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Bando K, Ohashi K, Fujiwara K, Osanai T, Morii Y, Tanikawa T, Fujimura M, Ogasawara K. The Capacitated Maximal Covering Location Problem Improves Access to Stroke Treatment: A Cross-Sectional Simulation Study. Health Serv Insights 2024; 17:11786329241263699. [PMID: 39092183 PMCID: PMC11292677 DOI: 10.1177/11786329241263699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024] Open
Abstract
Disparities in accessing advanced stroke treatment have been recognized as a policy challenge in multiple countries, including Japan, necessitating priority solutions. Nevertheless, more practical healthcare policies must be implemented due to the limited availability of healthcare staff and financial resources in most nations. This study aimed to evaluate the supply and demand balance of mechanical thrombectomy (MT) and identify areas with high priority for enhancing stroke centers. The target area of this study was Hokkaido, Japan. We adopted the capacitated maximal covering location problem (CMCLP) to propose an optimal allocation without increasing the number of medical facilities. Four realistic scenarios with varying levels of total MT supply capacity for Primary stroke centers and assuming a range of 90 minutes by car from the center were created and simulated. From scenarios 1 to 4, the coverage increased by approximately 53% to 85%, scenarios 2 and 3 had 5% oversupply, and scenario 4 had an oversupply of approximately 20%. When the supply capacity cap was eliminated and 8 PSCs received 31 or more patients, they became priority enhancement targets. The CMCLP estimates demand coverage considering the supply and demand balance and indicates areas and facilities where MT supply capacity enhancement is a priority.
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Affiliation(s)
- Kyohei Bando
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Graduate School of Commerce, Otaru University of Commerce, Otaru, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Faculty of Engineering, Muroran Institute of Technology, Muroran, Japan
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Ohashi K, Osanai T, Bando K, Fujiwara K, Tanikawa T, Tani Y, Takamiya S, Sato H, Morii Y, Ishikawa T, Ogasawara K. Optimal allocation of physicians improves accessibility and workload disparities in stroke care. Int J Equity Health 2023; 22:233. [PMID: 37936211 PMCID: PMC10631210 DOI: 10.1186/s12939-023-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload. METHODS This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists. RESULTS The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities. CONCLUSIONS The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kyohei Bando
- Graduate School of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Graduate School of Commerce, Otaru University of Commerce, 3-5-21, 047-8501, Otaru, Midori, Japan
| | - Takumi Tanikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Faculty of Health Sciences, Hokkaido University of Science, 7-15-4-1, Maeda, Teine-ku, Sapporo, 006- 8585, Japan
| | - Yuji Tani
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Department of Medical Informatics and Hospital Management, Asahikawa Medical University, E2-1-1-1, 078-8510, Asahikawa, Midorigaoka, Japan
| | - Soichiro Takamiya
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan
- Department of Neurosurgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, 047-8550, Japan
| | - Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, E2-1-1-1, Midorigaoka, Asahikawa, 078- 8510, Japan
| | - Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6, Minami, Wako, Japan
| | - Tomoki Ishikawa
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan
- Institute for Health Economics and Policy, 1-21-19, Toranomon, Minato-ku, 105-0001, Japan
| | - Katsuhiko Ogasawara
- Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
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3
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Ohashi K, Abe A, Fujiwara K, Nishimoto N, Ogasawara K. Regional assessment of medical care provision system by principal component analysis. J Family Med Prim Care 2023; 12:734-742. [PMID: 37312784 PMCID: PMC10259538 DOI: 10.4103/jfmpc.jfmpc_2077_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/08/2022] [Accepted: 01/17/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction The Japanese government has promoted policies ensuring standardized medical care across the secondary medical care areas (SMCAs); however, these efforts have not been evaluated, making the current conditions unclear. Multidimensional indicators could identify these differences; thus, this study examined the regional characteristics of the medical care provision system for 21 SMCAs in Hokkaido, Japan, and the changes from 1998 to 2018. Materials and Methods This study evaluated the characteristics of SMCAs by principal component analysis using multidimensional data related to the medical care provision system. Factor loadings and principal component scores were calculated, with the characteristics of each SMCA visually expressed using scatter plots. Additionally, data from 1998 to 2018 were analyzed to clarify the changes in SMCAs' characteristics. Results The primary and secondary principal components were Medical Resources and Geographical Factors, respectively. The Medical Resources components included the number of hospitals, clinics, and doctors, and an area's population of older adults, accounting for 65.28% of the total variance. The Geographical Factors components included the number of districts without doctors and the population and a land area of these districts, accounting for 23.20% of the variance. The accumulated proportion of variance was 88.47%. From 1998 to 2018, the area with the highest increase in Medical Resources was Sapporo, with numerous initial medical resources (-9.283 to -10.919). Discussion Principal component analysis summarized multidimensional indicators and evaluated SMCAs in this regional assessment. This study categorized SMCAs into four quadrants based on Medical Resources and Geographical Factors. Additionally, the difference in principal component scores between 1998 and 2018 emphasized the expanding gap in the medical care provision system among the 21 SMCAs.
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Affiliation(s)
- Kazuki Ohashi
- Faculty of Health Sciences, Hokkaido University, Kita-Ku, Sapporo, Japan
| | - Arisa Abe
- Department of Health Sciences, School of Medicine, Hokkaido University, Kita-Ku, Sapporo, Japan
| | - Kensuke Fujiwara
- Graduate School of Commerce, Otaru University of Commerce, Midori, Otaru, Japan
| | - Naoki Nishimoto
- Division of Data Management, Division of Biostatistics, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Kita-Ku, Sapporo, Japan
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Ohashi K, Osanai T, Fujiwara K, Tanikawa T, Tani Y, Takamiya S, Sato H, Morii Y, Bando K, Ogasawara K. Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan: an ecological study using a conditional autoregressive model. Int J Health Geogr 2022; 21:16. [PMID: 36316770 PMCID: PMC9623919 DOI: 10.1186/s12942-022-00316-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Accessibility to stroke treatments is a challenge that depends on the place of residence. However, recent advances in medical technology have improved health outcomes. Nevertheless, the geographic heterogeneity of medical resources may increase regional disparities. Therefore, evaluating spatial and temporal influences of the medical system on regional outcomes and advanced treatment of cerebral infarction are important from a health policy perspective. This spatial and temporal study aims to identify factors associated with mortality and to clarify regional disparities in cerebral infarction mortality at municipality level. METHODS This ecological study used public data between 2010 and 2020 from municipalities in Hokkaido, Japan. We applied spatial and temporal condition autoregression analysis in a Bayesian setting, with inference based on the Markov chain Monte Carlo simulation. The response variable was the number of deaths due to cerebral infarction (ICD-10 code: I63). The explanatory variables were healthcare accessibility and socioeconomic status. RESULTS The large number of emergency hospitals per 10,000 people (relative risk (RR) = 0.906, credible interval (Cr) = 0.861 to 0.954) was associated with low mortality. On the other hand, the large number of general hospitals per 10,000 people (RR = 1.123, Cr = 1.068 to 1.178) and longer distance to primary stroke centers (RR = 1.064, Cr = 1.014 to 1.110) were associated with high mortality. The standardized mortality ratio decreased from 2010 to 2020 in Hokkaido by approximately 44%. Regional disparity in mortality remained at the same level from 2010 to 2015, after which it narrowed by approximately 5% to 2020. After mapping, we identified municipalities with high mortality rates that emerged in Hokkaido's central and northeastern parts. CONCLUSION Cerebral infarction mortality rates and the disparity in Hokkaido improved during the study period (2010-2020). This study emphasized that healthcare accessibility through places such as emergency hospitals and primary stroke centers was important in determining cerebral infarction mortality at the municipality level. In addition, this study identified municipalities with high mortality rates that require healthcare policy changes. The impact of socioeconomic factors on stroke is a global challenge, and improving access to healthcare may reduce disparities in outcomes.
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Affiliation(s)
- Kazuki Ohashi
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan
| | - Toshiya Osanai
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, 060-8638 Sapporo, Japan
| | - Kensuke Fujiwara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan ,grid.444620.00000 0001 0666 3591Graduate School of Commerce, Otaru University of Commerce, 3-5-21, 047-8501 Midori, Otaru Japan
| | - Takumi Tanikawa
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan ,grid.444700.30000 0001 2176 3638Faculty of Health Sciences, Hokkaido University of Science, 7-15-4-1, Maeda, Teine-ku, 006-8585 Sapporo, Japan
| | - Yuji Tani
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan ,grid.252427.40000 0000 8638 2724Department of Medical Informatics and Hospital Management, Asahikawa Medical University, E2-1-1-1, 078-8510 Midorigaoka, Asahikawa Japan
| | - Soichiro Takamiya
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, 060-8638 Sapporo, Japan ,Department of Neurosurgery, Otaru General Hospital, 1-1-1, 047-8550 Wakamatsu, Otaru Japan
| | - Hirotaka Sato
- Department of Neurosurgery, Kitami Red Cross Hospital, N6-E2, Kitami, 090-8666 Sapporo, Japan
| | - Yasuhiro Morii
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan ,grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6, 351-0197 Wako, Minami Japan
| | - Kyohei Bando
- grid.39158.360000 0001 2173 7691Graduate school of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan
| | - Katsuhiko Ogasawara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, 060-0812 Sapporo, Japan
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Potential crowdedness of mechanical thrombectomy and cerebral infarction mortality in Japan: Application of inverted two-step floating catchment area method. J Stroke Cerebrovasc Dis 2022; 31:106625. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
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Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105843. [PMID: 34000607 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. MATERIALS AND METHODS he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. RESULTS DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. CONCLUSIONS Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.
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Yoshioka T, Kamitani T, Omae K, Shimizu S, Fukuhara S, Yamamoto Y. Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study. PLoS One 2021; 16:e0245724. [PMID: 33471838 PMCID: PMC7817052 DOI: 10.1371/journal.pone.0245724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/07/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To investigate the longitudinal association of urgency urinary incontinence (UUI) with loss of independence (LOI) or death among independent community-dwelling older adults. Design Population-based cohort study. Setting The Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), Minami-Aizu Town and Tadami Town, Fukushima, Japan. Participants A total of 1,580 participants aged ≥65 years who underwent a health check-up conducted by LOHAS in 2010. Measurements Exposure was defined as the presence of UUI, which was measured by a questionnaire based on the definition of UUI from the International Continence Society. The primary outcome was defined as incidence of LOI or death. After the check-up in 2010, the outcome was monitored until March 2014. A multivariable Cox proportional hazard analysis was performed to estimate the hazard ratio for the outcome. Ten potential confounders were adjusted in the analysis. Furthermore, we defined the secondary outcomes as two separate outcomes, LOI and death, and performed the same analysis. Results Among all participants, 328 reported UUI. The incidence rates of the outcome were 20.4 and 11.4 (per 1,000 person–years) among participants with and without UUI, respectively. After multivariable adjustment, those who experienced UUI showed a substantial association with LOI or death (HR, 1.65; 95% CI, 1.01–2.68). However, they did not show such an association with LOI alone (HR, 1.07; 95% CI, 0.49–2.33). On the other hand, those with UUI exhibited a substantial association with death (HR, 2.23; 95% CI, 1.22–4.31). Conclusions In this study, UUI was associated with the occurrence of LOI or death; however, UUI is not associated with the occurrence of LOI alone among independent community-dwelling older adults. Our results suggest that there may be a difference between UUI-associated diseases that cause LOI and those that cause death.
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Affiliation(s)
- Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan.,Institute for Health Outcome & Process Evaluation Research (iHope international), Kyoto, Japan
| | - Kenji Omae
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan.,Department of Innovative Research & Education for Clinicians & Trainees (DiRECT), Fukushima Medical University, Fukushima, Japan
| | - Sayaka Shimizu
- Institute for Health Outcome & Process Evaluation Research (iHope international), Kyoto, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan
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Morii Y, Furuta S, Ishikawa T, Fujiwara K, Yamashina H, Ogasawara K. Projecting supply and demand for pharmacists in pharmacies based on the number of prescriptions and system dynamics modeling. HUMAN RESOURCES FOR HEALTH 2020; 18:85. [PMID: 33153487 PMCID: PMC7643472 DOI: 10.1186/s12960-020-00524-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pharmacists play an important role in promoting people's health in Japan, which has an aging population. Hence, it is necessary that the distribution of pharmacists meets the population's needs in each region. This study projects the future supply and demand for pharmacists in pharmacies to consider an optimal distribution of pharmacists. METHODS The future supply of pharmacists working in pharmacies in Hokkaido is projected using system dynamics modeling, according to their career path. The demand is projected based on the number of prescriptions, sourced from publicly available sources. The analysis period is 2015-2040. The estimated demand is converted into the number of pharmacists and the sufficiency is evaluated using sufficiency ratio (supply/demand ratio). Sensitivity analyses of the sufficiency ratio were conducted to estimate the effects of changes in parameters such as national exam pass rate, enrollments, attrition rates, the number of prescriptions per pharmacist, and diffusion of newly licensed pharmacists. RESULTS The projected supply, in 2025 and 2040, is 1.24 and 1.56 times, respectively, as that in 2015 and the demand is 1.11 and 0.98 times, respectively. In 2015, although the sufficiency ratio in Hokkaido overall is 1.19, the ratios are higher in urban medical areas and lower than 1 in rural medical areas, such as Minamihiyama, Emmon, and Nemuro. By 2040, the sufficiency ratios are greater than 1 for all areas except for Emmon and higher than 2 in some areas. The sensitivity analyses found that the sufficiency ratio was most sensitive to diffusion of newly licensed pharmacists and the number of prescriptions per pharmacist. CONCLUSION Optimal distribution should be considered, as the results reveal a possible shortage in the number of pharmacists in rural medical areas in 2015-2025. Conversely, as the demand is projected to decrease after 2025 with a population decrease, future supply should be determined in order not to cause an oversupply after 2025. Refinements of the projection model should be conducted since the related factors such as the roles of pharmacists will change over time.
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Affiliation(s)
- Yasuhiro Morii
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Seiichi Furuta
- The Department of Pharmacy, Hokkaido University of Science, Sapporo, Japan
| | - Tomoki Ishikawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Institute for Health Economics and Policy, Tokyo, Japan
| | - Kensuke Fujiwara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Graduate School of Commerce, Otaru University of Commerce, Otaru, Japan
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Nogueira RC, Lam MY, Llwyd O, Salinet ASM, Bor-Seng-Shu E, Panerai RB, Robinson TG. Cerebral autoregulation and response to intravenous thrombolysis for acute ischemic stroke. Sci Rep 2020; 10:10554. [PMID: 32601359 PMCID: PMC7324382 DOI: 10.1038/s41598-020-67404-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/02/2020] [Indexed: 11/20/2022] Open
Abstract
We hypothesized that knowledge of cerebral autoregulation (CA) status during recanalization therapies could guide further studies aimed at neuroprotection targeting penumbral tissue, especially in patients that do not respond to therapy. Thus, we assessed CA status of patients with acute ischemic stroke (AIS) during intravenous r-tPA therapy and associated CA with response to therapy. AIS patients eligible for intravenous r-tPA therapy were recruited. Cerebral blood flow velocities (transcranial Doppler) from middle cerebral artery and blood pressure (Finometer) were recorded to calculate the autoregulation index (ARI, as surrogate for CA). National Institute of Health Stroke Score was assessed and used to define responders to therapy (improvement of ≥ 4 points on NIHSS measured 24–48 h after therapy). CA was considered impaired if ARI < 4. In 38 patients studied, compared to responders, non-responders had significantly lower ARI values (affected hemisphere: 5.0 vs. 3.6; unaffected hemisphere: 5.4 vs. 4.4, p = 0.03) and more likely to have impaired CA (32% vs. 62%, p = 0.02) during thrombolysis. In conclusion, CA during thrombolysis was impaired in patients who did not respond to therapy. This variable should be investigated as a predictor of the response to therapy and to subsequent neurological outcome.
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Affiliation(s)
- Ricardo C Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, 01246-904, Brazil. .,Department of Neurology, Hospital Nove de Julho, São Paulo, Brazil.
| | - Man Y Lam
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, LE2 7LX, UK
| | - Osian Llwyd
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, LE2 7LX, UK
| | - Angela S M Salinet
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, 01246-904, Brazil
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, 01246-904, Brazil
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, LE3 9QP, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, University of Leicester, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, LE3 9QP, UK
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10
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Hashimoto D, Poudel S, Hirano S, Kurashima Y, Akiyama H, Eguchi S, Fukui T, Hagiwara M, Hida K, Izaki T, Iwase H, Kawamoto S, Otomo Y, Nagai E, Saito M, Takami H, Takeda Y, Toi M, Yamaue H, Yoshida M, Yoshida S, Ohki T, Kodera Y. Is there disparity between regions and facilities in surgical resident training in Japan? Insights from a national survey. Surg Today 2020; 50:1585-1593. [PMID: 32488479 DOI: 10.1007/s00595-020-02037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study sought to assess the disparity between regions and facilities in surgical resident training in Japan via a national level needs-assessment. METHODS A survey was sent to all 909 graduating residents of 2016. Residents trained in the six prefectures with a population of 7 million or more were included in the large prefecture (LP) group. Residents trained in the other 41 prefectures were included in the small prefecture (SP) group. Each group was further divided into a university hospital (UH) group and a non-university hospital (NUH) group. RESULTS The response rate was 56.3% (n = 512). Excluding nine residents who did not report their prefectures and facilities, surveys from 503 residents were analyzed. The UH group received significantly more years of training. In the SP and UH groups, there were significantly fewer residents who had performed 150 procedures or more under general anesthesia in comparison to the LP and NUH groups, respectively. Self-assessed competencies for several procedures were significantly lower in the SP and UH groups. CONCLUSION Disparity in surgical resident training was found between regions and facilities in Japan. The surgical residency curriculum in Japan could be improved to address this problem.
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Affiliation(s)
- Daisuke Hashimoto
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan. .,Department of Gastroenterological Surgery, Omuta Tenryo Hospital, Fukuoka, Japan. .,Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan.
| | - Saseem Poudel
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Izaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirotaka Iwase
- Department of Breast and Endocrine Surgery, Kumamoto University, Kumamoto, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Takeda
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motofumi Yoshida
- Department of Medical Education, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ishikawa T, Mizuguchi H, Murayama H, Fujiwara K, Tanikawa T, Kobayashi E, Ogasawara K. Relationship between accessibility and resources to treat acute ischemic stroke. Hokkaido, Japan: Analysis of inequality and coverage using geographic information systems. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patel TM, Shah SC, Pancholy SB. Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience. EClinicalMedicine 2019; 14:53-58. [PMID: 31709402 PMCID: PMC6833466 DOI: 10.1016/j.eclinm.2019.07.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/05/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (R-PCI) has been successfully employed in the United States since 2011. Performing R-PCI from a remote location has never been reported but if feasible would extend availability of treatment to many patients with coronary artery disease (CAD) who would otherwise go without. OBJECTIVE To assess the feasibility of remote tele-R-PCI with the operator 20 miles away from the patients. METHODS Five patients with single, type A coronary artery lesions treatable by PCI consented to participate. The primary endpoint was procedural success with no major adverse cardiac events (MACE) before discharge. Procedural success was defined as achieving < 10% diametric stenosis of the occluded target vessel utilizing tele-R-PCI balloon angioplasty and stent deployment (CorPath GRX®, Corindus Vascular Robotics, USA) without converting to in-lab manual PCI by an on-site standby team. Procedural, angiographic, and safety data were collected as were questionnaire scores from the remote operator evaluating the robot-network composite, image clarity, and overall confidence in the procedure. RESULTS The primary endpoint was achieved in 100% of patients. No procedural complications or adverse events occurred, and all patients were discharged the following day without MACE. The operator scores were favorable with the operators rating the procedure as equivalent to an in-lab procedure. CONCLUSIONS Performing long distance tele-R-PCI in patients with CAD is feasible with predictably successful outcomes if reliable network connectivity and local cardiac catheterization facilities are available.
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Affiliation(s)
- Tejas M. Patel
- Apex Heart Institute, Ahmedabad, India
- Corresponding author at: Apex Heart Institute, Ahmedabad, India.
| | | | - Samir B. Pancholy
- The Wright Center for Graduate Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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Morii Y, Osanai T, Ishikawa T, Fujiwara K, Tanikawa T, Houkin K, Kobayashi E, Ogasawara K. Cost Effectiveness of Drive and Retrieve System in Hokkaido for Acute Ischemic Stroke Patient Treatment Using Geographic Information System. J Stroke Cerebrovasc Dis 2019; 28:2292-2301. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022] Open
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Osanai T, Ito Y, Ushikoshi S, Aoki T, Kawabori M, Fujiwara K, Ogasawara K, Tokairin K, Maruichi K, Nakayama N, Kazumata K, Ono K, Houkin K. Efficacy of ‘drive and retrieve’ as a cooperative method for prompt endovascular treatment for acute ischemic stroke. J Neurointerv Surg 2019; 11:757-761. [DOI: 10.1136/neurintsurg-2018-014296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 11/04/2022]
Abstract
BackgroundOutcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized ‘mothership’ method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, ‘drive and retrieve’ describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke.ObjectiveTo describe the drive and retrieve system and verify the effects of this new collaboration on outcomes in patients with acute ischemic stroke among facilities.MethodsThis non-randomized, single-arm study retrospectively analyzed patients who met the inclusion criteria for endovascular treatment provided through a drive and retrieve system. Among the 122 patients treated by this system, we analyzed the time of onset to recanalization as the primary outcome. We also analyzed the efficacy of the drive and retrieve system using geographic information system analysis.ResultsThe median time from onset to recanalization was 229 min (IQR 170–307 min, 95% CI 201 to 252 min). The upper limit of the 95% CI for the time from onset to recanalization was shorter than the median times reported in two previous trials. Geographic information system analysis revealed an upward trend in the population coverage rate in each secondary medical area after the drive and retrieve method was introduced.ConclusionThe drive and retrieve method may be an effective form of cooperation between facilities located within 1 hour of a comprehensive stroke center.
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