Background: No studies in Japan have examined whether dispensing by family pharmacists, who are incentivized by reimbursement to provide continuous and exclusive medication management, results in ...prescription changes. Our primary objective was to identify the variables affecting prescription changes, particularly to investigate dispensing by family pharmacists as a possible factor.Methods: We identified 333,503 records of pharmacy claims data from patients aged 65 years or older who received medication instructions at outpatient pharmacies at Tsukuba, a medium-sized city near Tokyo, between April 2018 and March 2019. We extracted data on dispensing by family pharmacists, number of medicines, patient sex, patient age, and pharmacy category. A multilevel modified Poisson regression analysis was performed to analyze the correlation between dispensing by family pharmacists and pharmacist-initiated prescription change.Results: Dispensing by family pharmacists was 1.37 times more likely to involve a record of prescription change than dispensing by non-family pharmacists. Older age, female sex, polypharmacy, and small-scale pharmacies were also found to be factors.Conclusion: This study indicated that dispensing by family pharmacists was a potential factor for pharmacist-initiated prescription changes that may prevent excessive medication and limit pharmacological interactions. Since the likelihood of inappropriate prescriptions being issued varies from hospital to hospital, subsequent studies should take into account the quality of each institution.
This study aims to determine the approximate number of hospitalizations of persons without family and the medical challenges they encounter in hospitals across Japan. Self-administered questionnaires ...were mailed to 4,000 randomly selected hospitals nationwide to investigate the actual conditions and problems, decision-making processes, and use of the government-recommended Guidelines for the hospitalization of, and decision-making support for, persons without family. To identify the characteristics of each region and role of hospitals, chi-square tests were used to make separate group comparisons by hospital location and type. Responses were received from 1,271 hospitals (31.2% response rate), of which 952 hospitals provided information regarding the number of admissions of persons without family. The mean (SD) and median number of hospitalizations (approximate number per year) of patients without family was 16 (79) and 5, respectively. Approximately 70% of the target hospitals had experienced the hospitalization of a person without family, and 30% of the hospitals did not. The most common difficulties encountered during the hospitalization were collecting emergency contact information, decision-making related to medical care, and discharge support. In the absence of family members and surrogates, the medical team undertook the decision-making process, which was commonly performed according to manuals and guidelines and by consulting an ethics committee. Regarding the use of the government-recommended Guidelines, approximately 70% of the hospitals that were aware of these Guidelines responded that they had never taken any action based on these Guidelines, with significant differences by region and hospital type. To solve the problems related to the hospitalization of persons without family, the public should be made aware of these Guidelines, and measures should be undertaken to make clinical ethics consultation a sustainable activity within hospitals.
Background: With increasing age globally, more people may become vulnerable to food choking. We investigated the nationwide epidemiology of food choking deaths in Japan. Methods: Using Japanese Vital ...Statistics death data between 2006 and 2016, we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract) as a primary diagnosis. We assessed the demographics of people with food choking deaths; temporal trends of food choking deaths by the year (overall and by age group), the day of year; and prefecture variations. Results: Overall, 52,366 people experienced food choking deaths (median age, 82 years, 53% were male, and 57% occurred at home). The highest numbers occurred January 1–3, and were lowest in June. Despite a stable total number of cases at around 4,000 yearly, from 2006 to 2016 the incidence proportion declined from 16.2 to 12.1 per 100,000 population among people aged 75–84 years. Among people ≥85 years, the incidence proportion peaked at 53.5 in 2008 and decreased to 43.6 in 2016. The number of food choking deaths varied by prefecture. Conclusions: There are temporal and regional variations of food choking deaths in Japan, possibly due to the consumption of Japanese rice cake (mochi), particularly over the New Year’s holiday.
This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan.
We used data on medical and ...long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level.
The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio IRR 0.90; 95% confidence interval CI, 0.87-0.92 for men and IRR 0.97; 95% CI, 0.95-0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54-2.56 and IRR 1.42; 95% CI, 1.20-1.67, respectively), and higher total expenditures (exp(β) 1.09; 95% CI, 1.01-1.18 and exp(β) 1.09; 95% CI, 1.05-1.14, respectively).
This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.
Abstract
Background
Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan.
Objective
To estimate the effect of ...additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan.
Design
A 24-month retrospective cohort study.
Setting and subjects
Residents aged ≥65 years who were newly admitted to LTCHFs in the 2014 fiscal year.
Methods
National LTC claims data were linked to the survey of institutions and establishments for LTC. Competing risk regression was performed with functional decline as the primary outcome, and additional payments as exposure, controlling for individual and facility characteristics. The level of LTC needs certified in the LTC insurance system was applied as a proxy of functional ability. Death, hospitalisation, discharge to home and transfer to other LTC facilities were treated as competing events. Individual- and facility-level additional payments were presented as binary variables: being reimbursed or not during the follow-up period.
Results
At baseline, 146,311 residents from 3,724 LTCHFs were included. The vast majority of additional payments were associated with a lower risk of functional decline at follow-up. At the individual level, additional payment for pre/post admission instructions had the strongest association with a lower risk of functional decline. Despite this, only 8% of residents were reimbursed for this additional payment. At the facility level, residents in LTCHFs with additional payments for support for home-life resumption and nutritional management were associated with a decreased risk of functional decline.
Conclusions
The results of our study may be of particular interest to policymakers in monitoring and evaluating additional payment approaches and provide insight into improving quality of care.
The COVID-19 pandemic has impacted peoples' health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the ...pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.
In this study, we used anonymized data from "Kaipoke," a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.
The participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD - 1668.8 in adult day care.
The decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.
Despite high expectations from the government and researchers regarding data utilization, comprehensive analysis of long-term care (LTC)-related data use has been limited. This study reviewed the use ...of LTC-related data, including Kaigo-DB, in Japan after 2020. There was an increase in studies using LTC-related data in Japan between 2020 and 2021, followed by a stabilization period. The national government provided 13.5% of this data (6.5% from Kaigo-DB), while prefectures and municipalities contributed 85.2%, and facilities provided 1.3%. The linked data used in 90.4% of the studies primarily consisted of original questionnaire or interview surveys (34.6%) and medical claims (34.0%). None of the studies based on Kaigo-DB utilized linked data. In terms of study design, cohort studies were the most common (84.6%), followed by descriptive (5.1%), cross-sectional (3.2%), and case-control studies (1.3%). Among the 138 individual-based analytical descriptive studies, the most frequently used LTC-related data as an exposure was LTC services (26.8%), and the most common data used as an outcome was LTC certification or care need level (43.5%), followed by the independence degree of daily living for the older adults with dementia (18.1%). To enhance the use of LTC-related data, especially the valuable national Kaigo-DB, insights can be gleaned from how researchers effectively utilize municipal and prefectural data. Streamlining access to Kaigo-DB and enabling its linkage with other datasets are promising for future research in this field.
In Japan, which has the most rapidly aging population worldwide, the number of geriatric health service facilities (GHSFs) has been increasing. GHSF physicians play significant roles in integrated ...care for the elderly. However, little is known about the temporal trends of physicians working in GHSFs.
We aim to examine temporal trends in the characteristics of GHSF physicians and identify physician factors associated with starting work at GHSFs.
Cohort study.
Physicians responding to biennial national physician census surveys conducted by the Ministry of Health, Labour and Welfare of Japan from 1996 to 2016. The response rate was approximately 90%.
We estimated temporal trends in the number, proportion, and characteristics of GHSF physicians. A multivariable logistic regression analysis identified physician factors associated with starting work at GHSFs 10 years after 1996-2006 and 2006-2016 among physicians not working in GHSFs at baseline (1996 and 2006).
GHSF physicians rapidly increased in the first decade from 1,127 (0.47%) in 1996 to 2,891 (1.04%) in 2006; this trend then slowed and was almost proportional to that of all physicians, reaching 3,345 (1.05%) in 2016. GHSF physicians aged ≥65 years increased from 61.2% in 1996 to 68.5% in 2016, while those aged <40 years decreased from 13.8% to 1.9%. The sex ratio (male vs. female physicians) increased from 5.7 in 1996 to 6.4 in 2016. Physician factors associated with starting to work at GHSFs included older age, female sex, rural area, working at hospitals, and majored in internal medicine and surgery specialties.
The proportion of GHSF physicians among all physicians has stagnated, and GHSF physicians are aging. Facilitating the transition of younger physicians from clinical practice in hospitals to GHSFs will increase the number of GHSF physicians and improve the quality of care in GHSFs.
PDF
