Efforts of Medical Associations to Support Home Medical Care Services: Case of the Nagasaki City Medical Association.

Establishment and structure In order for general clinics with outpatient facilities to undertake home care services, it is essential that the burden be reduced through mutual collaboration. The Dr. Net was launched in 2003 as an organization for promoting clinicclinic collaboration. The network was created based on the idea of preventing patients from giving up on home care because no physician is available to oversee their care in cities where the number of clinics is large but the ratio of patients dying at home is low. In the case that a physician for home care cannot be found for a hospitalized patient who wishes to be cared for at home, the secretariat acts as a contact/liaison, introducing chief and sub-chief physicians to the hospital and patient. In concrete terms, coordinators located in 5 districts within Nagasaki City notify network members via mailing list regarding information about the patient’s condition and the area where they are living—with all due care being given to the handling of personal information—and the both physicians are decided according to a “show of hands.” The chief physician newly provides the subchief physician with the patient’s treatment information; the role of the sub-chief physician is to provide support should the need arise, and he/she does not carry out everyday home visits or visiting care. Since the sub-chief physician acts as back-up for the chief physician, the sense of burden for him/her is smaller and he/she is not inconvenienced. In addition to enabling 24-hour responses, the both physicians can also cover each other with their different areas of specialization. A questionnaire survey found that, although sub-chief physicians actually carried out home visits rarely, the existence of them gave the chief physician a sense of security. Dr. Net was launched in 2003 with 13 physicians, and acquired a corporate status as specified nonprofit corporation in 2008, and then became an approved specified nonprofit corporation in 2010. Currently the network has more than 170 participating physicians, and it also doubles as a Nagasaki City Medical Association committee on home care.