The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Multidimensional Community Systems for ALS with Home Mechanical Ventilation

Konishi, K., PhD, RN, Showa University, Japan, Kawamura, S., PhD RN, Aomori University of Health and Welfare, Japan, Ogura, A., PhD RN, Ishii, M. MA, RN, Itagaki, Y. MA, RN, Tokyo Metropolitan Institute for Neuroscience, Japan

Background:
Medical treatment including suctioning must be given by MDs and RNs in Japan. However, family members of ALS with Home Mechanical Ventilation (HMV) have to take medical care under their charge at their home. To lighten the burden imposed on the family, home help services (non-medical staff) have been accepted to do suctioning with qualifications since 2005 in Japan. Objectives: To identify actual state of home care services and multidimensional community systems for ALS with HMV in Japan.

Methods: All of ALS patients in Japan through a registration system were given an informed consent letter and interviewed by public health nurses belonging to public health centers. Five thousand seven hundred seventy one subjects (88.6%) were participated this study.

Results:
The results are presented in the table.

ALS n=5,771
  ALS with HMV n=1,530 (26.8%)
    Home care Acute Hospital Long-term Hospital Others
   
    665 (43.5%) 109 (7.1%) 333 (21.8%) 423 (27.6%)


Among 774 (665 home care + 109 acute hospital) examinees, 740(95.6%) were TIPPV, mean years from diagnosis to TIPPV were 3.0(±3.65), 745(97.3%) were regularly provided home visiting nursing service. Mostly(91.5%) using by day on weekday, mean hours of nursing service were 5.2(±3.86) hours par week. Regarding to home help service (non-medical staff), 664(85.8%) were regularly provided the service, 63.3% were using by day on weekday, however, night service is finding increasing use, mean hours of home helping service were 11.8(±13.84) hours per week, 240(30.8%) were regularly doing suctioning not under medical management.

Conclusions:
Home help service was given to provide for long hours and by night under medical insurance system and care insurance system in Japan. The roles of each staff in home care team have to be clarified for patients' safety, and educational systems need to be developed.


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