“From Health Center to Community” January 4, 19:19

This is the beginning of a new year with a strong desire to regain a peaceful life.

It is the new coronavirus "Omicron strain" that rages in the world as if to destroy that earnest feeling.



Measures such as vaccines and oral drugs are also in progress, but their characteristics are not yet fully understood, and it is unpredictable what kind of effect they will have in Japan.

If the infection spreads as it is, the hospital will be full and hospitalization will not be possible, and the severe condition of having to stay at home will be reborn.

I think there are many people who have such anxiety.



The movement to face the anxiety and try to resolve it is gradually spreading.


The keyword is "from health center to community".



(Sayaka Kobayashi, Social Affairs Department)

Forefront of New Year's return

Last December 24th, at the Shinagawa Ward Health Center in Tokyo on Christmas Eve.



Dr. Uko Takachopsticks, who is the chief of the health prevention section, was busy in the ward.

This is to go around the homes of close contacts of Omicron strains and collect samples.



As a border measure for Omicron strains, the government has identified all those who were on the same plane as the infected as close contacts and requested that they stay in lodging facilities or at home for 14 days.

In addition, since they were required to undergo three PCR tests after entering Japan, the staff of health centers in each region visited individually to collect the samples.



From December 27, the range of close contacts on board was reduced to two rows before and after the infected, but on that day, 66 close contacts were at home in Shinagawa Ward alone.



For this reason, the section chief himself collected and collected the sample.



Furthermore, the infected person of Omicron strain was confirmed for the first time in the ward, and more than 10 staff members went to work every day during the year-end and New Year holidays, and it was forced to take measures without holidays.

Shinagawa Ward Health Center, Uko Takachopsticks Health Prevention Section Chief


"I thought that the 5th wave was calming down and I could spend the year-end and New Year holidays calmly, but that was not the case with the wholesaler. If the infection spreads further in the city, the current number of people will not be enough. I am doing it with a sense of mission to protect the people and the people of Tokyo. "

Nightmare again?

Growing concerns

A situation in which there are many infected people and close contacts in a "home" without medical equipment.

In fact, many areas have experienced it last year.



A wave of infection in which mutant strains raged.

It is the 4th wave of spring in Kansai and Hokkaido, and the 5th wave of summer in Kanto.

The number of infected people increased explosively and the beds became tight, and even people with severe symptoms could not be hospitalized and had to wait at home.



At the moment, in principle, people infected with Omicron strain can be hospitalized, but some people are concerned that the "nightmare" at that time may be repeated again.

I am Dr. Chusuke Inaji, who specializes in home-visit medical care in Funabashi City, Chiba Prefecture.



The origin of Dr. Inaji's concern was last August.

It was a phone call from a local health center that suddenly came in the car to my usual home visit.

This is a request for a home visit to a home recuperator.

Dr. Inaji had never seen a patient with the new coronavirus.



However, when I took it on the spot and rushed to the patient's home, I saw that there was a remaining amount of oxygen cylinder, but I could not find a hospitalization destination and an ambulance was waiting for hours at home. It was the harsh reality of the person.



Among them, Dr. Inaji is a male patient in his 60s.



I heard from the health center that it was relatively mild, but when I moved a little, it was said that I was in a dangerous state where the oxygen saturation in the blood dropped to the 70% level.

At this time, the man was 9 days after the onset.

When he couldn't protect the man who lived alone, he strongly appealed to the health center for his hospitalization.



However, three days later without finding a hospital.

A man was found dead in a corridor at home.

It is said that Dr. Inaji continued to respond to home visits and telephone calls until the day before.

Yushokai Home Clinic Director Chusuke Funabashi


"It was an example of

remorse. I wonder

if it was a life that was originally saved because we were able to go to the home visit. At this time, the number of patients was at its peak, so I think it was difficult for the health center, but if you live alone without watching over, you have to deal with it especially quickly. I wonder if there was a breakthrough if was strengthened. "

Why the health center is tight

How can we prevent the worst case of a patient dying at home?

Dr. Inaji believes that the key to the current work of the health center is.



At the time of the 5th wave, the information on the patients brought to Dr. Inaji from the health center was scarce, the patient's condition was insufficiently grasped, and the equipment necessary for oxygen inhalation at home had to be arranged by himself. It is said that the health center and local doctors were not able to fully cooperate with each other.

Yushokai Home Clinic Director Chusuke Funabashi


"I didn't understand what home-visit medical care and oxygen administration at home were, and I felt uncomfortable with the appearance of introducing patients. The health center is rooted in the community. Even though I was singing the service, it seemed like I was throwing the ball and leaving it to me. "

If you are infected with the new coronavirus, the law stipulates that hospitalization should be adjusted by the health center in principle.



However, it was not clearly defined who would be responsible for medical treatment if a patient with an infectious disease requiring isolation could not be hospitalized and was treated at home.

As a result, the health center had no choice but to support home care workers who had never experienced it before, and the work became tight.



The director of a health center in the Tokyo metropolitan area recalls, "The delay in dealing with mildly ill people has created a vicious circle in which symptoms worsen and work doubles."



Based on this experience, Dr. Inaji said that he was keenly aware of the need for an urgent need to put in place a mechanism to support patients throughout the region, rather than having the health center take charge of all medical coordination.

Yushokai Home Clinic Director Chusuke Funabashi


"There is a limit to how much the health center can handle, and there is a limit to protecting the area with only volunteer doctors. The crisis cannot be overcome unless we take the attitude of "seeing ourselves." Now, the health center must listen to the opinions of local doctors and create a system to protect patients in the area. "

Protecting home recuperators in the community

"Collaboration between health center and community" appealed by Dr. Inaji.

The Shinagawa Ward Health Center in Tokyo, which I introduced at the beginning, is one of the first to promote this.



In Shinagawa Ward, the number of home care recipients per day reached a maximum of 218 in August last year.

The health center has fallen into a state where it cannot keep up with the number of staff twice as many as usual.



It was the doctors of the local medical association who started to support these health centers.

Practitioners at local clinics and others have advocated an approach to seeing home caregivers online.

In the past, when a patient occurred, the health center individually interviewed, adjusted the hospitalization destination, arranged for a home-visit doctor, and coordinated with the pharmacy.



This individual matching took a lot of work.



The idea of ​​the doctors in Shinagawa Ward was to take part in the work of the health center, such as coordination with pharmacies and daily health observations, with the online medical treatment by local doctors as the entrance.

The procedure is summarized as follows.

1. The patient at home is given an ID to log in to online medical care from the health center.



2. When the patient logs in, a local doctor who is waiting online in turn will see the doctor.



3. The doctor will give a prescription to the pharmacy in charge. and FAX, pharmacist is delivered to the home medicine



pharmacist who deliver 4. drugs, in accordance with the guidance of the drinking of the medicine, every day of interviews the health state



and 5. need with local doctors and if it is determined nurse Home visit

Hajime Kato, Chairman of the Shinagawa Ward Pharmacist Association


"Along with the guidance on how to take medicine, you can also ask about problems in your life such as understanding the patient's health condition and whether you are eating properly. This summer, the health center I was on the verge of puncture, so I thought that if we pharmacists were in charge of health observation, it would help the public health nurse. "

Director Kazuhiro Miura, Shinagawa Ward Medical Association


"Because we will be able to treat patients from an early

stage

, hospitals can concentrate on treating more severely ill patients. Also, for health centers, matching will be easier and we will spend more time investigating close contacts. This will help prevent infections. I think we have created a virtuous cycle in which each region can share what it should do. "

Until now, some doctors were reluctant to see patients with the new coronavirus because it was difficult to control infection, but if there was no fear of infection in online medical care, the number of participating doctors gradually increased to 18.



In addition, we are trying to expand the base by holding workshops for doctors, nurses, pharmacists, etc. in the ward.

The doctor who participated in the training


"I was able to communicate with the three parties, such as a health center, a hospital, and a general medical institution like us, in a face-to-face relationship. I want to do my best "

Doctors who participated in the training


"Not only the

doctors in the

hospital have a hard time, we are the same doctors. I thought that many people should participate in order to work together. There is a limit to what a practitioner can do. I've been doing it, but I'll do my best. "

The Shinagawa Ward Health Center hopes that if there is this mechanism supported by the community, it will be possible to meet the Omicron strain.

Shinagawa Ward Health Center, Uko Takachopsticks Health Prevention Section Chief


"Since it is impossible to deal with patients only at the

health center, we will use the help

of those who are good at the impossible. Originally, it is the local doctors who support the patients' home medical care. I'm a nurse's specialty, so even if the number of home care patients increases, I think I'll be able to deal with various occupations. "

Cooperation with the region led by the national and local governments

Now that the Omicron strain is spreading rapidly across the country, what can we do to avoid repeating nightmares?

Many local governments are being questioned.



There is no doubt that one of the keywords is "from health center to community".



In the fifth wave, it was pointed out that Corona's response worked relatively well in areas where cooperation between governments and health centers and local medical institutions was originally advanced, but there was a large difference from areas where it was not. increase.



The Ministry of Health, Labor and Welfare also requested each prefecture to formulate a plan for cooperation with local medical institutions, and announced that it had built a system to cooperate with about 34,000 medical institutions.

Cooperation like Shinagawa Ward is also progressing.



However, simply listing medical institutions does not work.

Who and how will they work together according to individual circumstances such as the number of hospitals and doctors that differ from region to region, the age group of residents, and lifestyle habits?



It is time for the national and local governments to take the lead in creating a mechanism for fine-tuned cooperation with doctors and pharmacists who know the actual situation in the region as soon as possible.


Sayaka Kobayashi ,

Reporter, Social Affairs Department


Joined in 2007


After working at the Kitakyushu Bureau and Fukuoka Bureau


, from 2019,


mainly covered care and child-rearing in charge of the Ministry of Health, Labor and Welfare.