Regional social system for specialized medical care in hematologic malignancies: a pilot study.

INTRODUCTION The uneven distribution of physicians in Japan disadvantages rural and remote patients with hematological malignancies to the extent that they may not receive standard treatments. There are 7 core regional medical centers in Tokushima Prefecture. A Tokushima rural medical center's clinical hematology division experienced difficulty in treating patients due to a lack of physicians despite an increasing number of patients with hematological malignancies. The aim of this pilot study was to investigate the regional medical supply and demand associated with newly diagnosed hematological malignancies in Tokushima Prefecture, Japan. METHODS The study investigated the home addresses of patients with newly diagnosed acute leukemia, malignant lymphoma and multiple myeloma who were hospitalized in the 7 core Tokushima centers in 2006. The surveyed patients were compared with the estimated number of patients with those diseases that were newly developed, based on a calculation of incidence and population by age group. The survey also investigated the number and distribution of hematologists. RESULTS A total of 248 patients were newly hospitalized in the 7 core centers in Tokushima Prefecture during the 1 year period. The surveyed number of patients was similar to the estimated number of patients in all secondary medical areas, except for one area where there was active traffic to and from adjacent prefectures. More than 70% (median 80%; range 72-100%) of the patients received their treatments within a radius of approximately 25 km from their homes. There were 24 hematologists in November 2006 and 63% of these worked in the city with the largest population. The mean estimated number of patients per unit population was significantly higher in rural and remote areas than in urban areas (p <0.01). Three regional centers had only one or two hematologists. CONCLUSIONS Most patients with newly developed hematological malignancies in Tokushima Prefecture received treatment from intra-prefectural hematologists within a 25 km distance of their homes. Rural areas had a shortage of hematologists who were localized in urban areas. It is recommended that functions of core medical centres and rural clinics are redesigned according the availability of specialized treatments, and to maximize cooperation between physicians at rural clinics and hematologists at urban hospitals.