[Usual Relationship to Support Sudden Discharge-Coordination Starting from Pre-Discharge Support Considered through a Case Report of Supporting a Patient with ALS].

Due to promotion of home medical care, the number of patients who highly depend on medical care is increasing. Therefore, the role of pre-discharge conferences where a care manager is involved starting from pre-discharge support has become more important. In addition, in a usual relationship, cooperation between the hospital staff and the home care support team is crucial. Among home care workers, the word "coordination" has generally been used for a long time to prepare for the transfer of patients from a hospital to home. However, there is a considerable gap between healthcare and caregiving; consequently, it is difficult to actually create coordination between them because the terms to be used and the contents mastered by personnel in each field are different. In this paper, we report a case of successful coordination for smooth transfer of a patient with ALS from a hospital to home, by creating a homecare team in which all members work together based on the information obtained from a hospital social worker.

[Team Collaboration in Home Medical Care to Support Patients at the End-of-Life - Review of Service Personnel Meeting on Discharge Day].

Due to the rising number of patients at the terminal stage or with high dependence on medical care, the cooperation of 2 teams, the hospital discharge support team and the home support team, has become very important. The recent spread of the Internet has enabled both patients and their families who have chosen home care to obtain a wide range of information about home services, as well as diseases, and form a picture of what will happen. However, there are actually many cases in which patients and families find that things are not as they imagined, and they are uneasy and unsure of what to do. Here, we report a case in which the mismatch between the patient's and family's expectations created an unsatisfactory care situation.

[Collaboration of Hospitals and Home Care Providers - Lessons to be Learned from an Actual Case to Enable Patients to Keep Living at Home by Their Own Values].

The aging society has arrived, and home care options are being promoted. To date, because of an increase in the number of patients with higher disability levels in greater need of medical help and senior people living alone or in senior-person households, more patients are in need of discharge support. Many medical institutions cannot consider the option of staying at home and receiving home care services for such patients, and such patients often give up on going home. In the case of service recipients suffering from incurable diseases or disabilities and undergoing age-related changes, it is necessary that they decide on their own"where and how they want to live."For their decision to be respected, a key is collaboration with those who support patient discharge from the hospital and those who support patient home care. This paper explores a patient appropriate for level-3 care with brain hemorrhage and paralysis of the left half of the body. This patient required supportive and adaptive devices, a cane for walking, and constant observation. In consideration of the wishes of the patient and his family, he was allowed to go home.

[Supporting Patients with Disease Living at Home].

In daily life, many are not familiar with progressive intractable disease. It is often the case that the patient's family confronts a rare progressive disease only once a diagnosis is made. In recent years, the internet has made it possible for families to learn about diseases in detail, and they can more or less predict the likely course of nursing care required by the patient in the days to come. Yet families often lack understanding of terms related to a disease and how to respond to disease progression. It is desirable that, when a patient confronts a disease and home health care is going to be provided, a care provider be able to show empathy for the patient and the family and build a trust relationship with them. Under the theme of"living at home with disease,"this study examines the case of a patient who copes with the diagnosis of a specified disease and who remains at home. This paper highlights the importance of ongoing collaboration between community medicine and home health care service.

[Provision System of Medical Narcotics].

Patients with cancer are increasingly opting for home health care, resulting in a rapid increase in the number of prescriptions for narcotics aimed at pain control. As these narcotics are issued by pharmacies only upon presentation of valid prescriptions, the quantity stored in the pharmacies is of importance. Although many pharmaceutical outlets are certified for retail sale of narcotic drugs, the available stock is often extremely limited in variety and quantity. Affiliated stores of wholesale(or central wholesale)dealers do not always have the necessary certifications to provide medical narcotics. Invariably, the quantity stored by individual branches or sales offices is also limited. Hence, it may prove difficult to urgently secure the necessary and appropriate drugs according to prescription in certain areas of the community. This report discusses the problems faced by wholesalers and pharmacies during acquisition, storage, supply, and issue of prescription opioids from a stockpiling perspective.

[The Home Care Doctor Today is "STRIKE" - Considering Care of Terminal Stage Patients with Cancer through a Case Report].

Although many patients wish to remain in their familiar home environment while undergoing cancer treatment, many obstacles prevent a patient from receiving cancer care at home. With early-stage cancer, the patients may better accept the diagnosis and have a greater will to fight the illness. However as time proceeds, progression or recurrence of cancer may occur, and eventually, proactive treatments will not be available. This progression results in great physical and mental strain on the patients and their family. At all stages of such progression, opportunities exist for a care provider to assist with overcoming potential obstacles by openly communicating with the patients, talking through the patients' experiences, and understanding their feelings. However, on diagnosis, cancer patients must often face the reality that they have very little time left to live. When transiting medical care from their long-trusted hospital to a home care base, a new physician must be selected and other decisions related to their care must be quickly made. Transferring responsibility to a good home care provider can greatly influence a patient's emotional state. This paper reports one such case in which the patients died in their homes with the best comfort and possible outcome.

[Leadership in the promotion of inter-professional collaboration in terminal cancer care].

Home care requires indispensable inter-professional/inter-organizational collaboration. However, due to differences in specialization, the language used, and work structure, medical professionals may be confronted with a gap between the ideal and reality of collaboration. In the present case, a 50-year-old female with terminal cancer wished to receive home care and was consequently transferred to her home. The patient has been receiving a 24-h continuous drip infusion via a central venous route and using a patient-controlled analgesia pump for pain management. She has chronic respiratory failure in addition to cancer-related pain. Furthermore, she has been injecting herself with insulin 4 times per day because she has type 2 diabetes. The patient requires almost full assistance in daily life. This type of home care is equivalent to inpatient care that requires inter-professional and inter-organizational collaboration by 12 professionals. The leadership of a care manager with knowledge of a patient's life and family background is essential in such cases.

[Home care for terminal cancer patients from the family and caregiver perspective].

The progression of home care provision is associated with an increased burden on the family, as patients tend to progressively become more dependent on medicine. In the present case, a family supported a patient by performing medical activities such as taking blood sugar measurements, administering insulin injections, exchanging fluids, managing each tube, handling medical devices, conducting status observations, and attending to emergency calls. Thus, the family caregiver undertakes duties that were previously performed by a nurse and interacts with the various professionals who visit the patient's home daily. Therefore, the caregiver undergoes a considerable amount of stress. Family caregivers with no medical knowledge or nursing experience require plenty of support, in order to fulfill a patient's requirements. The first step is the establishment of trust between the medical professionals and the caregiver. In the present case, because the trust had been established, interprofessional collaboration ensured that the patient received support until the end. Thus, we reported on the perspectives of the family and caregiver on home care for terminal cancer patients.

[The significance of visiting by pharmacist to home care patient].

The pharmacist visits the patient undergoing treatment in a house as a result that separation of pharmacy and clinic progressed and performs pharmaceutical management guidance. Because home care patients are old, and there are many kinds of the medicine to take, the pharmacist confirms the taking medicine actual situation of the patients and promotes risk management of the drug therapy. The pharmacist makes a reporting book aimed for proper use of the medicine about a visit result and donates it in the chief physician and the other medics. Most studies have not focused on reporting book. So I categorized the medicine of the patient and problems about the medical treatment.

[A questionnaire survey targeting pharmacists and health care professionals involved in home care].

Patients who need home care are often old, of delicate health, and take many different medications. In order to take these medicines properly, not only the patient him/herself but also their family, the helper, and the visiting nurse must have the correct information about them. Since home care is typically carried out by several medical professionals from different fields, we sent out questionnaires to pharmacists and nurse care professionals. From the results, we found that there was a discrepancy in level of interest in medications between the health care professionals who treat the patients daily and pharmacists who hardly visit the patient's home. As for dispensing, from a risk management point of view, standardization of the colors used to sort the medicine which is packed into one medicine package is required. And for pharmacists, the needs for more cooperation with physicians were pointed out.