STANDARDIZING FUNCTIONAL ROLES OF RURAL PUBLIC CLINICS IN JAPAN IN THE ASPECTS OF DEVELOPMENTAL STAGE

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After collecting the relevant original articles and monographs, authors visited 7 national health insurance clinics and 3 municipal clinics for the purpose of analyzing the most susceptible functioning roles by change of physicians. By using the long interview method to the nurses, clerks and public health nurses, it was turned out that functional activities of public clinics had been primarily influenced by factors concerned with physicians' responsibility, which were irrespective of the developmental stage determined by the municipalities' assignment.Acoording to the interviewers' description, 5 developmental stages were classified concerning the functioning stage of clinics. Six categories were selected for the assessment of primary care issues as well as comprehensive community-oriented preventive services. Those were accessibility to the clinic, comprehensiveness of the clinical services to outpatients and of the preventive services to the community, biopsychosocial approach to the patients, families and community itself, coordinative roles of the clinic, continuity and accountability. Quality assurance issues and philosophical issues of the clinic's activity were also added. Several sub-questions were developed for each category and finally it included 97 questions. Each questions were answered by "yes" or "no", and one point was given to "yes". Validity and reliability of the questionnaire should be evaluated by applying it for real clinics and be refined to more behavioral and practical use.