治療脱落結核患者の治療復帰への一つの試み「結核患者医療状況連絡簿」を使用する主治医と保健婦の結びつきをめぐって

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It is an important problem in the control of tuberculosis patients to find out defaulters and let them back to the treatment. Nagata Health Center of Kobe City had a talk with the Medical Association of Nagata-ku, and started the communication memo on the therapeutic status of registered patients between the physicians and public health nurses.<BR>Patients living and treated at the institutions in Nagata-ku were subjected to the study. A communication memo was prepared for each institution and includes the name list of patients, their address and therapeutic status in each month. By the end of each month, public health nurse delivers the memo to each physician, and after several days, she receive the memo from the physician showing the therapeutic status of each patient and necessary indications. If a defaulter is found out, a public health nurse in charge of the patient's residence make a home visit and give him a guidance to come back to treatment.<BR>Therapeutic status, a number and effect of home visit were investigated on patients under treatment during the period from September 1970 to March 1971. Out of 1, 251 cases, 75% were under regular treatment, 9% were under irregular treatment or interrupted treatment, 14% with unstable therapeutic status and 3% other types. The average number of home visit for each case was 1.3. After a home visit, 23% of cases under irregular treatment or inter rupted treatment became to receive regular treatment. Out of whole home visit, 52% were made on patients under regular treatment to prevent the defaulters. By the end of August 1970, the proportion of cases under regular treatment was 76%, and it raised to 82% by the end of June 1971 after adopting the communication memo, the proportion of cases interrupted dropped from 20% to 14% during the same period.<BR>After adopting this system, the human relation between physicians and public health nurses has been markedly improved. In the future, it is expected that physicians give guidance to prevent defaulters and public health nurses concentrate their efforts for defaulters and irregu larly treated patients. Medical treatment should be conducted through close cooperation of medical staff team consiting of a physician, nurse, public nurse, medicosocial case worker, phychiatric consultant, etc. In Japan, however, medical treatment is conducted mainly by a physician, and the contribution of paramedical staff is relatively few. It is hoped that physicians recognize the importance of cooperation of paramedical staff in the treatment of patients through such an activity as the communication memo.
一般社団法人日本結核病学会の論文

治療脱落結核患者の治療復帰への一つの試み「結核患者医療状況連絡簿」を使用する主治医と保健婦の結びつきをめぐって

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