Kawabata Hidenobu, Kawabata Megumi, Murakami Manabu, Maezawa Masaji
Department of Healthcare Systems Research, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Japan.
Hokkaido Igaku Zasshi. 2009 Jul;84(4):251-6.
In light of Japan's aging society, the number of homebound people is expected to increase, and health care services for such patients will need to expand. The authors implemented a one-month pilot program in a rural hospital, which uses home care as an educational tool to further resident interns' understanding in community medicine. The program was conducted for nine medical residents. Each resident was involved in a series of eight home visits, accompanied by an experienced nurse. Upon completion, to investigate the effect of the training program, the residents were interviewed about their experiences. Responses were analyzed by using qualitative methodology. Six categories for residents' learning emerged from the analysis. They included: fostering good doctor-patient relationships while recognizing psychosocial aspects, decision-making in view of ethics and patients' preferences, the value of teamwork, medical knowledge in geriatric care, consideration of the notion of home care itself, and the significance of local characteristics. It was found that home care experience with a geriatric team can not only help deepen the residents' knowledge and skills regarding geriatric care at home, but also foster the residents' attitude toward consideration of psychosocial aspects. It was concluded that initiating a home care program is both a valuable and useful educational tool for residents in managing chronic elderly patients. Residents achieved a new viewpoint which integrated both patients' and physicians' perspectives while witnessing patients' daily lives in the community.
鉴于日本社会老龄化，居家患者数量预计将会增加，针对这类患者的医疗保健服务也需要扩大。作者在一家乡村医院实施了为期一个月的试点项目，该项目将居家护理作为一种教育工具，以加深住院实习医生对社区医学的理解。该项目针对九名住院医生开展。每位住院医生在一名经验丰富的护士陪同下参与了一系列八次家访。项目结束后，为了调查培训项目的效果，对住院医生的经历进行了访谈。采用定性方法对回复进行了分析。分析得出住院医生学习的六个类别。它们包括：在认识到心理社会因素的同时培养良好的医患关系、基于伦理和患者偏好进行决策、团队合作的价值、老年护理方面的医学知识、对居家护理本身概念的思考以及当地特色的重要性。研究发现，与老年护理团队一起的居家护理经历不仅有助于加深住院医生在家中进行老年护理方面的知识和技能，还能培养住院医生考虑心理社会因素的态度。研究得出结论，启动居家护理项目对于住院医生管理老年慢性病患者来说是一种有价值且有用的教育工具。住院医生在社区中见证患者日常生活的同时，获得了一个整合患者和医生视角的新观点。
