新潟県内の病院における摂食嚥下障害の評価およびリハビリテーション診療体制調査  [in Japanese] A Survey of Medical Systems for Dysphagia Evaluation and Rehabilitation at Hospitals in Niigata Prefecture  [in Japanese]

Access this Article

Author(s)

    • 張替 徹 HARIGAI Toru
    • 新潟大学医歯学総合病院総合リハビリテーションセンター Rehabilitation Center, Niigata University Medical and Dental Hospital
    • 木村 慎二 KIMURA Shinji
    • 新潟大学医歯学総合病院総合リハビリテーションセンター Rehabilitation Center, Niigata University Medical and Dental Hospital
    • 眞田 菜緒 SANADA Nao
    • 新潟大学医歯学総合病院総合リハビリテーションセンター Rehabilitation Center, Niigata University Medical and Dental Hospital
    • 遠藤 直人 ENDO Naoto
    • 新潟大学医歯学総合病院総合リハビリテーションセンター|新潟大学医歯学総合病院整形外科 Rehabilitation Center, Niigata University Medical and Dental Hospital|Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital
    • 伊藤 加代子 ITO Kayoko
    • 新潟大学大学院医歯学総合研究科摂食嚥下リハビリテーション学 Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences
    • 井上 誠 INOUE Makoto
    • 新潟大学大学院医歯学総合研究科摂食嚥下リハビリテーション学 Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences

Abstract

<p>【目的】新潟県内の病院における摂食嚥下障害の評価とリハビリテーション(以下,リハ)の実施状況,診療受け入れが可能な病院の分布を把握し,地域の摂食嚥下障害診療システムを構築するうえでの課題について検討する.【方法】調査期間は 2014年 7月 1日から 8月 30日.新潟県内の全病院に調査用紙を郵送した.内容は,摂食嚥下障害の評価とリハ実施の有無,関わる職種,検査内容,摂食嚥下障害のための特別食の有無・種類,摂食嚥下障害の評価・リハ(評価かリハの一方あるいは両方)の他医療機関からの受け入れ,受け入れ不可能な理由などである.調査結果から,摂食嚥下障害患者の受け入れが可能な病院の分布図を作成した.【結果】 130病院中 120病院(92.3%)から回答を得た.評価は 93病院(回答した 120病院の 77.5%),リハは 83病院(69.2%)で実施されていた.評価・リハに関わる職種は,言語聴覚士が 71病院(評価・リハが実施されていた 94病院の 75.5%),医師 70病院(74.5%),看護師 65病院(69.1%)などであった.嚥下造影検査は 41病院(評価が実施されていた 93病院の 44.1%),嚥下内視鏡検査は 29病院(31.2%)で実施されていた.特別食は 120病院中 94病院(78.3%)で提供されていた.評価・リハの外来での受け入れ意向があったのは 120病院中 47病院(39.2%),入院での受け入れ意向があったのは 60病院(50.0%)であった.受け入れ不可能な理由は,人員の不足,経験・知識の不足,機器の準備がない,などであった.精査(嚥下造影検査か嚥下内視鏡検査の一方あるいは両方)を実施,かつ外来受け入れ意向があったのは 120病院中 33病院(27.5%),入院受け入れ意向があったのは 37病院(30.8%)で,成人の受け入れ可能な病院はすべての二次医療圏に存在したが, 2つの二次医療圏で小児の受け入れ可能な病院がなかった.【結論】新潟県では約 70%の病院で摂食嚥下障害の評価・リハが実施されていたが,他医療機関からの受け入れ可能な病院は 3割程度であった.小児の受け入れ可能な病院がない 2つの二次医療圏の解消が課題である.</p>

<p> Objective:  This study surveyed the situation of evaluation of and rehabilitation for dysphagic patients at hospitals and the distribution of hospitals that can accept dysphagic patients in Niigata Prefecture and presents the problems involved in establishing a medical system for dysphagia.  Methods:  We conducted a questionnaire survey by mail of all hospitals in Niigata Prefecture from July 1, 2014 to August 30, 2014. The questionnaire contained items related to the following: presence or absence of evaluation of and rehabilitation for dysphagic patients; type of medical staff involved in evaluation and rehabilitation for dysphagic patients; examinations used in evaluating dysphagia; presence or absence and details of special foods for dysphagic patients; acceptance or non-acceptance of dysphagic inpatients and outpatients; and reasons for non-acceptance.  Based on the responses, we made a distribution map of the hospitals which accepted dysphagic patients and performed detailed examinations (videofluoroscopic (VF) and/or videoendoscopic examination of swallowing (VE)).  Results:  Among the 130 hospitals, we received responses from 120 hospitals (92.3%). Evaluation of and rehabilitation for dysphagic patients were performed in 93 hospitals (77.5% of the 120 hospitals that answered the questionnaire) and 83 hospitals (69.2%), respectively. The medical staff involved in evaluation and rehabilitation included speech-language-hearing therapists (in 71 hospitals, 75.5% of the 94 hospitals that performed evaluation and/or rehabilitation), physicians (in 70 hospitals, 74.5%), and nurses (in 65 hospitals, 69.1%). VF and VE were performed in 41 hospitals (44.1% of the 93 hospitals that performed evaluation), and 29 hospitals (31.2%), respectively. Special foods for dysphagic patients were provided at 94 hospitals (78.3% of the 120 hospitals). Among the 120 hospitals, 47 hospitals (39.2%) and 60 hospitals (50.0%), respectively, accepted dysphagic outpatients and inpatients. The reasons for declining patients were lack of medical specialists and related staff, lack of experience or knowledge, and inadequate equipment. VF and/or VE was performed at 33 hospitals (27.5% of the 120 hospitals) that accepted outpatients and at 37 hospitals (30.8%) that received inpatients. Every secondary medical zone has hospitals which could accept dysphagic adult patients but two zones had no hospitals which could accept dysphagic children.  Conclusions:  Evaluation of and rehabilitation for dysphagic patients are conducted in over 70% of hospitals in Niigata Prefecture. Among those hospitals, about 30% can accept dysphagic patients from other medical institutions. We should support the two secondary medical zones in which there are no hospitals that can accept dysphagic children. </p>

Journal

  • The Japanese Journal of Dysphagia Rehabilitation

    The Japanese Journal of Dysphagia Rehabilitation 22(1), 3-11, 2018

    The Japanese Society of Dysphagia Rehabilitation

Codes

  • NII Article ID (NAID)
    130007609423
  • NII NACSIS-CAT ID (NCID)
    AA11193069
  • Text Lang
    JPN
  • ISSN
    1343-8441
  • NDL Article ID
    029150027
  • NDL Call No.
    Z74-B252
  • Data Source
    NDL  J-STAGE 
Page Top