Nitta Katsuya, Naito Haruaki, Kakiuchi Yasuhiro
Department of Forensic Medicine, Kindai University, Osakasayama, JPN.
Cureus. 2023 Sep 2;15(9):e44585. doi: 10.7759/cureus.44585. eCollection 2023 Sep.
Introduction Most people would prefer end-of-life care to be provided at home. Although Japan has tried to promote home care and end-of-life care, very few people die at home in Japan. On the other hand, deaths at home are not necessarily attended deaths at home by end-of-life care because they include many deaths, such as deaths from external causes and solitary deaths. We obtained the data on the number of postmortem examinations at home in the main areas of Osaka City and calculated the estimated number of attended deaths at home by subtracting the number of postmortem examinations at home from the number of total deaths at home. We analyzed the contribution of medical resources to end-of-life care from a forensic perspective for a closer analysis of the actual situation. Methods The data about the population, the number of total deaths, deaths at home, and medical resources related to home care in Osaka City was obtained from the website of a public institution in Japan. The data about the number of postmortem examinations in Osaka City was obtained from the Osaka Medical Examiner's Office. The estimated number of attended deaths at home was calculated by subtracting postmortem examinations at home from total deaths at home. We conducted univariate and multivariate analyses between the number of medical resources and the prevalence of attended deaths at home. Results In the univariate analysis of the prevalence of attended deaths at home, a high positive correlation was observed in "doctors," "total clinics," "clinics except HCSC," and "general beds." A high negative correlation was observed in "long-term care beds." In the multivariate analysis, a positive coefficient was observed in "clinics except HCSC," and a negative one was observed in "HCSC or HCSH." Conclusion The policy of shifting general clinics and hospitals to HCSC and HCSH may not be as effective for end-of-life care because the criteria do not include any restrictions on the number or use of beds. However, general clinics may have played an important role in end-of-life care, even if they were not HCSC.
引言 大多数人希望在自己家中接受临终关怀。尽管日本一直在努力推广居家护理和临终关怀，但在日本，很少有人在家中去世。另一方面，在家中死亡并不一定意味着是在临终关怀下的在家中离世，因为其中包括许多因外部原因导致的死亡以及孤独死亡等情况。我们获取了大阪市主要区域在家中进行尸检的数量数据，并通过从家中总死亡人数中减去在家中进行尸检的数量来计算在家中接受临终关怀离世的估计人数。我们从法医角度分析了医疗资源对临终关怀的贡献，以便更深入地了解实际情况。
方法 关于大阪市的人口、总死亡人数、在家中死亡人数以及与居家护理相关的医疗资源的数据，是从日本一家公共机构的网站上获取的。关于大阪市尸检数量的数据是从大阪法医办公室获取的。在家中接受临终关怀离世的估计人数是通过从家中总死亡人数中减去在家中进行的尸检数量来计算的。我们对医疗资源数量与在家中接受临终关怀离世的患病率之间进行了单变量和多变量分析。
结果 在对在家中接受临终关怀离世患病率的单变量分析中，在“医生”“诊所总数”“除家庭护理支持诊所外的诊所”和“普通病床”方面观察到高度正相关。在“长期护理病床”方面观察到高度负相关。在多变量分析中，在“除家庭护理支持诊所外的诊所”方面观察到正系数，在“家庭护理支持诊所或家庭护理支持医院”方面观察到负系数。
结论 将普通诊所和医院转变为家庭护理支持诊所和家庭护理支持医院的政策对于临终关怀可能并不那么有效，因为该标准没有对病床数量或使用进行任何限制。然而，即使不是家庭护理支持诊所，普通诊所可能在临终关怀中也发挥了重要作用。
