Upper respiratory infections (URIs), including the common cold, can lead to community-acquired pneumonia and pose significant risks for older adults. In this study, we aimed to examine the influence of psychosocial factors on URIs among community-dwelling older adults.
Methods
A cross-sectional survey was administered to 500 community-dwelling older adults via an internet research panel (386 males and 114 females). The prevalence of colds in the past year and demographic variables were assessed. Psychosocial factors were measured using the 8-item short-form health survey (SF-8). Participants were categorized into two groups: those who experienced a cold within the past year (cold group) and those who did not (no-cold group). Group comparisons were conducted using t-tests or Chi-square tests, followed by logistic regression analysis. Statistical significance was set at p < 0.05.
Results
After adjusting for age, BMI, and smoking and drinking habits, scores for general health, vitality, role emotional functioning, mental health, and mental component summary score (MCS) on the SF-8 were significantly higher in the no-cold group than in the cold group.
Conclusions
Psychosocial factors, such as enhanced general health, vitality, role emotional functioning, mental health, and MCS are associated with decreased susceptibility to URIs.
{"title":"Psychosocial factors and susceptibility to upper respiratory infections in community-dwelling older adults of Japan","authors":"Noriko Okamoto PhD, Hiroki Matsui MN, Hirohito Tsuboi MD, PhD","doi":"10.1002/jgf2.70063","DOIUrl":"https://doi.org/10.1002/jgf2.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Upper respiratory infections (URIs), including the common cold, can lead to community-acquired pneumonia and pose significant risks for older adults. In this study, we aimed to examine the influence of psychosocial factors on URIs among community-dwelling older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was administered to 500 community-dwelling older adults via an internet research panel (386 males and 114 females). The prevalence of colds in the past year and demographic variables were assessed. Psychosocial factors were measured using the 8-item short-form health survey (SF-8). Participants were categorized into two groups: those who experienced a cold within the past year (cold group) and those who did not (no-cold group). Group comparisons were conducted using <i>t</i>-tests or Chi-square tests, followed by logistic regression analysis. Statistical significance was set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for age, BMI, and smoking and drinking habits, scores for general health, vitality, role emotional functioning, mental health, and mental component summary score (MCS) on the SF-8 were significantly higher in the no-cold group than in the cold group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Psychosocial factors, such as enhanced general health, vitality, role emotional functioning, mental health, and MCS are associated with decreased susceptibility to URIs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"579-584"},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaher Yar, Fizza Asghar, Zahin Shahriar, Muhammad Shahzad Asif
<p>Safdar and Aslam's narrative evaluation of primary care chronic kidney disease management provides a comprehensive overview of current evidence-based approaches [<span>1</span>]. While their review effectively summarizes contemporary CKD screening, diagnosis, and management protocols, we propose focusing on two specific, well-evidenced implementation strategies that could substantially enhance the translation of these guidelines into routine primary care practice.</p><p>Electronic health record-integrated clinical decision support (CDS) systems represent a promising yet complex intervention for addressing CKD management gaps in primary care. The largest cluster randomized trial to date, conducted by Sperl-Hillen et al. [<span>2</span>], involved 32 primary care clinics and 6420 patients with CKD stages G3–G4. This rigorous study provides critical insights into CDS effectiveness for CKD management.</p><p>The trial demonstrated modest improvements favoring CDS intervention, though none achieved statistical significance: CKD diagnosis documentation increased from 21.8% to 26.6% (RR 1.17; 95% CI 0.91–1.51, <i>p</i> = 0.21), and nephrology referrals improved from 36.1% to 38.7% (RR 1.02; 95% CI 0.79–1.32, <i>p</i> = 0.86). However, other outcomes showed minimal differences, with blood pressure control remaining essentially unchanged (20.2% vs. 20.4%).</p><p>The study revealed critical implementation barriers that limited CDS effectiveness. COVID-19 pandemic disruptions substantially reduced intervention exposure, with CDS print rates recovering to only 67% of pre-pandemic levels [<span>2</span>].</p><p>Team-based CKD management demonstrates substantially stronger evidence for clinical effectiveness compared to CDS systems alone. The nationwide Japanese multicenter study by Masanori et al. [<span>3</span>] examined 2954 CKD patients and provided compelling evidence for multidisciplinary care superiority. Additionally, implementation of a primary care CKD registry has been shown to improve identification and management of at-risk patients, facilitating team-based care and tracking outcomes in high-need populations [<span>4</span>].</p><p>Multidisciplinary care significantly reduced the composite endpoint of renal replacement therapy initiation and all-cause mortality compared to conventional care (HR 0.71; 95% CI 0.60–0.85, <i>p</i> = 0.0001) [<span>3</span>]. Teams involving more healthcare disciplines showed superior outcomes, with inpatient-based multidisciplinary care (mean 4.5 professionals) outperforming outpatient-based care (mean 2.6 professionals).</p><p>Effective teams require nephrologists, specialist nurses, registered dietitians, pharmacists, and social workers working collaboratively [<span>3</span>]. For healthcare systems serving diverse populations, systematic cultural competency interventions show measurable effectiveness. Kanagaratnam et al.'s systematic review [<span>5</span>] identified specific culturally adapted CKD interventio
Safdar和Aslam对初级保健慢性肾脏疾病管理的叙述性评估提供了当前循证方法的全面概述[b]。虽然他们的综述有效地总结了当代CKD筛查、诊断和管理方案，但我们建议关注两个具体的、有充分证据的实施策略，这些策略可以大大提高这些指南在常规初级保健实践中的转化。电子健康记录集成临床决策支持（CDS）系统是解决初级保健中CKD管理差距的一种有希望但复杂的干预措施。迄今为止，由Sperl-Hillen等人进行的最大的集群随机试验，涉及32个初级保健诊所和6420名CKD G3-G4期患者。这项严谨的研究为慢性肾病管理中CDS的有效性提供了重要的见解。该试验显示了有利于CDS干预的适度改善，尽管没有达到统计学意义：CKD诊断文件从21.8%增加到26.6% (RR 1.17; 95% CI 0.91-1.51, p = 0.21)，肾脏病转诊从36.1%提高到38.7% （RR 1.02; 95% CI 0.79-1.32, p = 0.86）。然而，其他结果显示差异很小，血压控制基本保持不变（20.2% vs. 20.4%）。该研究揭示了限制CDS有效性的关键实施障碍。2019冠状病毒病大流行造成的中断大大减少了干预措施的风险敞口，CDS打印率仅恢复到2010年大流行前水平的67%。与单独使用CDS系统相比，基于团队的CKD管理显示出更强的临床有效性证据。Masanori等人进行的日本全国性多中心研究对2954名CKD患者进行了检查，为多学科治疗优势提供了令人信服的证据。此外，实施初级保健CKD登记已被证明可以改善对高危患者的识别和管理，促进基于团队的护理，并跟踪高需求人群的结果[10]。与传统治疗相比，多学科治疗显著降低了肾脏替代治疗起始的综合终点和全因死亡率（HR 0.71; 95% CI 0.60-0.85, p = 0.0001）。涉及更多医疗保健学科的团队表现出更好的结果，基于住院的多学科护理（平均4.5名专业人员）优于基于门诊的护理（平均2.6名专业人员）。有效的团队需要肾病专家、专科护士、注册营养师、药剂师和社会工作者协同工作。对于服务于不同人群的医疗保健系统，系统的文化能力干预显示出可衡量的有效性。Kanagaratnam等人的系统综述b[5]确定了具有临床效益的特定文化适应性CKD干预措施。在涉及106名患者的6项研究中实施了文化健康联络官，与常规护理相比，改善了包括血压降低在内的临床结果。与以医院为基础的方案相比，以社区为基础的干预措施由当地投入设计并通过可信赖的社区合作伙伴提供，取得了更好的结果。虽然CDS系统显示出希望，但实施需要仔细关注工作流程集成、竞争的临床优先级和持续的组织支持，以实现有效性。Shaher Yar构思、撰写并修改了手稿。Fizza Asghar修改了手稿。Zahin Shahriar负责参考文献和数据收集。Muhammad Shahzad Asif监督了这个项目。作者声明无利益冲突。本文链接到萨夫达尔和阿斯拉姆报纸。要查看这些文章，请访问https://doi.org/10.1002/jgf2.70054。
{"title":"Implementation Challenges in Primary Care CKD Management: Beyond Clinical Guidelines","authors":"Shaher Yar, Fizza Asghar, Zahin Shahriar, Muhammad Shahzad Asif","doi":"10.1002/jgf2.70067","DOIUrl":"https://doi.org/10.1002/jgf2.70067","url":null,"abstract":"<p>Safdar and Aslam's narrative evaluation of primary care chronic kidney disease management provides a comprehensive overview of current evidence-based approaches [<span>1</span>]. While their review effectively summarizes contemporary CKD screening, diagnosis, and management protocols, we propose focusing on two specific, well-evidenced implementation strategies that could substantially enhance the translation of these guidelines into routine primary care practice.</p><p>Electronic health record-integrated clinical decision support (CDS) systems represent a promising yet complex intervention for addressing CKD management gaps in primary care. The largest cluster randomized trial to date, conducted by Sperl-Hillen et al. [<span>2</span>], involved 32 primary care clinics and 6420 patients with CKD stages G3–G4. This rigorous study provides critical insights into CDS effectiveness for CKD management.</p><p>The trial demonstrated modest improvements favoring CDS intervention, though none achieved statistical significance: CKD diagnosis documentation increased from 21.8% to 26.6% (RR 1.17; 95% CI 0.91–1.51, <i>p</i> = 0.21), and nephrology referrals improved from 36.1% to 38.7% (RR 1.02; 95% CI 0.79–1.32, <i>p</i> = 0.86). However, other outcomes showed minimal differences, with blood pressure control remaining essentially unchanged (20.2% vs. 20.4%).</p><p>The study revealed critical implementation barriers that limited CDS effectiveness. COVID-19 pandemic disruptions substantially reduced intervention exposure, with CDS print rates recovering to only 67% of pre-pandemic levels [<span>2</span>].</p><p>Team-based CKD management demonstrates substantially stronger evidence for clinical effectiveness compared to CDS systems alone. The nationwide Japanese multicenter study by Masanori et al. [<span>3</span>] examined 2954 CKD patients and provided compelling evidence for multidisciplinary care superiority. Additionally, implementation of a primary care CKD registry has been shown to improve identification and management of at-risk patients, facilitating team-based care and tracking outcomes in high-need populations [<span>4</span>].</p><p>Multidisciplinary care significantly reduced the composite endpoint of renal replacement therapy initiation and all-cause mortality compared to conventional care (HR 0.71; 95% CI 0.60–0.85, <i>p</i> = 0.0001) [<span>3</span>]. Teams involving more healthcare disciplines showed superior outcomes, with inpatient-based multidisciplinary care (mean 4.5 professionals) outperforming outpatient-based care (mean 2.6 professionals).</p><p>Effective teams require nephrologists, specialist nurses, registered dietitians, pharmacists, and social workers working collaboratively [<span>3</span>]. For healthcare systems serving diverse populations, systematic cultural competency interventions show measurable effectiveness. Kanagaratnam et al.'s systematic review [<span>5</span>] identified specific culturally adapted CKD interventio","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"672-673"},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 68-year-old man was diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago. He had been previously treated with edaravone and riluzole. We initiated high-dose methylcobalamin (50 mg, twice weekly by intramuscular injection) as part of home visit medical care. The day after starting methylcobalamin, his urine turned red (Figure 1A). At that time, he had no symptoms of abdominal or urinary pain. A dipstick test was negative for blood, urobilinogen, and bilirubin, and urine sedimentation tests showed no erythrocytes. Urine myoglobin was also negative. Three days after the methylcobalamin treatment, his urine color returned to yellow (Figure 1B). Following each subsequent dose of methylcobalamin, his urine again turned red. Based on these findings, we concluded that the change in urine color was caused by methylcobalamin. Methylcobalamin has long been used to treat peripheral neuropathy.1 High doses of methylcobalamin are effective in slowing disease progression in patients with early ALS.2 The occurrence of red urine during high-dose vitamin B12 therapy has been documented in two published clinical trials.2, 3 The occurrence of reddish urine has been noted in the package insert of the vitamin B12 formulation indicated for ALS.4 However, patients may become alarmed upon noticing reddish urine. Therefore, it is important to inform them of this possibility in advance. Additionally, red urine can result from various medications (e.g., rifampin, chloroquine), intravascular hemolysis (e.g., hemolytic anemia, G6PD deficiency), other medical conditions (e.g., nephrolithiasis, nutcracker syndrome), or dietary factors (e.g., beets, blackberries).5 Thus, if red urine occurs during methylcobalamin administration, other potential causes should be carefully ruled out.
Kento Furuya: conceptualization; writing—original draft preparation; writing—review and editing (lead). Naoya Itoh: Funding acquisition; supervision; writing—review and editing (supporting).
None.
None declared.
None.
The patient has provided written consent for the publication of the images and the accompanying text.
{"title":"Red urine in a 68-year-old man with amyotrophic lateral sclerosis","authors":"Kento Furuya MD, Naoya Itoh MD, DTM&H, PhD","doi":"10.1002/jgf2.70066","DOIUrl":"https://doi.org/10.1002/jgf2.70066","url":null,"abstract":"<p>A 68-year-old man was diagnosed with amyotrophic lateral sclerosis (ALS) 2 years ago. He had been previously treated with edaravone and riluzole. We initiated high-dose methylcobalamin (50 mg, twice weekly by intramuscular injection) as part of home visit medical care. The day after starting methylcobalamin, his urine turned red (Figure 1A). At that time, he had no symptoms of abdominal or urinary pain. A dipstick test was negative for blood, urobilinogen, and bilirubin, and urine sedimentation tests showed no erythrocytes. Urine myoglobin was also negative. Three days after the methylcobalamin treatment, his urine color returned to yellow (Figure 1B). Following each subsequent dose of methylcobalamin, his urine again turned red. Based on these findings, we concluded that the change in urine color was caused by methylcobalamin. Methylcobalamin has long been used to treat peripheral neuropathy.<span><sup>1</sup></span> High doses of methylcobalamin are effective in slowing disease progression in patients with early ALS.<span><sup>2</sup></span> The occurrence of red urine during high-dose vitamin B12 therapy has been documented in two published clinical trials.<span><sup>2, 3</sup></span> The occurrence of reddish urine has been noted in the package insert of the vitamin B12 formulation indicated for ALS.<span><sup>4</sup></span> However, patients may become alarmed upon noticing reddish urine. Therefore, it is important to inform them of this possibility in advance. Additionally, red urine can result from various medications (e.g., rifampin, chloroquine), intravascular hemolysis (e.g., hemolytic anemia, G6PD deficiency), other medical conditions (e.g., nephrolithiasis, nutcracker syndrome), or dietary factors (e.g., beets, blackberries).<span><sup>5</sup></span> Thus, if red urine occurs during methylcobalamin administration, other potential causes should be carefully ruled out.</p><p>\u0000 <b>Kento Furuya:</b> conceptualization; writing—original draft preparation; writing—review and editing (lead). <b>Naoya Itoh:</b> Funding acquisition; supervision; writing—review and editing (supporting).</p><p>None.</p><p>None declared.</p><p>None.</p><p>The patient has provided written consent for the publication of the images and the accompanying text.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"659-660"},"PeriodicalIF":2.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An elderly man in his 80s receiving home medical care presented with recurrent loss of appetite. Although the physical examination was normal, thiamine deficiency was suspected based on his history of chronic alcohol use, prior unexplained anorexia, and ongoing cancer treatment. Oral thiamine supplementation resulted in marked improvement within days. Subsequent testing confirmed thiamine deficiency, leading to the diagnosis of gastrointestinal beriberi. This case underscores the importance of considering gastrointestinal beriberi in patients with nonspecific gastrointestinal symptoms in the home medical care setting, particularly when risk factors for thiamine deficiency are present.
{"title":"Recurrent anorexia because of gastrointestinal beriberi in a home care patient","authors":"Ren Kawamura MD, PhD, Tsuyoshi Enokihara MD, Yousuke Tsukinaga MD, MBA, Taro Shimizu MD, PhD, Msc, MPH, MBA","doi":"10.1002/jgf2.70065","DOIUrl":"https://doi.org/10.1002/jgf2.70065","url":null,"abstract":"<p>An elderly man in his 80s receiving home medical care presented with recurrent loss of appetite. Although the physical examination was normal, thiamine deficiency was suspected based on his history of chronic alcohol use, prior unexplained anorexia, and ongoing cancer treatment. Oral thiamine supplementation resulted in marked improvement within days. Subsequent testing confirmed thiamine deficiency, leading to the diagnosis of gastrointestinal beriberi. This case underscores the importance of considering gastrointestinal beriberi in patients with nonspecific gastrointestinal symptoms in the home medical care setting, particularly when risk factors for thiamine deficiency are present.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"637-641"},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While interprofessional collaboration is becoming increasingly important, its current status and the competency of nurse practitioners (NPs) to collaborate with multiple professionals in Japan have not been studied. This study aimed to clarify and examine the current status of interprofessional collaboration in the workplace for Japanese NPs and its related factors.
Methods
For this cross-sectional study, 760 Japanese NPs who had passed the NP qualification exam conducted by the Japanese Organization NP Faculties were targeted. Data were collected between July and December 2023, using the Assessment of Interprofessional Team Collaboration Scale-II-J (AITCS-II-J), the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), and the Workplace Support Scale. Descriptive statistics and multiple regression analyses were used for data analysis.
Results
Of the 760 targeted, 137 participated, indicating a response rate of 18.0% (100% valid response rate). The AITCS-II-J was associated with the JASSIC and Workplace Support Scale. It was also associated with the JASSIC subscales of “Patient-/Client-/Family-/Community-Centered” and “Facilitation Relationship.” The JASSIC was associated with “Informational Support” and “Evaluative Support.”
Conclusions
These results indicated that NPs' interprofessional collaboration skills and workplace support were the main factors determining collaboration quality. Additionally, informational and evaluative support from superiors was crucial to improve NPs' ability to collaborate with other professionals. To achieve effective interprofessional collaboration, developing advanced clinical and communication skills among NPs is necessary.
虽然跨专业合作变得越来越重要，但其现状和护士从业人员（NPs）与日本多个专业人员合作的能力尚未得到研究。本研究旨在厘清和检视日本新移民职场跨专业合作的现况及其相关因素。方法本横断面研究以760名通过日本组织国家警察学院举办的国家警察资格考试的日本国家警察为研究对象。数据采集时间为2023年7 - 12月，采用跨专业团队协作评估量表- ii - j （AITCS-II-J）、日文版跨专业能力自评量表（JASSIC）和工作场所支持量表。数据分析采用描述性统计和多元回归分析。结果760人参与问卷调查，137人参与问卷调查，有效率为18.0%（100%有效有效率）。AITCS-II-J与JASSIC和工作场所支持量表相关。与JASSIC“以患者/客户/家庭/社区为中心”和“促进关系”分量表相关。JASSIC与“信息支持”和“评估支持”相关。结论NPs的跨专业协作技能和工作场所支持是影响协作质量的主要因素。此外，来自上级的信息和评价支持对于提高NPs与其他专业人员合作的能力至关重要。为了实现有效的跨专业合作，必须在np之间发展先进的临床和沟通技巧。
{"title":"Cross-sectional study of interprofessional collaboration among Japanese nurse practitioners","authors":"Naoko Tokunaga MSN, Akihiro Araki PhD, Hiromi Fukuda PhD","doi":"10.1002/jgf2.70062","DOIUrl":"https://doi.org/10.1002/jgf2.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While interprofessional collaboration is becoming increasingly important, its current status and the competency of nurse practitioners (NPs) to collaborate with multiple professionals in Japan have not been studied. This study aimed to clarify and examine the current status of interprofessional collaboration in the workplace for Japanese NPs and its related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this cross-sectional study, 760 Japanese NPs who had passed the NP qualification exam conducted by the Japanese Organization NP Faculties were targeted. Data were collected between July and December 2023, using the Assessment of Interprofessional Team Collaboration Scale-II-J (AITCS-II-J), the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), and the Workplace Support Scale. Descriptive statistics and multiple regression analyses were used for data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 760 targeted, 137 participated, indicating a response rate of 18.0% (100% valid response rate). The AITCS-II-J was associated with the JASSIC and Workplace Support Scale. It was also associated with the JASSIC subscales of “Patient-/Client-/Family-/Community-Centered” and “Facilitation Relationship.” The JASSIC was associated with “Informational Support” and “Evaluative Support.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results indicated that NPs' interprofessional collaboration skills and workplace support were the main factors determining collaboration quality. Additionally, informational and evaluative support from superiors was crucial to improve NPs' ability to collaborate with other professionals. To achieve effective interprofessional collaboration, developing advanced clinical and communication skills among NPs is necessary.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"570-578"},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As older adults lose physical function with age, family members often become primary, unpaid caregivers. In Japan, despite having a universal long-term care (LTC) system, families often still bear the caregiving burden. Limited research exists on who supports older outpatients with daily tasks and healthcare access. This study aimed to identify caregivers' involvement in healthcare access and assistance with household tasks for patients aged 80 years or older.
Methods
A descriptive study at a suburban hospital in Japan from April 2023 to March 2024. We developed a self-administered questionnaire about LTC certification, transportation to the hospital, and daily activities, and distributed it to all outpatients aged 80 and over. Caregivers or staff assisted patients unable to complete it themselves.
Results
Among 371 older patients approached, 359 participated (median age 84; 61.8% female). Among 334 respondents, 32.4% relied on family for visiting the hospital, while 29.3% drove themselves. Fewer used LTC (6.4%) or public transport (7.0%). Reliance on family increased with higher care need levels. Among 358 respondents, 53.4% relied on families for shopping and 48.3% for laundry. Approximately one-third handled these tasks themselves. Use of LTC services was limited (11.7% for shopping, 8.7% for laundry), and reliance on family increased with care needs.
Conclusions
In primary care settings, older adults frequently depend on family caregivers for both access to healthcare and the management of daily household tasks. Primary care professionals are well-positioned to recognize and address these prevalent challenges.
{"title":"Family caregiver facilitating access to healthcare and providing daily support for older patients: A descriptive study","authors":"Junki Mizumoto MD, PhD, Hirohisa Fujikawa MD, PhD, Masashi Izumiya MD, PhD, Masato Eto MD, PhD","doi":"10.1002/jgf2.70064","DOIUrl":"https://doi.org/10.1002/jgf2.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As older adults lose physical function with age, family members often become primary, unpaid caregivers. In Japan, despite having a universal long-term care (LTC) system, families often still bear the caregiving burden. Limited research exists on who supports older outpatients with daily tasks and healthcare access. This study aimed to identify caregivers' involvement in healthcare access and assistance with household tasks for patients aged 80 years or older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive study at a suburban hospital in Japan from April 2023 to March 2024. We developed a self-administered questionnaire about LTC certification, transportation to the hospital, and daily activities, and distributed it to all outpatients aged 80 and over. Caregivers or staff assisted patients unable to complete it themselves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 371 older patients approached, 359 participated (median age 84; 61.8% female). Among 334 respondents, 32.4% relied on family for visiting the hospital, while 29.3% drove themselves. Fewer used LTC (6.4%) or public transport (7.0%). Reliance on family increased with higher care need levels. Among 358 respondents, 53.4% relied on families for shopping and 48.3% for laundry. Approximately one-third handled these tasks themselves. Use of LTC services was limited (11.7% for shopping, 8.7% for laundry), and reliance on family increased with care needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In primary care settings, older adults frequently depend on family caregivers for both access to healthcare and the management of daily household tasks. Primary care professionals are well-positioned to recognize and address these prevalent challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"585-590"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated social participation trajectories following the Coronavirus Disease 19 (COVID-19) pandemic and its relationship with frailty among community-dwelling older adults.
Methods
We selected 5000 older residents (65–84 years) from Kitaibaraki City, Japan, excluding those certified for long-term care. After the first survey in April 2022, the second survey was conducted with 1931 respondents from the first survey in May 2023. Respondents of the second survey who had participated in social participation activities in January 2020 were eligible for this study. The questionnaire included social participation status in January 2020, April 2022, and May 2023, along with the Kihon Checklist in April 2022 and May 2023. Participants were categorized into four groups according to the participation status: Continued, Resumed, Discontinued in 2023, and Discontinued in 2022. Binary logistic regression analysis assessed the relationship between these groups and frailty risk assessed by Kihon Checklist, adjusting for age, gender, living status, economic conditions, working status, self-rated health, and 2022 frailty status.
Results
Of 1289 respondents (66.8%), 648 were analyzed. Social participation groups were: Continued (284, 43.8%), Resumed (119, 18.4%), Discontinued in 2023 (92, 14.2%), and Discontinued in 2022 (153, 23.6%). The Discontinued in 2022 group had a significantly higher risk of frailty (OR = 2.26, 95% CI: 1.16–4.42, p = 0.017) compared to the Continued group.
Conclusions
Social participation trajectories are associated with frailty risk in older adults. Sustained discontinuation of social activities, particularly since 2022, is related to increased frailty risk, highlighting the importance of maintaining social engagement.
背景本研究调查了2019冠状病毒病（COVID-19）大流行后社区老年人的社会参与轨迹及其与虚弱的关系。方法我们从日本北原市选取5000名老年居民（65-84岁），不包括获得长期护理认证的老年人。在2022年4月的第一次调查之后，在2023年5月的第一次调查中，有1931名受访者进行了第二次调查。第二次调查的受访者在2020年1月参加过社会参与活动，符合本研究的条件。问卷包括2020年1月、2022年4月和2023年5月的社会参与状况，以及2022年4月和2023年5月的基洪清单。参与者根据参与状态分为继续、恢复、2023年停止和2022年停止四组。在调整年龄、性别、生活状况、经济状况、工作状况、自评健康状况和2022年衰弱状态等因素后，通过二元logistic回归分析评估这些人群与Kihon Checklist评估的衰弱风险之间的关系。结果1289人（66.8%）中，分析648人。社会参与群体为：继续（284人，43.8%）、恢复（119人，18.4%）、2023年停止（92人，14.2%）、2022年停止（153人，23.6%）。与继续组相比，2022年停药组的衰弱风险明显更高（OR = 2.26, 95% CI: 1.16-4.42, p = 0.017）。结论社会参与轨迹与老年人衰弱风险相关。社会活动持续中断，特别是自2022年以来，与脆弱性风险增加有关，这凸显了保持社会参与的重要性。
{"title":"Relationship of frailty and resumption of social participation activities after the COVID-19 pandemic among community-dwelling older adults in Japan","authors":"Sachiko Ozone MD, PhD, Ryohei Goto PT, PhD, Shogo Kawada PT, PhD, Shoji Yokoya MD, PhD, Tetsuhiro Maeno MD, PhD","doi":"10.1002/jgf2.70061","DOIUrl":"https://doi.org/10.1002/jgf2.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study investigated social participation trajectories following the Coronavirus Disease 19 (COVID-19) pandemic and its relationship with frailty among community-dwelling older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We selected 5000 older residents (65–84 years) from Kitaibaraki City, Japan, excluding those certified for long-term care. After the first survey in April 2022, the second survey was conducted with 1931 respondents from the first survey in May 2023. Respondents of the second survey who had participated in social participation activities in January 2020 were eligible for this study. The questionnaire included social participation status in January 2020, April 2022, and May 2023, along with the Kihon Checklist in April 2022 and May 2023. Participants were categorized into four groups according to the participation status: Continued, Resumed, Discontinued in 2023, and Discontinued in 2022. Binary logistic regression analysis assessed the relationship between these groups and frailty risk assessed by Kihon Checklist, adjusting for age, gender, living status, economic conditions, working status, self-rated health, and 2022 frailty status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1289 respondents (66.8%), 648 were analyzed. Social participation groups were: Continued (284, 43.8%), Resumed (119, 18.4%), Discontinued in 2023 (92, 14.2%), and Discontinued in 2022 (153, 23.6%). The Discontinued in 2022 group had a significantly higher risk of frailty (OR = 2.26, 95% CI: 1.16–4.42, <i>p</i> = 0.017) compared to the Continued group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Social participation trajectories are associated with frailty risk in older adults. Sustained discontinuation of social activities, particularly since 2022, is related to increased frailty risk, highlighting the importance of maintaining social engagement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"563-569"},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychological stress like depression, anxiety, and anger is a common comorbidity of irritable bowel syndrome (IBS). This clinical pilot study aimed to investigate if individuals employ emotional suppression to cope with the psychological burden associated with IBS.
Methods
Emotional suppression was measured with the Courtauld Emotional Control Scale (CECS) in non-IBS (50 women/50 men; average age 24.5 years) and IBS subjects (58 women/41 men; average age 41.0 years). IBS diagnosis was performed using the IBS questionnaire for Health Care Providers of the World Gastroenterology Organization, and the severity of IBS symptoms was assessed with the IBS Severity Scoring System.
Results
Individuals with moderate to severe IBS showed significantly higher emotional suppression compared with non-IBS subjects. Scores (median, interquartile range (IQR)) of the general coefficient of emotional control were 52.0 (IQR 48–56) vs. 45.0 (IQR 43–48) (p < 0.001), for depression 19.0 (IQR 17–21) versus 15.5 (IQR 15–17) (p < 0.001), for anxiety 17.0 (IQR 15–18) versus 15.0 (IQR 14–16) (p < 0.001), and for anger 16.0 (IQR 15–19) versus 14.5 (IQR 13–16) (p < 0.001) for IBS and non-IBS subjects, respectively.
Conclusion
IBS patients have higher emotional control levels compared with non-IBS patients. Concealing emotions is considered a negative approach for dealing with psychological stress. Physicians and individuals with IBS should be aware of these facts. Including therapeutic approaches to address emotional control as part of IBS treatment is recommended.
{"title":"Coping with the burden of irritable bowel syndrome by emotional suppression—A cross sectional observational pilot study","authors":"Henning Sommermeyer PhD, Magdalena Ciesla MD, Dominika Szczerbiec PhD, Pawel Olszewski MD, Paulina Wojtyla-Buciora PhD, Jacek Piatek MD, PhD","doi":"10.1002/jgf2.70060","DOIUrl":"https://doi.org/10.1002/jgf2.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psychological stress like depression, anxiety, and anger is a common comorbidity of irritable bowel syndrome (IBS). This clinical pilot study aimed to investigate if individuals employ emotional suppression to cope with the psychological burden associated with IBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Emotional suppression was measured with the Courtauld Emotional Control Scale (CECS) in non-IBS (50 women/50 men; average age 24.5 years) and IBS subjects (58 women/41 men; average age 41.0 years). IBS diagnosis was performed using the IBS questionnaire for Health Care Providers of the World Gastroenterology Organization, and the severity of IBS symptoms was assessed with the IBS Severity Scoring System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Individuals with moderate to severe IBS showed significantly higher emotional suppression compared with non-IBS subjects. Scores (median, interquartile range (IQR)) of the general coefficient of emotional control were 52.0 (IQR 48–56) vs. 45.0 (IQR 43–48) (<i>p</i> < 0.001), for depression 19.0 (IQR 17–21) versus 15.5 (IQR 15–17) (<i>p</i> < 0.001), for anxiety 17.0 (IQR 15–18) versus 15.0 (IQR 14–16) (<i>p</i> < 0.001), and for anger 16.0 (IQR 15–19) versus 14.5 (IQR 13–16) (<i>p</i> < 0.001) for IBS and non-IBS subjects, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>IBS patients have higher emotional control levels compared with non-IBS patients. Concealing emotions is considered a negative approach for dealing with psychological stress. Physicians and individuals with IBS should be aware of these facts. Including therapeutic approaches to address emotional control as part of IBS treatment is recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"555-562"},"PeriodicalIF":2.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Primary care is a core component of most healthcare systems. Patients often present with symptoms that can be investigated and treated by primary care clinicians without requiring further specialist input. Although the way primary care is provided differs across countries, it serves various purposes, including providing continuity of care, coordinating with secondary care services, and offering a patient-centered approach to encourage individuals to take control of their health.</p><p>Despite its global importance, the clinical education system in Japan places limited focus on primary care. Undergraduate education primarily focuses on specialists and secondary care. Although structured training programs have recently been established in general practice and family medicine, physicians often enter primary care roles without undergoing formal retraining. Given that Japan's rapidly aging population will lead to an increase in patients with complex multimorbidities and long-term conditions, physicians in Japan must be equipped with the knowledge to treat them through an effective primary care education system.</p><p>There are several differences between primary care education in the United Kingdom and Japan (Table 1). Primary care in the United Kingdom is mainly delivered through the specialty of General Practice. The United Kingdom places a strong emphasis on GP training as a core part of undergraduate education, with the General Medical Council (GMC), the UK's medical regulatory body, advising that all students should be placed in General Practice.<span><sup>1</sup></span> Medical students in the United Kingdom typically spend longer studying General Practice than students in Japan. Research suggests that across all UK medical schools, students spent a median of 53 full days either in teaching sessions or on placement at GP surgeries.<span><sup>2</sup></span> In contrast, the Japanese medical curriculum remains largely focused on specialist care, with the median duration of community-based clinical training estimated at approximately 12 days to 4 weeks.<span><sup>3</sup></span> Therefore, UK graduates typically gain more experience in primary care than their Japanese counterparts, potentially increasing their understanding of the GP specialty when leaving medical school.</p><p>After graduating, doctors in the United Kingdom undertake 2 years of foundation training, which is equivalent to 2 years of junior residency in Japan. During these 2 years, all doctors should undertake community placement, meaning that many of them experience 4 months of work in General Practice. Upon completion, doctors in the United Kingdom choosing to specialize in GP complete three further years of specialty training. This involves the time spent in the relevant hospital departments and approximately 18–24 months in GP posts.<span><sup>4</sup></span> Following the completion of this program, doctors must pass the Royal College of General Practitioner (RCGP) exams to pr
{"title":"Advancing primary care education: Lessons from the United Kingdom for Japan","authors":"Lauren Glover MD, Takashi Watari MD, MHQS, PhD, Tomoko Miyoshi MD, ME, PhD, Hitomi Kataoka MD, PhD","doi":"10.1002/jgf2.70058","DOIUrl":"https://doi.org/10.1002/jgf2.70058","url":null,"abstract":"<p>Primary care is a core component of most healthcare systems. Patients often present with symptoms that can be investigated and treated by primary care clinicians without requiring further specialist input. Although the way primary care is provided differs across countries, it serves various purposes, including providing continuity of care, coordinating with secondary care services, and offering a patient-centered approach to encourage individuals to take control of their health.</p><p>Despite its global importance, the clinical education system in Japan places limited focus on primary care. Undergraduate education primarily focuses on specialists and secondary care. Although structured training programs have recently been established in general practice and family medicine, physicians often enter primary care roles without undergoing formal retraining. Given that Japan's rapidly aging population will lead to an increase in patients with complex multimorbidities and long-term conditions, physicians in Japan must be equipped with the knowledge to treat them through an effective primary care education system.</p><p>There are several differences between primary care education in the United Kingdom and Japan (Table 1). Primary care in the United Kingdom is mainly delivered through the specialty of General Practice. The United Kingdom places a strong emphasis on GP training as a core part of undergraduate education, with the General Medical Council (GMC), the UK's medical regulatory body, advising that all students should be placed in General Practice.<span><sup>1</sup></span> Medical students in the United Kingdom typically spend longer studying General Practice than students in Japan. Research suggests that across all UK medical schools, students spent a median of 53 full days either in teaching sessions or on placement at GP surgeries.<span><sup>2</sup></span> In contrast, the Japanese medical curriculum remains largely focused on specialist care, with the median duration of community-based clinical training estimated at approximately 12 days to 4 weeks.<span><sup>3</sup></span> Therefore, UK graduates typically gain more experience in primary care than their Japanese counterparts, potentially increasing their understanding of the GP specialty when leaving medical school.</p><p>After graduating, doctors in the United Kingdom undertake 2 years of foundation training, which is equivalent to 2 years of junior residency in Japan. During these 2 years, all doctors should undertake community placement, meaning that many of them experience 4 months of work in General Practice. Upon completion, doctors in the United Kingdom choosing to specialize in GP complete three further years of specialty training. This involves the time spent in the relevant hospital departments and approximately 18–24 months in GP posts.<span><sup>4</sup></span> Following the completion of this program, doctors must pass the Royal College of General Practitioner (RCGP) exams to pr","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"504-507"},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Effective collaboration both within and beyond hospital settings, grounded in an understanding of the social determinants of health (SDH), can improve the quality of care, especially in discharge planning and readmission prevention.<span><sup>1</sup></span> In acute care hospital wards, where medical services are often fragmented, general practitioners are expected to deliver care informed by SDH-related evidence, adopting a holistic and patient-centered approach.</p><p>At the 30th Annual Meeting of the Japanese Society of Hospital General Medicine, we convened a symposium to explore the necessity of evidence-based interventions targeting SDH to reduce readmissions and support effective discharge planning in hospital settings.</p><p>First, we presented recent evidence on the prevention of readmissions through interventions addressing the social determinants affecting patients with chronic heart failure—an ambulatory care-sensitive condition of great relevance. While the evidence on the effectiveness of social interventions for reducing readmissions remains inconsistent, current data suggest that individualized, context-sensitive support may provide benefit. For instance, younger male patients have been identified as being at higher risk of readmission, and targeted lifestyle modifications, including dietary changes and medication adherence, have demonstrated efficacy.<span><sup>2</sup></span> Additionally, a retrospective observational study of heart failure patients in Japan shows that structured once-weekly monitoring for patients with dementia is independently associated with readmission, demonstrating the importance of social support.<span><sup>3</sup></span></p><p>Second, we introduced a case study from a large acute care hospital that has implemented a continuum of care framework focused on the “Patient Journey.” This initiative seeks to identify patients' SDH and deliver context-sensitive support aligned with their personal values. We demonstrated that screening for SDH during hospitalization, alongside integrated admission and discharge planning, can improve post-discharge outcomes for both older adults and pediatric patients.<span><sup>4</sup></span> Among older patients, a narrative review and thematic analysis highlight the complexity of frail syndrome and the need for contextualized interventions.<span><sup>5</sup></span> By embedding SDH screening into the clinical pathways for geriatric syndromes, socioeconomic status, educational attainment, social support, and housing conditions were systematically addressed by the interdisciplinary admission and discharge support team. This approach has the potential to improve healthcare quality, including reduced hospital length of stay and lower readmission rates.</p><p>Finally, we discussed an original case that one of the authors experienced involving a heart failure patient who experienced fragmented care delivery, and we examined strategies for the patient journey. The case is an 80-yea
在了解健康的社会决定因素（SDH）的基础上，医院内外的有效合作可以提高护理质量，特别是在出院计划和再入院预防方面在急症病房，医疗服务往往是碎片化的，全科医生应该根据与sdh相关的证据提供护理，采用整体和以患者为中心的方法。在日本医院综合医学学会第30届年会上，我们召开了一次研讨会，探讨针对SDH的循证干预措施的必要性，以减少再入院率，并支持医院环境中有效的出院计划。首先，我们提出了最近关于通过解决影响慢性心力衰竭患者的社会决定因素的干预措施来预防再入院的证据——慢性心力衰竭是一种非常相关的门诊护理敏感疾病。虽然关于社会干预对减少再入院的有效性的证据仍然不一致，但目前的数据表明，个性化的、对环境敏感的支持可能会带来好处。例如，年轻的男性患者被认为有更高的再入院风险，有针对性的生活方式改变，包括饮食改变和药物依从性，已经证明是有效的此外，日本一项针对心力衰竭患者的回顾性观察研究显示，对痴呆症患者进行每周一次的结构化监测与再入院独立相关，这表明了社会支持的重要性。其次，我们介绍了一家大型急症护理医院的案例研究，该医院实施了以“患者旅程”为重点的连续护理框架。这一举措旨在确定患者的SDH，并提供符合其个人价值观的上下文敏感支持。我们证明，在住院期间进行SDH筛查，以及综合入院和出院计划，可以改善老年人和儿科患者的出院后结果在老年患者中，叙述性回顾和专题分析强调了虚弱综合征的复杂性和对情境化干预的需要通过将SDH筛查纳入老年综合征的临床途径，跨学科入院和出院支持团队系统地解决了社会经济地位、教育程度、社会支持和住房条件等问题。这种方法有可能提高医疗保健质量，包括缩短住院时间和降低再入院率。最后，我们讨论了一个原始案例，其中一位作者经历了一个心力衰竭患者，他经历了支离破碎的护理服务，我们研究了患者旅程的策略。该病例是一名独居日本山区的80岁老年妇女，患有慢性心力衰竭和轻度痴呆。在门诊医生不知情的情况下因心力衰竭住院，出院后因入院医院配合不力心力衰竭再次加重。这个案例在听众中引发了激烈的讨论。住院是解决社会脆弱问题、开展痴呆症评估和促进引入长期护理保险服务的关键机会。必须让所有有助于支持患者日常生活和长期健康的利益攸关方参与进来。总之，强调SDH和促进跨机构边界的协作护理可以大大提高医疗保健质量。由于最佳干预策略因个体患者的情况和条件而异，全科医生和医院初级保健医生必须继续积极发表案例研究和实证研究，以指导未来的实践。小坂信太郎获得了大冢制药厂和Mypecon的讲座酬金，以及Cardinal Health、MEDSI和IGAKU-SHOIN Ltd的手稿写作酬金。他还获得了Triple W Japan和卫生劳动科学研究基金的研究资助。所有其他作者声明他们没有利益冲突。
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