Factors Influencing Cooperation Among Healthcare Providers in a Community-Based Stroke Care System in Japan

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• 作者：Masatoshi  ; Koga MD^&lowast ; ;   ; ^{koga@hsp.ncvc.go.jp} ; Toshiyuki  ; Uehara MD^&lowast ; ; Nobuyuki  ; Yasui MD^&dagger ; ; Yasuhiro  ; Hasegawa MD^&Dagger ; ; Kazuyuki  ; Nagatsuka MD^&lowast ; ; Yasushi  ; Okada MD^§ ; ; Kazuo  ; Minematsu MD^&lowast ;
• 关键词：Community based stroke care ; healthcare provider ; cooperation ; local government
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2011
• 出版时间：September-October 2011
• 年：2011
• 卷：20
• 期：5
• 页码：413-423
• 全文大小：92 K

文摘

Community-based stroke care in Japan is currently provided in acute hospitals, convalescent rehabilitation units, general practices, sanatorium-type wards, nursing care facilities, and in-home/commuting care services. We conducted a nationwide survey to identify factors influencing cooperation among the various providers of community-based stroke care. We sent questionnaires to 11,178 facilities and assessed the independent variables of excellent and fair cooperation among the care providers. Of the providers that responded, 66 % were engaged in medical practice or long-term care for stroke patients. The following independent variables were inversely associated with excellent or fair cooperation in the community: area with the higher population density among 3 groups divided by tertile threshold (odds ratio [OR], 0.53; 95 % confidence interval [CI], 0.41-0.69), facilities covered by long-term care insurance (OR, 0.27; 95 % CI, 0.22-0.34), and insufficient communication with local government (OR, 0.19; 95 % CI, 0.14-0.24). Positive independent variables of excellent or fair cooperation were the sharing of patient information in the community (OR, 2.53; 95 % CI, 1.78-3.66), use of a scale for assessing activities of daily living (OR, 1.93; 95 % CI, 1.42-2.63), appropriate utilization of care support managers (OR, 1.91; 95 % CI, 1.43-2.55), and adequate comprehension of the long-term care insurance system (OR, 1.54; 95 % CI, 1.24-1.92). Our findings suggest that improved communication between healthcare providers and local government, along with appropriate attention to the problems facing providers covered by long-term care insurance, may improve community-based stroke care in Japan.