Michiko Moriyama

Effectiveness of an educational self-management program for outpatients with chronic heart failure

AIM The occurrence rate of chronic heart failure (CHF) in Japan is estimated to be 50,000 per one million persons. It is important for the Japanese medical financial system to institute a program of disease management in order to prevent the deterioration of persons with CHF. However, there are still few studies on the disease management of CHF in Japan. Therefore, the purpose of this study was to provide an educational self-management program to Japanese outpatients with CHF in order to improve their clinical outcomes. METHODS A randomized, controlled trial with 102 outpatients with CHF was conducted. There were 50 participants in the intervention group and 52 participants in the control group. The control group received medical treatment and standard care. In addition to this, the intervention group also received an educational program for 6 months. The program consisted of six nurse-directed sessions that were provided to each outpatient once per month in a clinical setting for a total of 6 months. A follow-up session was conducted each month for 6 months. The data collection was carried out at the start of the program and at 3, 6, 9, and 12 months. RESULTS Significant differences could be observed in the primary and secondary outcomes and in the process indicators between the two groups after the program began. In other words, all the indicators improved for the intervention group, compared to the control group. Therefore, this program was considered to be effective. CONCLUSION Further long-term care is necessary for outpatients with CHF in order to prevent their deterioration and to maintain their health status, even though this 6 month program did provide them with proper knowledge regarding self-care for CHF and affected their therapy results.

Follow‐up study for a disease management program for chronic heart failure 24 months after program commencement

AIM There are few studies dealing with comprehensive chronic heart failure (CHF) disease management programs, which are based on self-management, in Japan. We developed and conducted a comprehensive educational program for CHF for 6 months that aimed to improve self-management and prevent the deterioration of outpatients with CHF. Our follow-up research focused on whether performance of self-management in the intervention group continued for 24 months after commencement. METHODS Participants were selected from patients who went for follow-up visits to one Japanese clinic, which specialized in cardiovascular internal medicine, that were diagnosed with CHF. During the first follow-up period, 7 to 12 months after program commencement, 47 participants in the intervention group and 47 participants in the control group were analyzed. During the second follow-up period, 13 to 24 months after program commencement, 41 participants in the intervention group were analyzed. RESULTS Participants in the intervention group acquired self-management skills and activities and these continued up to 24 months after the program commencement. As a result, no deterioration in symptoms related to CHF was demonstrated. Meanwhile, quitting smoking and drinking depended on individual preference and it was difficult to improve. CONCLUSIONS The educational program was effective in the long term and the program is significant for use in busy medical situations that do not offer sufficient follow-up support for patients. Regular intervention and ways that produce longer-lasting effects should be further developed.

Baseline Feature of a Randomized Trial Assessing the Effects of Disease Management Programs for the Prevention of Recurrent Ischemic Stroke

BACKGROUND Comprehensive and long-term patient education programs designed to improve self-management can help patients better manage their medical condition. Using disease management programs (DMPs) that were created for each of the risk factor according to clinical practice guidelines, we evaluate their influence on the prevention of stroke recurrence. METHODS This is a randomized study conducted with ischemic stroke patients within 1 year from their onset. Subjects in the intervention group received a 6-month DMPs that included self-management education provided by a nurse along with support in collaboration with the primary care physician. Those in the usual care group received ordinary outpatient care. The primary end point is a difference of the Framingham risk score-general cardiovascular disease 10-year risk [corrected]. Patients were enrolled for 2 years with plans for a 2-year follow-up after the 6-month education period (total of 30 months). RESULTS A total of 321 eligible subjects (average age, 67.3 years; females, 96 [29.9%]), including 21 subjects (6.5%) with transient ischemic attack, were enrolled in this study. Regarding risk factors for stroke, 260 subjects (81.0%) had hypertension, 249 subjects (77.6%) had dyslipidemia, 102 subjects (31.8%) had diabetes mellitus, 47 subjects (14.6%) had atrial fibrillation, and 98 subjects (30.5%) had chronic kidney disease. There were no significant differences between the 2 groups with respect to subject characteristics. CONCLUSIONS This article describes the rationale, design, and baseline features of a randomized controlled trial that aimed to assess the effects of DMPs for the secondary prevention of stroke. Subject follow-up is in progress and will end in 2015.

Family Nursing Practice and Education What Is Happening in Japan

Significant developments in family nursing in Japan are described and analyzed beginning with the political and health care legislation in the country that stimulated a need for family nursing and the early adoption of family nursing theories and models by visionary leaders in nursing education. In 1994, Japan was the first country in the world to establish a national family nursing association, the Japanese Association for Research in Family Nursing, that provided the necessary infrastructure and leadership for family nursing in Japan to flourish. The strengths and challenges of family nursing in Japan are identified and a call is made for innovations in nursing curricula as well as global networking of family nurses around the world.

Factors and Structural Model Related to End-of-Life Nursing Care in General Ward in Japan

This study aimed to determine the factors related to the implementation of end-of-life nursing care in general wards and to examine the adequacy of the hypothetical care implementation model. A cross-sectional survey was conducted. As the results of multiple regression analysis, 8 factors were determined: subjective evaluation of nurses’ own team, positive attitudes toward caring for dying persons, existence of a role model, death relief (Death Attitude Inventory), knowledge of symptom management knowledge of family assessment, abstract judgment skill, and participation in the seminar. The hypothetical model was constructed using these factors, and the adequacy of this model was confirmed by a structural equation modeling. These factors and the model would give suggestions of educational content and its method, which should be provided to general ward nurses.

An Investigation of Factors Influencing High Usage of Medical and Long-Term Care Services in an Aging Society in Japan:

Medical and long-term care costs are increasing all over the world. In this study, we investigated the characteristics of groups with high cost of medical and long-term care to define targets for curbing social security costs. As a result, for the population covered by the National Health Insurance, a large portion of medical costs were incurred for mental disorders, malignant neoplasms, and lifestyle-related diseases. For those covered by the Late Elderly Health Insurance System, most medical costs were incurred for lifestyle-related diseases, femoral fractures, neurological diseases, mental disorders, pneumonia, malignant neoplasms, and Alzheimer’s disease. From multiple regression analysis, the hospitalization days, use of advanced medical treatment, outpatient days, and high long-term care level influenced the increased costs. On the other hand, disease characteristics had only a very low effect. These findings suggest that the target population has complex medical and long-term care needs because they have multiple diseases.

Development and Testing of the Partnership Scale for Primary Family Caregivers Caring for Patients With Dementia

This article reports the development and preliminary testing of a new scale named “Partnership Scale for Primary Family Caregivers Caring for Patients With Dementia” that measures the ability of primary family caregivers to establish partnerships while providing care for patients with dementia in Japan. The first draft of the scale was developed using qualitative data from interviews with five primary family caregivers; a pool of 39 items was created through a review process with dementia care experts and researchers. An exploratory factor analysis and confirmatory factor analysis were conducted with data from 261 primary family caregivers who completed the instrument. This resulted in a multidimensional scale that consists of three factors with 13 items. The suitability of the model and intraclass correlation coefficient (ICC) values (1, 1) obtained by the test–retest method satisfied statistical standards. The criterion-related validity of the scale was significantly correlated to an external reference, which was the desired outcome. However, some subscales exhibited low internal consistency, demonstrating the need for further research.

Multifactorial Analysis of Factors Affecting Recurrence of Stroke in Japan

Data on factors affecting stroke recurrence are relatively limited. The authors examined potential factors affecting stroke recurrence, retrospectively. The study participants were 1087 patients who were admitted to stroke centers suffering from first-ever ischemic stroke and returned questionnaires with usable information after discharge. The authors analyzed the association between clinical parameters of the patients and their prognosis. Recurrence rate of during an average of 2 years after discharge was 21.3%, and there were differences among stroke subtypes. It was found that the disability level of the patients after discharge correlated well with the level at discharge (rs = 0.66). Multivariate logistic regression analysis of the data shows that modified Rankin Scale score, National Institute of Health Stroke Scale score, gender, age, and family history had statistically significant impacts on stroke recurrence, and the impact was different depending on subtypes. These findings suggest that aggressive and persistent health education for poststroke patients and management of risk factors are essential to reduce stroke recurrence.

712 Relevant factors of health and productivity management progress in small and medium-sized enterprises: a questionnaire survey for enterprises’ presidents

Introduction Although health and productivity management (HPM) is an important concept regardless of company size, there is a difference in recognition and degree of practice about HPM between small and medium-sized enterprises (SME) and large enterprises. The purpose of this study was to explore the factors related to the practical progress of HPM among SME’s presidents. Methods Anonymous self-administered questionnaire was conducted. The questionnaire was consisting of two parts. Part 1 was about the enterprises, types of industries, capital amount, and the enterprises’ presidents (age and period of position). Part 2 included behaviour modification strategies, developed based on four levels of changes proposed by Hersey and Blanchard and five stages of behaviour changes by Prochaska and DiClemente. JMP® 12 (SAS Institute Inc., Cary, NC, USA) was used to analyse the data. Results The questionnaire was completed by presidents of 22 SME’s aged between 30 years to 70 years. Their industries were mainly 6 kinds: construction, service, manufacturing, transportation and communication, electricity/gas/water service and real estate industry, and 2 others. In part 1, there was no significant correlation between stages of behaviour change about HPM and enterprise’s basic information (for example, industry, capital amount, age of presidents, or period as a president). In part 2, there was significant middle correlation between stages of behaviour change about HPM and states of having knowledge about HPM (correlation coefficient: 0.65, p<0.01), or attitude to practice HPM (0.61, <0.01). On the other hand, it was unclear whether there was a correlation between the stages and president’s personal practice of health promotion (0.27, p=0.24). Conclusion This study showed that the correlation factors to HPM’s progress could be strengthened by occupational health support. As the next step, we need to consider how to provide information and motivate to the enterprises’ presidents.

Workers’ sleep condition and related disorders in Japan: an analysis based on health insurance claim data and questionnaire

The purpose of this study was to clarify the sleep disorders and sleep conditions among workers in a company through descriptive statistics. We analyzed the data of individuals with suspected sleep disorders based on the 1-year outpatient health insurance claim data of 2803 employees in a company in Japan. We conducted a questionnaire survey to determine the sleep condition and drug usage of the same participants. Claim data of 339 employees (12.1%) were selected for analysis, and the breakdown of diseases comprised 153 (5.5%) with sleep disorders, 149 (5.3%) with headache, 119 (4.2%) with depression and 17 (0.6%) with autonomic imbalance. We recovered 2608 questionnaire responses (93.0%) and found that 1852 subjects (71.0%) were aware of insomnia symptoms within 1 year. Our findings highlight the prevalence of sleep disorders and drug usage among workers in a company, and the conditions of these disorders, including awareness of insomnia.