Shigeto Eriko
National Hospital Organization, Higashihiroshima Medical Center, Japan.
Kekkaku. 2010 Dec;85(12):861-7.
In Japan, the care of patients with tuberculosis has been mainly dependent on the state of hospital wards. The number of patients that have tuberculosis has steadily declined over the years, and we are now on the way to low prevalence state of tuberculosis. However there is a need for discussion about how future care for patients with tuberculosis should take place. The problems of present tuberculosis care system are as follows: (i) there is inefficiency and difficulty in maintaining the tuberculosis wards because of the declining number of patients and specialists; (ii) there are difficulties in treating complications such as renal insufficiency which requires blood dialysis, delivery, psychiatric diseases in tuberculosis beds; (iii) there is a high proportion of elderly patients that require substantial nursing care and long-term admission in the hospital; (iv) there is not only insufficient patient care but also financial support for patients with socioeconomic problems such as foreign-born worker or homelessness, (v) in addition to the medical care for patients of MDR-TB being insufficient, there are also inappropriate environment and amenities for long-term hospitalization. Moreover the public subsidy system for medical treatment requires patients to pay 5% of expense cost in the outpatient clinic. The following points should be discussed for the future tuberculosis care system: (i) general hospitals should take more part in caring for patients with complications and there should be a close cooperation among general hospitals, tuberculosis specialists and the administration; (ii) there should be a limited number of hospitals maintained for the integrated treatment of MDR-TB including surgical treatment and suitable circumstances for long-term hospital care. Additionally, there should be a system of detention for non-adherent patients or home isolation for adherent patient; (iii) there should be reinforcement of public commitment for patients with socioeconomic problems or MDR patients such as public subsidized full coverage of medical expense, free treatment in regional health centers
在日本，结核病患者的护理主要依赖于医院病房的状况。多年来，结核病患者数量一直在稳步下降，我们目前正朝着结核病低流行状态发展。然而，对于未来结核病患者的护理应如何进行，仍有必要进行讨论。当前结核病护理系统存在以下问题：（i）由于患者和专科医生数量减少，维持结核病病房存在效率低下和困难；（ii）在结核病床位上治疗诸如需要血液透析的肾功能不全、分娩、精神疾病等并发症存在困难；（iii）需要大量护理和长期住院的老年患者比例很高；（iv）对于有社会经济问题的患者，如外国出生的工人或无家可归者，不仅患者护理不足，而且缺乏财政支持；（v）除了耐多药结核病患者的医疗护理不足外，长期住院的环境和设施也不合适。此外，医疗公共补贴系统要求患者在门诊支付5%的费用。对于未来的结核病护理系统，应讨论以下几点：（i）综合医院应更多地参与并发症患者的护理，综合医院、结核病专科医生和管理部门之间应密切合作；（ii）应保留有限数量的医院用于耐多药结核病的综合治疗，包括手术治疗以及适合长期住院护理的环境。此外，应有针对不依从患者的拘留制度或针对依从患者的居家隔离制度；（iii）应加强对有社会经济问题的患者或耐多药患者的公共投入，如公共补贴全额覆盖医疗费用、在地区医疗中心免费治疗
