2003 OPEN FORUM Abstracts
Respiratory care From
hospital to home in Japan
T.Tsuda,MD,PhD, M.Kawamata, S.Yamanoue, N.Zaitsu,, H.Nakayama, M.Tsuda, S.Osaki, K.Machida, N.Narita, H.Senjyu*, *Nagasaki University School of Health Sciences
Department of Rehabilitation and Department of Respiratory Medicine, Tsuda Hospital, HOT-Home Kirigaoka Kitakyusyu, 802-0083 JAPAN
Hospital Acute exacerbation hospitalization Comprehensive Pulmonary Rehab Sleep study for NPPV Continuing Pulmonary Rehab Day Care Pulmonary rehab for outpatient Visiting Ns and Helper Station
Long term care Insurance:
Insurance for Care and Assistance for the Elderly
Background: Our primary mission is to provide specialized care, and related medical and social support services to chronic respiratory failure patients, thereby justifying the development of multifaceted strategies to address this problem. In Japan, insurance for care and assistance for the elderly (long term care insurance) has gone into effect April 1, 2000. We have started Day Care for chronic respiratory failure patients insured by long term care insurance from June 1, 2000. This program is including pick-up service, pulmonary rehab, taking bath, lunch, education of nutrition, short nap and social time. In the 12 months following completion of program, hospitalization and length of stay in winter season were reduced compared to prior to starting the program (pre program, 42.7±54.5 days; post program 18.1±26.1 days: p<0.01).
OBJECTIVES: The purposes of this study were to clarify the effectiveness of the home care system including Day Care, Visiting Ns and Helper Station for chronic lung disease patients in Japan. This time, we focused on the continuation of pulmonary rehabilitation.
Methods: Sixty-five stable patients with chronic respiratory failure were enrolled in the program; 65 patients (31 COPD, 12 lung complication of tuberculosis, 12 pneumoconiosis and 10 other disease), 37 patients were received home oxygen therapy. We examined the effectiveness and the continuation ratio of an outpatient pulmonary rehabilitation program at the Day Care for older patients (77±7 years) with chronic respiratory failure.
RESULTS: We observed the patients after they had followed the program for 2 years, and found that the continuation ratio of rehabilitation in the over 75 years old was inferior to that in the below 75 years old (continuation ratios for 1 year and 2year in the older were 61%, 48%, respectively, and in the younger were 75% and 50%). The continuation rate for 1year and 2 year except for the death case were 89%, 77%, respectively.
Conclusions: This Day Care is the first system that is specific for chronic lung disease in Japan. The continuation rate is high even in the over 75 years old. It could play a important role for patients to continue pulmonary rehabilitation at home.
PULMONARY REHAB PROGRAM:
6 weeks of Pulmonary Rehab Program on Admission
Pulmonary Rehab Educational Class: 2/week
Anatomy and disease (MD), Smoking cessation (MD & MSW)
Medicine and inhaler (Pharmacist)
ADL, Panic control, Relaxation (PT)
Acute Exacerbation and infection control (RT & NS)
Social resources and patients' organization, Stress management (MSW& PSW)
Lung function tests, Sleep study (PSGT)
O2 devices, NPPV (Health care provider)