Introduction: The purpose of this study was to investigate the immediate cause of death recorded by home medical care physicians on the death certificates of senile patients who died of pneumonia as a complication, and to examine physician-level factors related to selection of the cause of death.Methods: We used a mail questionnaire survey to conduct a cross-sectional study of members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 470 valid responses were received (response rate: 51.8%). The immediate cause of death was recorded as pneumonia in cases of complication by pneumonia "always" by 95 physicians (20.2%), "often" by 131 (27.9%), "sometimes" by 134 (28.5%), "rarely" by 91 (19.4%), and "never" by 19 (4.0%). Multivariate analysis revealed that female physicians were significantly less likely to record the immediate cause of death as senility (OR: 0.10, 95%CI: 0.01-0.71).Conclusion: The immediate cause of death recorded on death certificates varied in cases of senile patients who died of pneumonia as a complication. The present study also suggested that selection of the cause of death was influenced by the gender of physicians.

Introduction: The purpose of this study was to investigate the risk factors for emergency hospitalization in Japanese nursing home residents.

Methods: Our retrospective cohort study included 170 nursing home residents who had stayed in two nursing homes in Saitama for more than one year by May 1, 2013. The association between emergency hospitalization within one year and 17 factors was examined initially by univariate analysis. Putative factors with P-values <0.05 on univariate analysis were considered in the multivariate analysis.

Results: A total of 70 (41.2%) of 170 nursing home residents were hospitalized emergently at least once within one year. In a logistic regression model, diagnosis of chronic heart failure (OR: 5.73, 95%CI: 1.37-23.84), presence of a decubitus ulcer (OR: 16.70, 95%CI: 1.89-147.41), and 5% loss of body weight over a one-year interval (OR: 2.47, 95%CI: 1.07-5.68) were associated with emergency hospitalization.

Conclusion: Diagnosis of chronic heart failure, presence of a decubitus ulcer, and a 5% loss of body weight over a one-year interval were risk factors for emergency hospitalization in Japanese nursing home residents.

Introduction: Although the number of deaths following a diagnosis of senility is increasing in Japan, the criteria of senility are unclear. Therefore, the purpose of this study was to investigate methods to diagnose senility in home medical care.Methods: We mailed questionnaires to 908 members of the Japan Network of Home Care-Supporting Clinics.Results: In total, 535 members (58.9%) responded. Responses of 501 members who selected senility as the cause of death were analyzed. Most doctors considered "continuous care of the patient", "the patient's ADL and gradual decline in oral intake", and "the absence of other critical diseases" to be important when diagnosing senility. The items affecting a diagnosis of senility were "the family's understanding and opinions", "other diseases being medically excluded", and "contribution to the patient's QOL".Conclusion: In home medical care, many doctors consider continuity of care, gradual decline, and the absence of other critical diseases to be important when diagnosing senility. Non-medical aspects, such as the family's opinions and patient's QOL, affected the diagnosis.

Purpose : To investigate the desirable communication methods, which can be used during home medical care visits of patients with intractable neurological disorders (INDs) who are unable to use any communication tools (hereinafter referred to as “communication methods”).
Methods : Interview surveys were conducted with the spouses of the patients with INDs who were unable to use any communication tools, and among bereaved family members of patients with INDs to whom home medical care had previously been provided. At the interviews, both voice recording and dictation were utilized to prepare a verbatim record, with which qualitative analyses were later conducted.
Results : In respect of communication methods, three concepts were apparent ; 1) family members who were present during home medical care visits “interpreted” and “inferred” what the patient wanted to convey to the medical care provider, 2) the family and the medical care provider conversed away from the patient in order to reduce patient anxiety and to provide reassurance, and 3) the medical care provider judged the correct timing for communication between himself/herself and the family, and exceptionally in the absence of the patient.
Conclusion : A hypothesis was formulated, which is that “communication with the patient in the presence of the family” is the basic “communication method.”

Background: Group practices with multiple physicians are preferred for promoting home medical care, but the explanations to patients and families given by the visiting doctors may differ. That could sometimes lead to confusion in patients and families.
Methods: We conducted a cross-sectional mail survey of families of Japanese patients who had previously received home medical care. Multivariable adjusted logistic regression for families’ sense of discrepancy between the explanations by doctors in a group practice was performed using eleven explanatory variables including: (1) number of doctors; (2) interval between the doctors’ visits; (3) duration of the doctor’s stay; (4) doctors’ frequent use of technical terminology; (5) doctors’ interruption of family’s talking, etc.
Results: Among 271 families who were mailed surveys, 227 responded (83.8%). The final sample for the analyses was 139. Responses were divided into two groups: families who had experienced a sense of discrepancy about explanations by different doctors (“Experienced”, 30 families, 21.6%) and those who had not (“Non-experienced”, 109 families, 78.4%). Families’ sense of discrepancy between the explanations by doctors in group practice was significantly associated with a longer time interval between doctors’ visits (OR: 1.103, 95% CI: 1.008–1.208, p = 0.03) and doctors interrupting families while they were talking (OR: 2.559, 95% CI: 1.166–5.615, p = 0.02).
Conclusions: Visiting doctors need to understand that families may have a sense of discrepancy about explanations given by different doctors. This sense of discrepancy was associated with less frequent doctors’ visits and doctors’ interrupting families while they are talking.

Background: Internal medicine physicians are able to convert to "general practitioners" in the future.Objective: To examine factors related with "career conversion to a general practitioner" conceived by hospital internal-medicine physicians specializing in organs/regions.Materials and Method: A semi-structured interview was conducted for 20 internal-medicine physicians with their consent from November 2014 to November 2015. The verbatim records were analyzed with the modified grounded theory approach.Results: The facilitating factors for career conversion consisted of "a career plan where characteristics of a general practitioner can be utilized", "high-quality training that combines practical conditions", and "diverse ways of working and a specialist-licentiate who has opportunities for learning".On the other hand, the suppressive factors consisted of "a lack of understanding of general practitioners", "difficulties associated with re-training", and "a feeling of resistance toward comprehensiveness of general practitioners".Conclusions: Career conversion to general practitioner by qualified internal-medicine physicians was suggested to be promoted by enhancing the meaningfulness of the general practitioner license, the training circumstances, and ensuring the professionalism and financial aspects of physician life.