Yonaguni Municipal Clinic, Japan Association for Development of Community Medicine, Okinawa, Japan.
Department of General Medicine, Hirosaki University School of Medicine & Hospital, Aomori-ken, Japan.
PLoS One. 2018 Jun 28;13(6):e0199871. doi: 10.1371/journal.pone.0199871. eCollection 2018.
Yonaguni Island is a remote and isolated westernmost island in Japan, which is the fastest aging country in the world. This study evaluated the current status of medical supply-and-demand on the island and compared these results with previous surveys carried out in rural parts of Japan. This was a retrospective cohort study conducted at the Yonaguni Municipal Clinic, the only medical facility in Yonaguni Island. The participants were patients who visited the clinic over one year, between July 2015 and June 2016. We calculated the rate per 1,000 persons per month of clinic visits, referrals to off-island medical facilities (e.g., hospitals and specialist clinics), referrals to off-island emergency departments, off-island hospitalizations after referral, home visits, and overnight observations at the clinic. In total, 6,197 patients (males, 46.3%) visited the clinic. The rate of clinic visits per 1,000 persons per month was 516.4 (Standard deviation [SD] 28.1, 95% confidence interval [CI]: 500.5-532.3). The rate per 1,000 persons per month was 14.0 (SD 3.9, 95% CI: 11.8-16.2) for off-island referrals, 3.8 (SD 2.1, 95% CI: 2.6-5.0) for referrals to emergency departments, 4.8 (SD 2.6, 95% CI: 3.3-6.2) for hospitalizations, and 3.2 (SD 1.7, 95% CI: 2.2-4.1) for home visits. The rate of clinic visits was higher in Yonaguni Island than in other rural areas, although the rate of off-island referrals was lower. There were no significant differences between the number of referrals to emergency departments, hospitalizations, and home visits in Yonaguni Island, in comparison to other studies. Our study showed that patients presenting with emergencies had similar rates of healthcare-seeking behavior to those reported in previous studies in Japan; however, the referral rate was lower. We assessed the ecology of medical care in this district by evaluating patient behavior on an isolated island where access to medical care is geographically limited.
日本最西端的偏远岛屿与那国岛是世界上老龄化速度最快的国家。本研究评估了该岛上目前的医疗供需状况，并将这些结果与在日本农村地区进行的先前调查进行了比较。这是一项在与那国市诊所进行的回顾性队列研究，该诊所是与那国岛上唯一的医疗设施。参与者是在 2015 年 7 月至 2016 年 6 月期间一年内在诊所就诊的患者。我们计算了每月每 1000 人就诊率、转往岛外医疗机构（如医院和专科诊所）的转诊率、转往岛外急诊部的转诊率、转往岛外医院后的转院率、家访率和在诊所过夜观察率。共有 6197 名患者（男性 46.3%）就诊。每月每 1000 人就诊率为 516.4（标准差[SD]28.1，95%置信区间[CI]：500.5-532.3）。每月每 1000 人转诊率为 14.0（SD3.9，95%CI：11.8-16.2），转往岛外急诊部的转诊率为 3.8（SD2.1，95%CI：2.6-5.0），转往医院的转诊率为 4.8（SD2.6，95%CI：3.3-6.2），家访率为 3.2（SD1.7，95%CI：2.2-4.1）。与其他农村地区相比，与那国岛的就诊率较高，尽管转诊率较低。与其他研究相比，与那国岛急诊部、住院和家访转诊人数没有显著差异。我们的研究表明，在这个以急诊为主的地区，患者寻求医疗服务的行为与日本以前的研究报告相似，但转诊率较低。我们通过评估地理上医疗资源有限的偏远岛屿上的患者行为，评估了该地区的医疗保健生态。
