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

在收集相关的原创文章和专著后，笔者走访了7家国家医保诊所和3家市级诊所，分析了医生变动最易影响的功能角色。通过对护士、办事员和公共卫生护士的长时间访谈，结果表明，公共诊所的功能活动主要受到与医生责任有关的因素的影响，而这些因素与市政当局的任务所决定的发展阶段无关。根据访谈者的描述，将诊所的功能阶段分为5个发展阶段。选择了六个类别来评估初级保健问题以及面向社区的综合预防服务。这些是诊所的可及性，门诊病人的全面临床服务和社区的预防服务，对病人、家庭和社区本身的生物心理社会方法，诊所的协调作用，连续性和问责制。还增加了质量保证问题和诊所活动的哲学问题。每个类别都开发了几个子问题，最终包括97个问题。每个问题都以“是”或“否”作答，“是”得一分。问卷的效度和信度应通过实际临床应用来评估，并进一步细化，使其更具行为性和实用性。

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.