Home medical treatment and the transfer of medical care of patients at Tokyo Women's Medical University

摘要

We inquired the current status of our home care transfer patients who are highly dependent on medical treatment, and examined the factors that are needed to pay attention to keep a high level of QOL and to give a better long-term home care. The subjects are 380 patients who requested a homecare transfer. The following items were inquired: (1) the length of time from the request to home care transfer, (2) the length of home care, and (3) a place for the peaceful death. In addition to that, we asked for additional remarks. Fifty nine (59) % of the patients are over 65 years old, and 69% of the diseases were malignant neoplasms. The number of patients that requested a home care transfer was 68%, and for 70% of the patients it took 20 days or less after requesting a home care transfer to leaving the hospital. Forty five (45) % of the patients died within one month of home care, 70% within 2 months, 37% died at home and 45% died after reentering the hospital. There were many time consuming cases with respect to: guidance about medical treatment, guidance about alleviation of the symptoms and guidance about adjusting a patient out of the hospital. There were also cases where the patients had to be readmitted to the hospital. In fact, some of the patients died from an aggravation of disease symptoms and a breakdown of nursing care right after the start of home care. In cases of terminal stage patients with limited prognosis, we found that a long-term preservation of a patients' stable condition would lead to fill a satisfaction of patients cared at home. It is important to start adjusting things like the coordination of medical examination and treatment with local institutions in which a status of the patient and family needs is fulfilled individually at the earliest time, in order to reduce anxiety including the length of hospitalization in short by alleviating disease symptoms.