論文

This study aimed to develop a Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), which consists of six domains: Patient-/Client-/Family-/Community-Centered, Interprofessional Communication, Role Contribution, Facilitation Relationship, Reflection, and Understanding of Others. Validity of JASSIC was confirmed through a four-step process consisting of expert discussion, cognitive debriefing, feasibility, and statistical analysis. Confirmatory factor analysis (CFA) was performed by testing the correlation between the sum scores of JASSIC and the Assessment of Interprofessional Team Collaboration Scale-II(AITCS-II). First, 24 items were created through discussions among physicians, a nurse, a medical educator, and an information sociologist. Second, the items were modified by cognitive debriefing of a physician, nurse, pharmacist, occupational therapist, and social worker. Third, we provided the developed JASSIC for professionals at Hospital X (n = 139) and revised the wording and composition of the items. Finally, CFA among professionals at Hospital Y (n = 153) identified a 6-domain structure (GFI: 0.847, AGFI: 0.782, RMSEA: 0.088). Cronbach’s alpha was 0.92, and the correlation coefficient with AITCS-II was 0.72. Ongoing research into JASSIC will promote effective interprofessional collaborative practice not only in Japan but also other countries which share a similar culture and system.

目的:診療所・小病院と地域中核病院の職員の多職種連携と仕事に対する認識を調査する.方法:診療所・小病院4施設,病院3施設の職員を対象に,Assessment of Interprofessional Team Collaboration Scale(AITCS)日本語版,Readiness for Interprofessional Learning Scale(RIPLS)日本語版,職場満足度,近隣施設との関係性をアンケート調査した.結果:対象者は診療所・小病院職員74人/病院職員576人,平均年齢は41.9歳/40.6歳,診療所・小病院職員の方がAITCS,RIPLS,職場満足度が有意に高く,近隣施設との関係性を良好と判断した.結論:多職種連携や仕事に対する認識が所属組織により異なることを理解することで,地域包括ケアシステムにおける垂直統合が推進される可能性がある.(著者抄録)

Background: Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families. Objective: To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan. Methods: We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale. Results: A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not. Conclusions: This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan.

Background: Studies have reported positive impacts from community engagement in end-of-life (EoL) care. However, few studies have used a narrative for health promotion. Thus, we examined how and what lay participants learned through an EoL care education program using narrative. Methods: A case study in educational research was implemented through qualitative process evaluation. The program was conducted in a hospital in Japan. Participants living in the surrounding community were recruited by convenience sampling. We conducted 90-minute focus groups with participants at two and eight months after the completion of the program. All data were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Result: We identified five themes. First, participants reconstructed the concept of EoL care using their own experience and new knowledge gained in the program. Second, the stories in the program stimulated participants to recall their feelings and emotions, which caused catharsis effects. Third, the stories evoked other perspectives through metacognition. Fourth, their experience inspired altruism towards patients and their families at the EoL. Fifth, they reflected on their own deaths as an extension of their relationship with others. This learning process was consistent with Kolb’s experiential learning. Their experience enabled lay participants to overcome the existential terror of death while using the narrative mode of thinking to perceive their relationship with others as a symbolic identity. Conclusion: The educational program using narrative deepened lay participants’ understanding of the concept of EoL care. Such programs have the potential to enhance community engagement in EoL care.

Background: A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students’ understanding and level of reflection about SDH in a CBME curriculum. Methods: Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report. Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive. Results: We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable. Conclusions: The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

Background: The role of family caregivers has been vital, especially in superaging societies like Japan’s. The caregivers’ experience of interprofessional care is a key aspect in their evaluation of the quality of integrated care. We sought to explore whether family caregivers’ experience of interprofessional care is associated with their own participation in health checkups as preventive health behaviors. Methods: We used cross-sectional data obtained during the development of the Japanese version of the Caregivers’ Experience Instrument (J-IEXPAC CAREGIVERS). Participants who had provided care for at least one year were surveyed (n = 251). We assessed family caregivers’ experience of interprofessional care using J-IEXPAC CAREGIVERS and their participation in health checkups. Results: Multivariate logistic regression analysis revealed that the J-IEXPAC CAREGIVERS total score was significantly associated with the caregivers’ participation in health checkups [odds ratio per 1-point increase = 1.05; 95% confidence interval 1.01–1.09]. Two domain scores (attention for the patient and attention for the caregiver) of J-IEXPAC CAREGIVERS were significantly associated with the outcome. Conclusions: Family caregivers with more positive experiences of interprofessional care were more likely to participate in health checkups. These results support the significance of family caregivers’ experience of care, which may promote preventive health behaviors.

Background: To respond to increasingly complicated healthcare needs in primary care settings, all health and medical welfare professionals are required to collaborate with multiprofessionals, namely via “interprofessional work” (IPW). Interprofessional education (IPE) is essential for effective IPW, especially for medical students. This study aimed to determine whether participation in IPE can increase medical students’ readiness for interprofessional learning. Method: We examined the difference in readiness of medical students for interprofessional learning before and after an IPE program that used team-based learning (TBL). Each student was assigned to either a uniprofessional or multiprofessional group. They were evaluated using the Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS). Program participants were 126 second-year medical students and 18 students of healthcare professions other than medical doctor who participated in a combined IPE program conducted by two universities. Medical students were allocated to 12 uniprofessional and nine multiprofessional groups at random. Results: One hundred and twelve medical students who replied to the questionnaire both before and after the program (valid response rate, 88.9%) were eligible for analysis. Of these, 42 were assigned to uniprofessional groups and 70 to multiprofessional groups. After the program, the RIPLS total score increased to a greater extent in the multiprofessional groups than in the uniprofessional groups (difference 3.17, 95% confidence interval 0.47-5.88, P =.022). Multiple regression analysis showed the same result. Conclusions: Learning in multiprofessional groups increased medical students’ readiness for interprofessional learning in an IPE program using TBL.

目的:健診受診者を対象に、かぜに対する認識の現状と受診信念との関連を明らかにすべく調査した。方法:2012年8月〜9月、茨城県X市健診受診者に対し、かぜに対する認識や対処行動について無記名自記式質問紙で調査した。結果:1079名(有効回答率74.5%)が調査対象となり、かぜをひいたら「点滴や注射を受けると早く治る」に75.9%が賛成し、42.0%が「ウイルスが原因のかぜは抗生物質が効かない」に反対した。また、同項目で28.6%が「分からない」と回答。また「かぜ薬を早めに飲むと早く治る(OR:1.61)と「点滴や注射を受けると早く治る(OR:1.86)」が受診信念に関連する要因であった。結論:かぜに対する認識、そして、抗生物質の効果や医療機関で行われる治療に対する理解が不十分なことが分かった。また、かぜ薬や点滴・注射が治癒期間を短縮するという認識が、受診信念と関連することが示された。(著者抄録)

目的:医療資源の限られた地域で働く多職種は、どのような関係性の認識の中で在宅医療の問題をどのように認識しているか、そしてそれがどのように変容するかを明らかにする。方法:茨城県K市で働く多職種が在宅医療について主体的に話し合う場を提供し、その会議内容を逐語録化しテーマ分析を行った。結果:多職種は互いの関係性を階層構造の中で捉えるフェーズから、対話を通じて相互理解が深化する関係、ホラクラシーを理想とする考えが共有できる関係と変容する中で、在宅医療の問題を他人事の問題から自分事、地域全体の問題へと考えるようになった。結論:在宅医療推進に関わる問題は複雑であり、課題の共有や解決策を模索するだけでなく、問題に関わる多職種の関係性の変容が必要である。対話を通じて各専門職の関係性が変わることで、在宅医療不足の問題を自らの地域の問題として捉え、主体的に解決策を模索するようになることが明らかになった。(著者抄録)

© Objectives To clarify the process of how caregivers in a nursing home integrate the perspectives of rehabilitation into their responsibilities through working with a physical therapist. Design This study was conducted under an action research approach. Setting The target facility was a nursing home located in Japan. The researcher, a physical therapist, worked at the nursing home once a week from April 2016 to March 2017. During the study period, he created field notes focused on the dialogue and action of caregivers regarding care, responses of caregivers to the physical therapist and reflections as a physical therapist. Caregivers were also given a short informal interview about their relationship with the nursing home residents. For data analysis, two researchers discussed the content based on the field notes, consolidating the findings. Participants The participants were caregivers who worked at the target facility. Thirty-eight caregivers agreed to participate. Average age was 39.6±11.1 years, 14 (37%) were male and average caregiver experience was 9.8 years. Results Two cycles of action research were conducted during the study period. There were four stages in the process of how caregivers in the nursing home integrated the perspectives of rehabilitation through their work with the physical therapist. First, caregivers resisted having the rehabilitation programme carried out in the unit because they perceived that rehabilitation performed by a physical therapist was a special process and not under their responsibility. However, the caregivers were given a shared perspective on rehabilitation by the physical therapist, which helped them to understand the meaning of care to adapt the residents' abilities to their daily life. They practised resident-centred care on a trial basis, although with a sense of conflict between their new and previous role, which emphasised the safety of residents' lives and personhood. The caregivers increased their self-efficacy as their knowledge and skills were supplemented by the physical therapist and his approval of their attempted care. They were then able to commit to their newly conceived specialty of care as a means of supporting the lives of residents. Conclusions The process of working with a physical therapist led to a change in caregivers' perception and behaviours, which occurred in four stages: resistance to incorporation, recapture of other perspectives, conflicts and trials in the role of caregiver and transformation to a resident-centred perspective.

目的:健診受診者を対象に、かぜに対する認識の現状と受診信念との関連を明らかにすべく調査した。方法:2012年8月〜9月、茨城県X市健診受診者に対し、かぜに対する認識や対処行動について無記名自記式質問紙で調査した。結果:1079名(有効回答率74.5%)が調査対象となり、かぜをひいたら「点滴や注射を受けると早く治る」に75.9%が賛成し、42.0%が「ウイルスが原因のかぜは抗生物質が効かない」に反対した。また、同項目で28.6%が「分からない」と回答。また「かぜ薬を早めに飲むと早く治る(OR:1.61)と「点滴や注射を受けると早く治る(OR:1.86)」が受診信念に関連する要因であった。結論:かぜに対する認識、そして、抗生物質の効果や医療機関で行われる治療に対する理解が不十分なことが分かった。また、かぜ薬や点滴・注射が治癒期間を短縮するという認識が、受診信念と関連することが示された。(著者抄録)