徳島市医師会における在宅医療への取り組み

Japan is heading toward a super-aging society at a rate unparalleled with other countries. The vast increase in demand for medical treatment and care will exceed existing social resources by 2025 when the baby boom generation becomes older than 75 years. There are concerns that this may lead to the collapse of acute medical care, break out refugee Home Medical Care, and the loss of end-of-life care facilities in various areas. Therefore, Japan is promoting the establishment of a comprehensive community care system designed to allow elderly individuals to live in their own community with dignity for as long as possible. The development of home medical care is being promoted as the core component of this system.
The Tokushima City Medical Association has assessed the possible risks associated with this super-aging society that should emerge at a relatively early stage. Furthermore, the development of home medical care for the public to support community medical care is regarded as the best means of tackling future challenges. Therefore, we set up the Home Care Cooperation Committee in 2008 and have worked to develop home care in Tokushima City.
The Tokushima City Medical Association participated in the Home Medical Care Cooperation Base Service of commissioned projects by the Ministry of Health, Labour and Welfare as one of 105 institutions in whole country in 2012. Since 2013, we have already been implementing this with Tokushima City administration as a subsidized institution under the three year’s Home Medical Care Cooperation Base Service which was performed by the Tokushima prefecture. This base of operations incorporates the following five mandatory directives : 1. identify solutions to multidisciplinary cooperation issues, 2. develop a multidisciplinary cooperation system and a 24-h response system, 3. raise awareness among residents, 4. educate personnel engaged in home medical care, and 5. set up a consultation service for home medical care.
Because of community demands for projects to be implemented in a more area-wise appropriate manner, the Tokushima Home Care Cooperation Committee was newly established following general consensus within the association. This committee was composed of 14members not limited to individuals from medical associations ; individuals from the local government and various professions involved in home medical care were recruited and made decisions regarding operating policies.
The current major challenge in Tokushima City is the lack of a means to disseminate proposed solutions for home medical care throughout the entire community. Therefore, we are promoting the establishment of multiple working groups on home medical care to tackle this challenge in the future.
In addition, we intend to summarize the various challenges and their solutions that we identified during the course of our operations, draw up guidelines on home medical care based on the agreement of the local government and various professions and disseminate these guidelines throughout the community. We aim to effectively operate and from multiple levels a mutual support system between doctors who have long been working in medical associations, a multidisciplinary, conscientious cooperation system to support patients, a streamlined cooperation system for hospital admission and discharge, and a patient information sharing system utilizing ICT. These systems will be operated in parallel with our base operations.
We also aim to promote the future improvement of environments in which as many family doctors as possible can examine their patients at home with ease until their patient’s final breath. This should enable us to provide high-quality home medical care equally and widely throughout the community.
We hereby report the home medical care initiatives and future projects of the Tokushima City Medical Association centered on the Home Medical Care Cooperation Based Project.

P.71の著者の英語表記に誤植（誤）Toyusaki（正）Toyosaki