A study on the contribution of medical expense disclosure to patient satisfaction

わが国での医療の質の向上に対する取り組みは,病院機能評価や様々な満足度調査,医療の情報開示をはじめとして盛んに行われてきているが,診療情報の開示と病院の満足度の関連についての研究はない.本研究では,診療録開示の中でも特に診療費に焦点を当て,診療報酬明細書開示や診療費の情報提供に対する患者の意識と患者満足度の関連を明らかにし,今後の患者への情報提供について検討するものである.本研究は,調査対象施設に来院した外来患者とその付き添いの者に対し,診療費に関する意識・医療費の情報提供・患者満足度に関する自記式質問紙調査を行った.得られた回答より,559名を有効回答とし,診療費に関する情報提供の意識と満足度の関連を分析した.その結果,下記のような結果が得られた.1)病院全体への満足度に最も寄与したのは,「医師の説明」と「看護師の技術と能力」と「院内の待ち時間」であった.2)65%の患者が詳細な明細書を必要とし,その理由は診療内容を知る目的であった.3)詳細な明細書の要望は病院全体への満足度に関連していた.今後,明細書に記載される内容として,レセプト開示が患者の求めている情報になるかを明らかにする必要がある.Approaches to improve the quality of medical service have been studied in Japan by investigating patient satisfaction, the disclosure of their medical records and others. On the other hand, there have been no research studies on the relationship between patient satisfaction and the disclosure of the details of payment for medical services. In this study, we focused especially on medical expenses and investigated whether the disclosure of the details of payment contributed to patient satisfaction. We carried out a questionnaire to be filled out of out-patients and their attendants on patient satisfaction and the disclosure of the details of payment, and obtained 559 valid replies. The results of the statistical analysis were as follows: 1)The factors that contributed most to patient satisfaction were physicians' explanations, the skill and the competency of nurses, and waiting time. 2)65% of patients requested a detailed receipt, the main reason being to know the details of medical treatment. 3)The request for a detailed receipt (a break-down of payment for medical services) was also associated with satisfaction with the hospital as a whole. These results revealed the possibility that disclosing the details of payment for medical services could contribute to patient satisfaction. They also suggested the necessity of further studies on medical record disclosure and the actual informational needs of patients.広島保健学学会 特別講

The relationship between life expectancy and indexes of socioeconomy and nutrition at the prefectural level

日本は世界一の長寿国として知られている.その関連因子を探るため,さまざまな視点から研究されている.本研究は2000年における都道府県別の平均寿命,世帯における夫婦の就業状況,医療資源,医療費,栄養素摂取量などの指標を用い,日本人の平均寿命と関連する因子を明確にすることを目的にした.その結果,就業状況は男女の平均寿命と関連していることが示唆された.特に,男性の関連因子のなか,就業状況との関連性が最も強かった.医療指標に関しては,女性において,医療資源の充実は長寿につながることが示唆された.その他,男性において,生活習慣の一部を反映する指標は関連因子になった.女性では,栄養に関する指標は重要な関連因子の一つと考えられた.さらに,喫煙は男女の平均寿命と負の関連があったことも示唆された.It is well known that Japanese people have the longest life expectancy in the world at present. Variouspoints of view which focus on causal contexts are reported. The present study used a database at theprefectural level in Japan, which included Japanese life expectancy at birth, employment types of thehousehold, medical resources, medical expenses, and nutrition indexes in 2000. The purpose of the studywas to clarify the major related factors on Japanese life expectancy. The results suggest that theemployment types of the household had an effect on both men and women; however, the strongest effectwas seen among the related factors for men. Medical resources were also linked with longevity for womendue to the presence of substantial medical services. The indexes related to lifestyle habits appeared to beassociated more with life expectancy for men, while nutrition indexes contributed strongly for women. Itwas also suggested that smoking had a negative effect on life expectancy for both men and women

A study on the elderly in the community: the relationships among lifestyle, the degree of depression and characteristics of personality

65歳以上の地域高齢者を対象に質問紙調査法により生活習慣と抑うつ状況・性格傾向について調査を実施した.387人(男性180人,女性207人)から回答を得た.森本の生活習慣スコア,SDS指数(Self-rating Depression Scale),高齢者用簡易性格検査との関連を検討した.生活習慣スコアが良好な高齢者は51人(13.2%),中庸者116人(30.0%),不良者220人(56.8%)であった.男性高齢者は女性高齢者より,生活習慣スコアが高かった(p<0.05).SDS指数の平均値は52.5点(標準偏差12.0点)を示し,女性高齢者の抑うつ傾向が高かった(p<0.05).生活習慣スコアの不良者はSDS指数が高かった.生活習慣スコアと性格3 因子の関連は,社交性・新奇希求性傾向の高い群,神経症性傾向の低い群の男性高齢者の生活習慣スコアが高くなっていた.生活習慣スコアが低い要因は,高齢者の運動・活動に関する習慣が少ないことであった.「健康日本21」の活動の一環として,老人クラブが主体となり,「ウオーキング」を推進している.この活動を継続することが健康づくり対策にとって重要であるとの示唆が得られた.A questionnaire survey on lifestyle, mental health and personality was carried out among the elderly(age 65 or over) in the community, and a total of 387 (180 male and 207 female) responses were obtained.In the survey, Morimoto's scores for lifestyle, Self-rating Depression Scales (SDS) and the SimplePersonality Test for the elderly were used. The scores on lifestyle showed 51 persons (13.2%) to be good,116 (30.0%) to be intermediate and 220 (56.8%) bad. Males had higher scores than females on average(p<0.05). SDS were also calculated to find an average at 52.5 (SD=12.0). Females showed a higher degreeof depression (p<0.05). The results of the Simple Personality Test showed that male elderly with highsociability and/or novelty-seeking or with low neuroticism tended to have a higher score for lifestyle.Low scores for lifestyle were attributable to less frequent physical activities. The importance ofwalking promoted by clubs for the elderly as a response to ‘Healthy Japan 21'was confirmed in the healthpromotion

Determinants of the daily rhythm of blood fluidity

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Common eating habit patterns are associated with a high maximum occlusal force and pre-eating cardiac vagal tone

Background Masticatory function is associated with nervous function, including autonomic nervous function, and both functions are influenced by human habits. In a previous preliminary study of 53 young women, we found that eating habit patterns were associated with occlusal force as an indicator of masticatory function. Therefore, we hypothesized that relationships exist between occlusal force, the autonomic nervous system, and eating habit patterns. Methods To test our hypothesis, we analyzed the relationship between heart rate variability measured before and after lunch in 53 young women, and measured and surveyed maximum occlusal force and eating habit patterns, respectively, in these participants. Results High occlusal force was associated with an increased high-frequency (HF) component (vagal tone index) of the heart rate variability index immediately before lunch (standardized regression coefficient (β) = 0.417, P = 0.002). Each of the eating habit items surveyed in a questionnaire showed a similar tendency for the HF component immediately before lunch and maximum occlusal force; in particular, “Habit of eating breakfast” and “Number of meals per day” were significantly associated with both variables. Additionally, total eating habit scores related to higher maximum occlusal force were associated with an increase in the HF component immediately before lunch (β = 0.514, P < 0.001). The maximum occlusal force and the pre-eating HF component values were stratified by total eating habit scores (into low, medium, high categories), and the high scores were significantly higher than the medium or low scores. Conclusions Occlusal force and the pre-eating cardiac vagal response of individuals were characterized by their common eating habit patterns, indicating that eating habits may be simultaneously associated with the development of masticatory function, nervous system development, and cardiovascular rhythm. Although further research is needed to investigate these relationships in detail, our findings provide insights that will inform the study of physical functions, neurodevelopment, habitual behaviors, and health in humans

Seasonal variations and the effect of atmospheric temperature on the incidence of coronary heart disease in Hiroshima, Japan

Background : Seasonal variations in the incidence of Coronary Heart Disease (CHD) have rarely been studied qualitatively and quantitatively, although it is often pointed out that CHD is more likely to happen in winter. Methods and Results : We analyzed the 10 year population-based data by using Logistic Regression and Poisson Regression Models to examine seasonal variations and the effect of atmospheric temperature on the incidence of CHD in Hiroshima City, Japan. There were 3755 incident events, 63.33% days on which CHD events occurred and 1.03 events per day. Relative Risk (RR) for winter, spring and autumn in comparison with summer was 1.53, 1.25 and 1.24 respectively, and there were 30.0%, 19.4% and 19.2% more events than in summer. In contrast with September, there was a higher risk in January (RR=1.99, p0.05) and July (RR=1.00, p>0.05) was as low as September. Atmospheric temperature had a statistically significant effect on CHD incidence. Odds ratios and risk ratios estimated by Logistic Regression Model and Poisson Regression Model were all higher when the daily mean atmospheric temperature was lower than 18℃, the highest risk occurring below 4℃. Lower risks were observed from 18 to 30℃ and the lowest risk was found at 28-30℃. Conclusions : The incidence of CHD shows a more than 50% higher value in winter than in summer. There exists a higher risk on cold days, especially when the daily mean temperature is below 4℃

The self-esteem and the activities of daily living in inpatients after an ischemic stroke

急性期の脳梗塞患者の自尊感情と日常生活動作の関連を明らかにするために,入院中の脳梗塞患者150人に調査協力を依頼した.調査協力の同意が得られなかった患者25人と調査前に退院された患者17人を除き,108人(72.0%)(男性74人,女性34人,平均年齢64.5(SD 12.5)才)にアンケート調査を実施した.自尊感情(Rosenberg のSelf-Esteem,以下RSE と記載)は平均29.9(SD 6.1)点,日常生活動作(Barthel index,以下BI と記載)は平均89.4(SD 16.0)点であり,RSE とBI の間にはBI が低いとRSE が低いという正の相関がみられた(Spearman のρ= 0.461,p < 0.001).また,BI が低いことと「女性である」「高齢である」「入院時の機能障害が重い」の関連が示唆された.急性期には,脳梗塞患者の日常生活動作の自立に向けた援助と,自尊感情を高める介入が必要であると考えられた.The purpose of this study was to investigate the relationship between self-esteem and the activities of daily living in inpatients after an ischemic stroke. The level of Rosenberg's Self-esteem and the Barthel index were examined. There were 108 respondents (74 males and 34 females). Based on these results, selfesteem was significantly correlated to the Barthel Index (Spearman's ρ=0.461, p<0.001). Findings indicated that low self-esteem related to dependence, and the level of dependence showed a negative association with women, the elderly and severe disability. These results suggested the necessity of rehabilitation for re-acquiring the skills of daily living and enhancement of self-esteem in patients who are dependent.広島保健学学会 特別講