The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study
The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study
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DOI：
10.1186/s12913-017-1979-8
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发表时间：
2017-01-14
影响因子：
2.8
通讯作者：
Irving, Greg
中科院分区：
文献类型：
--
作者：
Kaneko, Makoto;Matsushima, Masato;Irving, Greg
背景资料：我们的目的是描述生态的医疗保健在一个孤立的岛屿上，有限的二级保健，并通过与以前的全国性survey.Methods比较，以评估岛上的初级保健诊所的守门功能：我们进行了回顾性的，开放的队列研究伊平谷，一个孤立的岛屿在冲绳县，有一个初级保健诊所。我们认为伊平谷是研究日本初级保健作用的独特场所。参与者是2013年2月1日至2014年1月31日期间访问该岛诊所的患者。我们使用电子医疗记录计算了到诊所就诊和转诊到岛外医疗设施的次数。我们还将Iheya的数据与2003年进行的全国性调查进行了比较。结果：Iheya在2013年有1314名居民。在为期一年的研究期间，在5 682次就诊中，有290人被转介到岛外医疗机构。有64人被转诊到急诊室，其中57人住院。每1000名居民每月就诊率为360.4次（95%置信区间：351.0-369.7）。其中，18.4人（16.3-20.5人）被转诊到岛外，4.1人（3.1-5.1人）被转诊到急诊科，3.6人（2.6-4.6人）住院。尽管发病率高的访问初级保健诊所，医院为基础的门诊就诊率，急诊科就诊，住院率低于在以前的Japanese study.Conclusions：这表明，初级保健的几个方面，特别是它的守门功能，很可能在这个地理环境中发挥重要作用。
Background: We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island's primary care clinic through comparison with a previous nationwide survey.Methods: We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island's clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003.Results: Iheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0-369.7). Of these, 18.4 (16.3-20.5) were referred off-island, with 4.1 (3.1-5.1) referrals to emergency departments and 3.6 (2.6-4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study.Conclusions: This suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting.