Abstract
Introduction : For stable patients, we actively performed a reverse introduction into peripheral medical institutions, but “the interinstitutional relations in medical treatment which a hospital doctor hopes for” were not promoted or established.
Aim : Our primary aims were to understand “the interinstitutional relations in the field of medical treatment that outpatients demand” and to obtain materials to promote and establish such relations. Another major aim was to substantially investigate the backgrounds of the patients, the coordinated medical institutions, and general hospitals by using structural equation modeling, and to identify latent factors promoting interinstitutional relations in medical treatment.
Method : We enrolled 471 outpatients as subjects and conducted a questionnaire survey.
Results : Both the hopes and expectations of patients for coordinated medical institutions were related to a “strong connection with the general hospital and with the specialists”. On the other hand, the issuing of a “long-term prescription” with the purpose of reducing the burden on the outpatient department was a strong factor that disturbed such relations.
Conclusions : Our study suggested that the strong relationships that exist among these three elements--patients, peripheral medical institutions, and general hospitals--are latent factors that satisfy the medical demands of the patients and are promoted by smooth interinstitutional medical cooperation.

Trifluridine (FTD) / tipiracil hydrochloride (TPI) has been approved for the treatment of colorectal cancer, but its dose-limiting toxicity is neutropenia. Elderly patients are at high risk of febrile neutropenia and should be monitored carefully when administering FTD / TPI. In this study, we retrospectively investigated the incidence of adverse events, dose reduction, and number of administered courses in 8 old-old patients treated with FTD / TPI for colorectal cancer. The results showed that severe neutropenia of Grade 3 or higher occurred in 5 of the 8 patients. Six patients had a dose reduction, but 5 of them were able to continue treatment for at least 3 courses. The frequency and severity of adverse events, including neutropenia, appears to be higher in old-old patients, so it is important to take appropriate measures.