中村 晃久

The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services in Saitama Prefecture (from October 2014 to September 2015). Residents who used the ETC services were divided into four age groups (20-39, 40-64, 65-74, and ≥75 years old). The number of calls per 1000 persons (call rate, CR) was compared between the groups. The annual CR for the top 10 symptoms/events were assessed. The annual CR was 2.6/1000 persons. The annual CR was significantly higher for women (2.9) than for men (2.3) (p < 0.05). ETC use was the highest in the 20-39 age group for both sexes (3.3 and 4.4 in men and women, respectively). All groups had fever, abdominal pain, and nausea/vomiting in common. In older adults, the frequency of events such as bruises and head injury was high. Women and younger adults tended to use ETC services. There were similarities and differences in symptoms/events among the groups, which should be recognized by call centers to help foster call center staff.

BACKGROUND: For achieving equity of the accessibility to primary healthcare, measuring potential geographical accessibility is essential. The provider-to-population ratio is the most frequently used measure. However, it is difficult to be used in closer region because it does not take into consideration the people and health services beyond its boundary. In order to overcome this problem, we measured the potential access to hospital, using both distance measures and the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to compare the number of hospitals in the neighborhood and the E2SFCA score with regard to the amount and equity for access to hospitals. METHODS: This descriptive study used publicly available data from 2010. The E2SFCA score and number of neighborhood hospitals were obtained from Tochigi province in Japan using a geographic information system. Dataset of four measures by each census tract was obtained. The measures were E2SFCA score, number of hospitals within the 5 km range, number of hospitals within the 10 km range, and number of hospitals within the 15 km range. Correlation and disparity analyses with the Lorenz curve and Gini coefficient were performed. RESULTS: The measures were obtained in a smaller area than municipality considering adjacent areas using a geographical approach. The E2SFCA score was 5.3 [3.2-7.3] hospitals/million (median [quantile range]), compared to 5.6 hospitals/million in total for the given district. The median number of hospitals within the 5 km, 10 km, and 15 km ranges were 1, 39, and 47, respectively. There was no hospital within the 5 km range in one third of the blocks. Both the number of hospitals within the 10 km range and those within the 15 km range were well correlated. Regional difference became smaller as the distance to count the number of hospitals increased. The gap between small number of hospitals and the high E2SFCA score indicated the location of community hospital in depopulated areas. CONCLUSIONS: The E2SFCA method is superior for analyzing spatial access to hospital, because it provides information in the closer sub-regions. Regional differences were hardly seen in access to hospital beyond the 10 km range. Further studies in other regions and countries are needed for precise assessment.

へき地(山間地域)において、住民・行政担当者・医療従事者の「医療へのアクセス」についての認識について検討した。2011年2月-3月に半構造化面接を行った。3者とも、「医療へのアクセス」が良好でないことを認識していた。「医療へのアクセス」を、住民は普段の受診だけでなく、急病時の不安、行政担当者は生活アクセスの問題の一部、医療従事者は実際の受診行動と想定していた。「医療へのアクセス」に対し、3者には共通点もあったが、相違点もあることがわかり、整備には情報を共有する必要があると思われた。