Establishing community-based integrated care for elderly patients through interprofessional teamwork: a qualitative analysis

BACKGROUND

Working in multidisciplinary teams is indispensable for ensuring high-quality care for elderly people in Japan's rapidly aging society. However, health professionals often experience difficulty collaborating in practice because of their different educational backgrounds, ideas, and the roles of each profession. In this qualitative descriptive study, we reveal how to build interdisciplinary collaboration in multidisciplinary teams.

METHODS

Semi-structured interviews were conducted with a total of 26 medical professionals, including physicians, nurses, public health nurses, medical social workers, and clerical personnel. Each participant worked as a team member of community-based integrated care. The central topic of the interviews was what the participants needed to establish collaboration during the care of elderly residents. Each interview lasted for about 60 minutes. All the interviews were recorded, transcribed verbatim, and subjected to content analysis.

RESULTS

The analysis yielded the following three categories concerning the necessary elements of building collaboration: 1) two types of meeting configuration; 2) building good communication; and 3) effective leadership. The two meetings described in the first category - "community care meetings" and "individual care meetings" - were aimed at bringing together the disciplines and discussing individual cases, respectively. Building good communication referred to the activities that help professionals understand each other's ideas and roles within community-based integrated care. Effective leadership referred to the presence of two distinctive human resources that could coordinate disciplines and move the team forward to achieve goals.

CONCLUSION

Taken together, our results indicate that these three factors are important for establishing collaborative medical teams according to health professionals. Regular meetings and good communication facilitated by effective leadership can promote collaborative practice and mutual understanding between various professions.

Problem-based learning for radiological technologists: a comparison of student attitudes toward plain radiography

BACKGROUND

Knowledge and skill expected of healthcare providers continues to increase alongside developments in medicine and healthcare. Problem-based learning (PBL) is therefore increasingly necessary in training courses for radiological technologists. However, it is necessary to evaluate the effects of PBL to completely introduce it in our education programs. As a Hypothesis, it seems that a change occurs in the student's attitudes by participating in PBL practical training. There is the Semantic Differential (SeD) technique as a method to identify student's attitudes. We conceived that PBL could be appropriately evaluated by using SeD technique. In this paper, we evaluated PBL for plain radiography practical training using the SeD technique.

METHODS

Thirty-eight third-year students studying radiological technology participated. PBL was introduced to practical training in plain radiography positioning techniques. Five sessions lasting 5 h each were delivered over a 5-week period during November to December 2012. The clinical scenario was an emergency case with multiple trauma requiring plain radiography. Groups comprising approximately eight students created workflows for trauma radiography with consideration of diagnostic accuracy and patient safety. Furthermore, students groups conducted plain radiography on a patient phantom according to created workflows and were then guided by feedback from professional radiologists. All students answered SeD questionnaires to assess views on plain radiography before instruction to provide preliminary practical training reports and after completing practical training.

RESULTS

The factors were identified using factor analysis of the questionnaires, which were answered before and after each practical training session. On evaluation of the relationships between factors and question items according to factor loading, we identified "reluctance", "confidence", and "exhaustion" as the predominant attitudes before practical training. Similarly, we identified "expectation", "self-efficacy", and "realness" as the predominant attitudes after practical training. The attitudes toward plain radiography changed before and after PBL practical training.

CONCLUSIONS

The attitude of self-efficacy was noted after practical training, which incorporated PBL. Student self-efficacy was thought to increase through self-directed learning, which is one of the aims of PBL. Although the influences of other lectures and training, which were performed in parallel with the PBL practice training, were not completely excluded, and although the number of study participants was small, we were able to confirm the effects of PBL.

A case of community-associated methicillin-resistant Staphylococcus aureus infections in a community hospital

Infections caused by methicillin-resistant Staphylococcus Aureus (MRSA) have recently occurred in communities in people lacking known healthcare risk factors. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection, and is distinct from hospital-associated MRSA infection, which occurs in people with risk factors. We experienced a patient diagnosed with CA-MRSA cellulitis, as culture of pus revealed MRSA and he had not been exposed to healthcare environments for the past year. The patient was a previously healthy 38-year-old man with suppurative cellulitis in his right index finger following injury to the finger at his worksite. The cellulitis was successfully managed with incision and drainage (I&D), followed by cefazolin during a 10-day clinical course, although the patient’s MRSA strain was resistant to cefazolin. There are several reports that suggest that I&D followed by antibiotic treatment for CA-MRSA skin infection produces equivalent clinical outcomes, whether the antibiotic prescribed was effective or not. Given that MRSA emerged in an outpatient setting, CA-MRSA should be considered a possible etiology of skin infection in healthy individuals with no classical risk factors for acquisition of MRSA.

Incidence of Community-associated Methicillin-resistant Staphylococcus aureus Infections in a Regional Hospital

Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital.

Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified.

Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization.

Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.

Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

Background

Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access.

Methods

We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively.

Results

Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking.

Conclusions

Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

[Questions that radiography students have regarding X-ray photography: a qualitative study]

OBJECTIVE

To improve lectures and training programs on X-ray photography, we aimed to determine the questions that radiography students have regarding X-ray photography.

METHODS

We collected text data from questions on X-ray photography in radiography student reports after an X-ray photography training program. The text data were analyzed using content analysis. Codes were assigned to segments and they were categorized according to similarities.

RESULTS

From 111 reports, 348 questions were collected. Four categories and 47 subcategories were obtained. The "Required Knowledge" category comprised subcategories concerning knowledge for the X-ray photography including X-ray radiography methodology and disease knowledge. The "Radiography Service" category comprised subcategories concerning radiographers' responsibilities in a hospital including the role of radiographer and the extent of responsibilities. The "Radiographers' Challenges" category comprised subcategories concerning unusual situations radiographers encounter at work including accurate positioning and communication with patients. The "Patient Types" category comprised subcategories concerning patients in whom X-ray photography was considered difficult including pediatric patients and patients with serious conditions. Questions related to subcategories in "Radiographers' Challenges" and "Patient Types" were interrelated. Radiography students had concerns regarding whether they would be able to handle difficult patients efficiently in clinical situations.

CONCLUSION

We were able to suggest the re-orientation of radiography education according to students' intellectual appetite regarding X-ray radiography.

What rural physicians need to engage in community based education: a qualitative interview survey

There is systematic evidence that community-based education is effective in the recruitment of rural physicians to remote communities. However, various obstacles may exist that prevent rural physicians from sustaining their mentoring activities. The aim of this study was to explore ways for rural physicians to overcome such adversities and continue their mentoring activities. We interviewed four nominated physicians (all male, mean age 48 years) based in Hokkaido, Japan, who practiced in an area with less than 10,000 inhabitants. Semi-structured interviews of approximately 60 minutes were performed and focused on topics rural physicians’ found necessary for their teaching activities. All interviews were tape-recorded and transcribed, the verbatim transcripts were analyzed and repeated themes were identified. Three themes that emerged as needs were 1. sustained significant human relationship, including the formation of a network between students and university faculty, as well as developing partnerships with many community relationships, or other medical professions; 2. intrinsic motivations and satisfaction, including pleasure in mentoring the younger generations; and 3. rewards, including financial compensation. Rural physicians as preceptors require nonremunerative, intrinsic motivational factors, such as a sense of satisfaction regarding the education of medical students and being able to relate to residents and others health-care professions, when pursuing their educational activities. To support them, focusing only on monetary facets may be unsuccessful in encouraging them to continue their educational work.

Survey of patient and physician satisfaction regarding patient-centered outpatient consultations in Japan

OBJECTIVE

The purpose of this study was to show the difference in consultation satisfaction between patient and physician in rural settings, and identify the variables affecting their satisfaction regarding these encounters.

METHODS

We collected data by administering questionnaires that included questions regarding satisfaction for a patient-centered approach to patients and physicians, transcribing data from medical records, and observing consultations in person. We then modeled cumulative logits of patient and physician satisfaction scores by performing ordered logistic regression using the proportional odds model.

PATIENTS

Seven physicians and 122 patients participated in the study.

RESULTS

Both patients and physicians expressed high satisfaction with their consultation sessions. Patient satisfaction tended to be higher than physician satisfaction. Physicians were satisfied with longer consultations but patients were not. Moreover, the long waiting times dissatisfied patients. In cases of multiple healthcare episodes (courses of treatment for a different condition) during a single visit, patient satisfaction decreased, while physician satisfaction increased. Physician satisfaction for interactions in general was less when they checked the same patient who had previously visited them.

CONCLUSION

Our findings suggest that if physicians feel satisfied with their consultation, patients also feel satisfied regardless of the physician's opinion. The variables that affect patient and physician satisfaction include prior visits with the same physician, consultation length, longer waiting times, and number of episodes. These findings from Japanese clinics are consistent with those previously reported for other countries.

A qualitative study of Japanese patients' perspectives on post-treatment care for gynecological cancer

The perspectives of cancer patients are important for designing a medically and economically effective follow-up program to help in the rapid recovery of patients. However, research focusing on the perspectives of Japanese gynecological cancer patients on follow-up programs is extremely scarce. In this study, we explored the perspectives and expectations of Japanese gynecological cancer patients with regard to post-treatment follow-up. Twenty-eight patients recruited through a gynecological cancer support group were included in focus groups 1-10 years post-treatment. Participants' accounts related to their perspectives on follow-up were coded and grouped into themes according to commonalities and differences. Seven themes emerged as follows: (1) living with uncertainty, (2) monitoring recurrence, (3) test content and frequency, (4) coping with "another illness", (5) provider communication and attitude, (6) holistic care, and (7) compromising with the reality of changed body. While these Japanese gynecological patients regarded follow-up as an opportunity for reassurance, they also wanted treatment for adverse effects and the opportunity to discuss their concerns. On the basis of the study findings, we conclude that during follow-up after cancer treatment, Japanese gynecological cancer patients not only prioritize recurrence management of cancer but also place a significant amount of importance on the management of symptoms and doctor-patient communication. However, these expectations for communication and care are often unmet. Thus, there is a need to fulfill the gap between the current follow-up programs and patients' expectations by reviewing and changing the hospital's policy that mainly focuses on the detection of recurrent diseases.

An interview survey on factors influencing the career choice of primary care physicians in rural areas

BACKGROUND

The lack of primary care physicians working in rural areas is a major problem both in Japan and worldwide. Particularly in Japan, healthcare provision in the community is seriously deteriorating, due to the absence of a regulated instructional system for primary care physicians in rural areas. Understanding what influences the career choice of rural primary care physicians is vital, and this study aims to examine those factors.

METHODS

Qualitative research methodology with semi-structured interviews and content analysis was used. All interviews were conducted in interviewees' rural clinics over three days in September 2007 and 2008; each interview lasted for 60 minutes. All interviews were recorded, transcribed verbatim, and analyzed thematically by two independent researchers, then the preliminary results were presented to the third and fourth authors. All authors were in agreement with the final results.

RESULTS

Fourteen physicians (13 males and 1 female; mean age 43-years-old) agreed to participate in the interviews, and four themes emerged: "existence of role models for younger primary care physicians," "affinity with rural backgrounds and culture," "understanding the importance of a holistic approach," and "internal motivation for challenging and rewarding work as a doctor." DISCUSSION & CONCLUSIONS: Our research results were similar to those of previous overseas studies, regardless of differences in cultural background. We could explain our themes with the concept of the "rural pipeline into medical practice" by JP Geyman et al. according to the time frame described therein. Taking some potential limitations like generalizability and translation into account, we could utilize our research results to indicate how the number of rural primary care physicians may be increased.

Factors affecting the physician-patient relationship regarding patient participation in medical encounters in primary care

BACKGROUND

Supporting the patient's right to participate more actively in medical encounters is recommended. However, the physician-patient relationship in the context of the respect for patient participation is unclear.

OBJECTIVE

To reveal the factors affecting the physician-patient relationship regarding patient participation in medical encounters in primary care.

METHODS

A qualitative study incorporating a focus group interview with five female participants. They belonged to a consumer organization, which represents patients who actively participate in medical consultations. Patient behaviors, which constitute active participation, are designated as expressing their concern, asking questions, and stating their expectations in medical consultations. The recorded interview was transcribed, and analyzed with a constant comparison method.

RESULTS

Four categories explaining the physician-patient relationship were extracted: Physicians' attitude; Patients' attitude; Other medical professionals' attitudes; Time environmental factors. Story lines were described; Other Medical professionals' attitudes and Time environmental factors were involved in the physician-patient relationship in accordance with the situation; Physicians' attitude and Patients' attitude had borne some mutual relations; when Patients' attitude to consultation had been active, physicians sometimes could have an aversion to these patients.

CONCLUSIONS

The patients' behaviors of active participation in medical encounters contributed to physicians' aversion to patients and lead the physician-patient relationship in an unfavorable direction. Physicians' attitude is of central concern for establishing the physician-patient relationship.

[Health status and lifestyle issues of homeless people in Sapporo city, 2000]

OBJECTIVE

To clarify the health status and lifestyle issues of homeless people in Sapporo city, voluntary "health consultations and medical examinations" were carried out near an emergency kitchen.

METHODS

The voluntary activities were held in a park near the shelter tents of homeless people seven times from December 1999 to December 2000. The homeless people who consulted us, medical doctors, were asked detailed questions about past history, present illness, subjective symptoms, lifestyles and so on, and were examined for their blood pressure and urinary parameter.

RESULTS

A total of 60 homeless people, including 59 men and 1 woman, were consulted and examined, Fifty-seven percent of them were 50 years old of older, and 30% had been homeless for less than half a year. Forty percent had some dental problems, 28% suffered neck stiffness, and 27% back pain. The medical examination found 53% of them to be hypertensive and 26% to be diabetic. Twenty-five percent had meals only once a day, 55% had meat or fish in their diet not more than twice a week and 57% had vegetables in their diet not more than twice a week. Forty-two percent slept not more than 5 hours a day, 13% often drank alcohol in the daytime, and 83% were smokers.

CONCLUSION

The present results suggest that lifestyle-related chronic diseases are more significant problems among homeless people in Sapporo city than common infectious diseases such as tuberculosis or dysentery, probably because it is colder and therefore there are fewer homeless people in Sapporo city than in other major cities in Japan such as Tokyo and Osaka. Further studies of the homeless people living in such a cold environment are warranted to develop better health policies for them in the context of their social and economical determinants. In addition, it is important to establish a more reliable registration system for these people in order to plan and provide a comprehensive social and health support network as needed.