Cooperation between Single-Handed and Group Practices Ensures the Replacement of Gastrostomy Tubes and Tracheal Cannulas in Home Medical Care Settings

Cooperation between Single-Handed and Group Practices Ensures the Replacement of Gastrostomy Tubes and Tracheal Cannulas in Home Medical Care Settings

TAKUMA KIMURA,^1,2 SATORU YOSHIE,^3,4 RUMIKO TSUCHIYA,⁵ SHOHEI KAWAGOE,^2,6 SATOSHI HIRAHARA,^2,7 KATSUYA IIJIMA,² TORU AKAHOSHI¹ and TETSUO TSUJI²

¹Department of General Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
²Institute of Gerontology, The University of Tokyo, Tokyo, Japan
³Neighborhood Care, Kashiwa, Chiba, Japan
⁴Center for Home Care Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
⁵Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
⁶Aozora Clinic, Matsudo, Chiba, Japan
⁷Center for Home Care, Kajiwara Clinic, Tokyo, Japan

In Japan, patients who require home medical care are increasing especially in the elderly. In home medical care settings, devices such as gastrostomy tubes, tracheal cannulas, and urethral catheters are usually replaced by visiting physicians or nurses. However, device replacement services are not always available in Japan. Unless device replacement services are sufficiently provided to patients at home, patients have to suffer various disadvantages, including a forced visit to a hospital for device replacement despite inability to walk. We therefore investigated background factors of clinics and nursing stations providing home-care visits using a cross-sectional postal survey from August to September 2013. We targeted physicians from 5,828 clinics providing home medical care and nurses from 1,798 home-visit nursing stations across six prefectures (Tokyo, Kanagawa, Saitama, Chiba, Miyagi and Iwate). Responses were received from 933 clinics (16.5%) and 552 stations (31.3%). We analyzed the responses using multivariable logistic regression with two models. “Model 1” mainly included the number of full-time staff and the availability of a 24-hour care service system, and “Model 2” mainly included the number of clinics, the number of home-visit nursing stations, and the ratio of the population aged ≥ 65 years to study the influence of medical resources. We thus found that clinic staff numbers and 24-hour care availability were associated with physicians' replacement of gastrostomy tubes and tracheal cannulas (p < 0.001 for each). In conclusion, single-handed and group practices need to cooperate to ensure the replacement of these devices in home medical care settings.

keywords —— gastrostomy tubes; home medical care; 24-hour care service system; staff numbers; tracheal cannulas

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Tohoku J. Exp. Med., 2017, 241, 189-199

Correspondence: Takuma Kimura, Department of General Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa 252-0374, Japan.

e-mail: takumak@med.kitasato-u.ac.jp