; caregivers' sex, age, health condition, and employment status; and demand for home care services. Subjects were divided into three groups, those who need bathing assistance, those who do not need bathing assistance, and those who do not need care in daily life, and the rate was shown for each item. The results indicated that the rate of those who need bathing assistance was higher among (1) aged people who were older, have poor health, and are in bed alweys or almost alweys, (2) aged people who needed care in daily life, used home care service, and required home care service, and (3) aged people whose caregivers required home care services.<br>Aged people who need bathing assistance are subject to frequent bathing accidents, so we need to pay attention to safe bathing service.
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To determine the need of guidelines for judgment of the bathing advisability for the aged in Councils of Social Welfare, we had a cross-sectional study in 1999.<br>A questionnaire survey by mail for Councils of Social Welfare which were extracted by systematic sampling (n=828, extraction rate was 25%) was conducted. The response rate was 83% and the proportion of respondents who answered the guidelines were necessary was 86% (n=642). Chi-square tests and logistic regressions analyses showed that bathing service in facility, existence of guidelines for judgment of the bathing advisability by body temperature, and respondents judging were independent factors associated with the need of guidelines for judgment on the bathing advisability in aged. Our results suggest the necessity to make guidelines for judgment of the bathing advisability in the aged.