Departmental Bulletin Paper 結核患者の効果的な服薬支援に関する研究(その1)-入院病棟と保健所との連携-
Research on effective medication support for tuberculosis patients (Part 1): Collaboration between inpatient wards and public health centers

岡本, ちさと  ,  水谷, 聖子  ,  坂本, 真理子

Description
 We conducted a survey to determine how collaboration between inpatient wards of tuberculosis hospitals and public health centers affects medication support for tuberculosis patients. The surveyed subjects were head nurses of inpatient wards of tuberculosis hospitals across Japan. The survey was conducted by sending a self-administered questionnaire by mail. Of the 235 head nurses of inpatient wards of tuberculosis hospitals across Japan (in 2013), 112 replied to the survey (47.6%). The in-hospital Directly Observed Treatment, Short-Course (DOTS) strategy was adopted by as many as 106 tuberculosis hospitals nationwide (94.6%); close collaboration existed between inpatient wards and public health centers through daily consultations and periodic conferences. Furthermore, issues regarding collaboration between inpatient wards and public health centers were uncovered, such as communication and liaison issues. Meanwhile, a significant relationship was found between "difficulties encountered" and "original ideas to overcome those difficulties" when inpatient wards and public health centers collaborated with each other. The key to the collaboration was medication support collaboration conferences, which had been held at least once by 82 inpatient wards(73.2%) and held monthly by 52 inpatient wards (63.4%). The key persons in the collaboration on the hospital side were nurses in tuberculosis wards. We also found that large numbers of head nurses and other nurses in inpatient wards of tuberculosis hospitals had actively participated in medication support collaboration conferences, hospital discharge conferences, and study meetings held jointly by medical institutions and public health centers, indicating close collaboration between tuberculosisward nurses and public health nurses. This suggested that sharing "difficulties encountered" and "original ideas to overcome those difficulties" would make the collaboration more effective. 結核患者の効果的な服薬支援のあり方を検討するため, 結核専門病院と保健所との連携に関する調査を行った. 調査対象は全国の結核専門病院の結核病棟の看護師長とし, 郵送法による自記式質問紙調査を実施した. 全国の結核専門病院の結核病棟235 施設(2013 年) 中, 112 施設(47.6%) より回答が得られた. 病棟における院内DOTS(Directly Observed Treatment, Short course;直接監視下短期化学療法) は106 施設(94.6%) と全国的に実施率が高く,日常的な相談や定期的な会議により病棟と保健所の連携は密接に図られていた. 病棟と保健所との連携においては, 病棟と保健所とのコミュニケーション, 連絡システムなどの課題があった. また, 連携上の「困っていること」と「工夫していること」の間には有意な関連があった. 服薬支援連携会議は82 施設(73.2%) が開催しており, 52 施設(63.4%) は, 月に1 回定期開催し病院と保健所の連携の要となっていた. 医療機関側の連携のキーパーソンは, 結核病棟の看護師であった. 医療機関と保健所が協働で行う服薬支援連携会議, 退院カンファレンスや勉強会には, 病棟師長はじめ病棟看護師の参加率が高く, 病棟看護師と保健所保健師が密に連携が行われている. 連携をより効果的なものとするために「困ったこと」や「工夫していること」の共有を図ることが有効であると示唆された.
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