The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study.
The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study.
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DOI：
10.1371/journal.pone.0199871
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Kobayashi T
中科院分区：
文献类型：
--
作者：
Namiki H;Kobayashi T
与那国岛是日本最西端的一个偏远孤岛，是世界上老龄化速度最快的国家。本研究评估了岛上医疗供需的现状，并将这些结果与以前在日本农村地区进行的调查进行了比较。这是在与那国岛唯一的医疗机构与那国市诊所进行的回顾性队列研究。参与者是在2015年7月至2016年6月期间访问诊所超过一年的患者。我们计算了每1,000人每月的诊所就诊率、岛外医疗设施的转诊率（例如，医院和专科诊所）、转诊到岛外急诊科、转诊后岛外住院、家访和在诊所过夜观察。共有6 197名患者（男性，46.3%）到诊所就诊。每月每千人的门诊就诊率为516.4（标准差[SD] 28.1，95%置信区间[CI]：500.5-532.3）。每月每千人的比率为14.0（SD 3.9，95% CI：11.8-16.2）岛外转诊，3.8（SD 2.1，95% CI：2.6-5.0）对于转诊至急诊科，4.8（SD 2.6，95% CI：3.3-6.2），家庭访视为3.2（SD 1.7，95% CI：2.2-4.1）。与那国岛的诊所就诊率高于其他农村地区，但岛外转诊率较低。与其他研究相比，与那国岛的急诊科转诊、住院和家访数量无显著差异。我们的研究表明，急诊患者的就医行为与日本以前的研究报告相似;但是，转诊率较低。我们评估了生态的医疗保健在这个地区通过评估病人的行为在一个孤岛上，获得医疗保健的地理限制。
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.
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