目的:医疗设施之间的合作对于向众多的癫痫患者提供全面的癫痫治疗至关重要。我们在日本各地不同规模的医疗机构中进行了一项调查,以调查癫痫护理的提供状况,功能,和推荐。
方法:在日本神经学会(1,428个设施)的合作下,日本神经外科学会(3,489名专家),和癫痫护理网络(948个设施),调查问卷邮寄至日本提供癫痫治疗的5,865个地点.这些设施被分类为诊所(19张床位或更少),小型医院(SH,20至199张床),大型医院(LH,200张床或更多),和癫痫中心(EC)。癫痫护理的现状,功能,并比较四组的转诊情况。
结果:收到了来自1,014个机构的答复(答复率为17.3%)。排除重复响应后,对957个设施进行了分析(394个诊所,149SH,388LH,26欧共体)。欧共体在更多的癫痫护理功能项目中回应“可管理”,尤其是那些与癫痫手术有关的手术,与设施规模相似的LH相比。然而,欧共体在精神科服务中的反应不太容易管理(61.5%),饮食疗法(46.2%),康复(53.8%),和病人就业支持(61.5%)。回答“总是能够参考”的设施百分比在诊所中最高(67.6%),在EC中最低(40%)。转诊困难在EC中更常见,在诊所不太常见。在EC中,无法转诊的最常见原因是患者或家属拒绝(64%).
结论:我们已经澄清了癫痫护理的提供,在日本各种规模的设施中运作和转诊。这项研究强调了EC的向下转诊和患者停滞的问题,没有受到太多关注。
OBJECTIVE: Collaboration among medical facilities is crucial to deliver comprehensive epilepsy care to a diverse and large population of people with epilepsy. We conducted a survey among medical facilities of various sizes throughout Japan to investigate the status of epilepsy care delivery, functioning, and referral.
METHODS: With the cooperation of the Japan Neurological Society (1428 facilities), Japanese Neurosurgical Society (3489 specialists), and Epilepsy Care Network (948 facilities), a questionnaire was mailed to 5865 locations that provide epilepsy care in Japan. The facilities were classified into clinics (19 beds or less), small hospitals (SH, 20-199 beds), large hospitals (LH, 200 beds or more), and epilepsy centers (EC). The status of epilepsy care delivery, functioning, and referral was compared among the four groups.
RESULTS: Responses were received from 1014 facilities (17.3% response rate). After excluding duplicate responses, 957 facilities were analyzed (394 clinics, 149 SH, 388 LH, 26 EC). EC responded \"manageable\" in more items of epilepsy care functions in general, especially those related to epilepsy surgery, compared to LH with similar facility size. However, EC responded being less manageable in psychiatric service (61.5%), dietary therapy (46.2%), rehabilitation (53.8%), and patient employment support (61.5%). The percentage of facilities that responded \"always able to refer\" was highest in clinics (67.6%) and the lowest in EC (40%). Referral difficulties were more commonly encountered in EC, and less common in clinics. In EC, the most common reason for inability to refer was patient or family refusal (64%).
CONCLUSIONS: We have clarified the epilepsy care delivery, functioning, and referral in facilities of various sizes in Japan. This study highlights the issues of downward referral and patient
stagnation in EC, which have not received much attention.
CONCLUSIONS: A nationwide survey of healthcare facilities ranging in size from small clinics to large hospitals in Japan examined medical care delivery and patient referrals related to epilepsy. Compared to other facilities, epilepsy centers provided a variety of medical services to people with epilepsy but were inadequate in addressing psychiatric symptoms, providing dietary therapy, rehabilitation, and patient employment support. Referrals from epilepsy centers to other medical facilities were often refused by patients and their families. This results in patient crowding at epilepsy centers.