Ohta Ryuichi, Yakabe Toshihiro, Sano Chiaki
Community Care, Unnan City Hospital, Unnan, JPN.
Family Medicine, Unnan City Hospital, Unnan, JPN.
Cureus. 2024 Jan 9;16(1):e51966. doi: 10.7759/cureus.51966. eCollection 2024 Jan.
Introduction As rural healthcare systems grapple with an aging population, understanding the factors influencing hospital admission decisions for elderly patients is crucial. This study explores the complex interplay of medical, social, and psychological factors that shape these decisions, as perceived by multiple stakeholders, including physicians, patients, and their families. Method This study was conducted in Unnan City Hospital, a rural community hospital in Unnan, Japan, using a qualitative thematic analysis approach. Participants included general physicians, patients admitted more than once, and their families. One-on-one semi-structured interviews were conducted in Japanese, recorded, transcribed, and analyzed. The analysis focused on identifying themes that influence decision-making processes regarding the admission of elderly patients. The research team, comprising family medicine, public health, and community health care experts, ensured a multi-perspective approach through collaborative coding and discussion. Results Three primary themes emerged from the analysis: "dilemma between medical indications and social admissions," "risks and benefits of hospitalization in response to unpredictable changes in the elderly," and "social factors intertwined with the multilayered nature of hospital admission decisions." Physicians reported a conflict between their medical training and the social needs of patients, often leading to stress and negative emotions. The unpredictable health trajectories of elderly patients necessitated a nuanced risk-benefit analysis for hospitalization. In addition, social factors, such as bed availability, patient's living environment, and psychosocial contexts, significantly influenced admission decisions. Conclusion The study highlights the need for a more holistic approach to medical education and practice, especially in rural healthcare settings. Recognizing the complexity of factors influencing hospitalization decisions, including medical, social, and individual patient circumstances, is vital. The findings underscore the importance of integrating biopsychosocial aspects into the decision-making process for the hospitalization of elderly patients, advocating for patient-centered care that respects the unique challenges in rural healthcare environments.
引言 随着农村医疗系统应对人口老龄化问题，了解影响老年患者住院决策的因素至关重要。本研究探讨了医学、社会和心理因素之间的复杂相互作用，这些因素塑造了包括医生、患者及其家属在内的多个利益相关者所感知的这些决策。方法 本研究在日本云南市的一家农村社区医院——云南市立医院进行，采用定性主题分析方法。参与者包括普通医生、多次住院的患者及其家属。以日语进行一对一的半结构化访谈，进行录音、转录和分析。分析重点是确定影响老年患者住院决策过程的主题。由家庭医学、公共卫生和社区医疗保健专家组成的研究团队通过协作编码和讨论确保采用多视角方法。结果 分析得出三个主要主题：“医学指征与社会住院之间的困境”、“应对老年人不可预测变化时住院的风险与益处”以及“与住院决策的多层性质交织的社会因素”。医生报告称，他们的医学培训与患者的社会需求之间存在冲突，这往往导致压力和负面情绪。老年患者不可预测的健康轨迹需要对住院进行细致入微的风险效益分析。此外，床位可用性、患者的生活环境和心理社会背景等社会因素对住院决策有重大影响。结论 该研究强调需要对医学教育和实践采取更全面的方法，尤其是在农村医疗环境中。认识到影响住院决策的因素的复杂性，包括医学、社会和患者个体情况，至关重要。研究结果强调了将生物心理社会方面纳入老年患者住院决策过程的重要性，倡导以患者为中心的护理，尊重农村医疗环境中的独特挑战。
