Tsukada Yayoi Tetsuou, Kodani Eitaro, Asai Kuniya, Yasutake Masahiro, Seino Yoshihiko, Shimizu Wataru
Department of General Medicine and Health Science, Nippon Medical School Tokyo Japan.
Department of General Medicine, Nippon Medical School Musashi Kosugi Hospital Kawasaki Japan.
Circ Rep. 2021 Jan 20;3(2):77-85. doi: 10.1253/circrep.CR-20-0132.
Given the high prevalence of heart failure (HF) in the elderly, it is essential to establish medical coordination between general practitioners (GPs) and acute care hospitals (ACHs) in an aging society. The aim of this study was to elucidate the status of acceptance of elderly patients with HF and their management requirements in a comprehensive community health system. Furthermore, we investigated GPs' interest in using information and communications technology (ICT) in patient care. We sent a questionnaire survey to 1,800 GPs in January 2015 and received 392 replies. The overall prevalence of home visits was 55%, with no differences according to GP background characteristics or geographic area. However, less than half (44%) reported accepting patients with symptomatic HF for treatment in their clinic. In addition, only 3 GPs reported accepting and providing emergency visits for patients with refractory HF. In particular, GPs who were not certificated cardiologists, female, and older showed poorer acceptance of symptomatic HF patients. More than half the GPs wanted the prompt acceptance by ACHs of emergency patients, followed by strengthening of home care support at discharge and support for end-of-life care. Half the GPs were interested in telemedicine. ACHs must promptly accept patients with HF in cases of emergency and strengthen nursing care support at discharge. It is also necessary to consider how to support older and female GPs.
鉴于老年人心力衰竭（HF）的高患病率，在老龄化社会中，全科医生（GPs）与急症医院（ACHs）之间建立医疗协调至关重要。本研究的目的是阐明在综合社区卫生系统中，老年HF患者的收治状况及其管理需求。此外，我们调查了全科医生在患者护理中使用信息通信技术（ICT）的意愿。2015年1月，我们向1800名全科医生发送了问卷调查，收到392份回复。家访的总体发生率为55%，根据全科医生的背景特征或地理区域没有差异。然而，不到一半（44%）的人报告在其诊所接受有症状HF患者进行治疗。此外，只有3名全科医生报告接受并为难治性HF患者提供紧急就诊服务。特别是，未获得心脏病专家认证的全科医生、女性全科医生和年长的全科医生对有症状HF患者的接受度较低。超过一半的全科医生希望急症医院能迅速接收急诊患者，其次是加强出院后的居家护理支持和临终关怀支持。一半的全科医生对远程医疗感兴趣。急症医院在紧急情况下必须迅速接收HF患者，并加强出院时的护理支持。还需要考虑如何支持年长的全科医生和女性全科医生。
