研究者詳細 - 春田　淳志

論文 - 春田　淳志

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特集語りたい!総合診療のエビデンス日本発! 総合診療医が作るエビデンス質的研究:医学生は地域の臨床実習でSDH をどのように学ぶのか?

春田淳志

治療（南山堂） 106 （ 9 ） 1054 - 1058 2024年09月

ISSN 00225207

Characteristics of the studies using realist evaluation to assess interventions that address psychosocial healthcare issues in older adults: a scoping review

Mitani S., Ogawara H., Haruta J., Sakakibara T., Fukahori H.

BMJ Open 14 （ 8 ） e078256 2024年08月

ISSN 2044-6055

Objectives Interventions to address psychosocial healthcare issues in older adults are increasing. Realist evaluation (RE) helps us understand how these interventions work for their issues. It is significant to obtain implications for further developing such research. We aimed to identify the characteristics of studies using RE to assess interventions that address psychosocial healthcare issues in older adults by mapping relevant literature. Design Scoping review. Data sources MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Cochrane Library, ICHUSHI (a Japanese database) and Google Scholar were used for searches between 5 January 2022 and 4 January 2024. Eligibility criteria (1) Showing that most of the participants were older adults or their stakeholders; (2) stating in the research background or aim sections that the target interventions aimed at addressing older adults’ psychosocial healthcare issues and (3) using RE to assess these interventions. Data extraction Data on country of origin, type of research, study design, qualitative data collection and analysis methods, desirable items for RE and intervention aims and purposes were extracted and summarised using descriptive statistics. Results Fifty-four studies were analysed. Most studies were conducted in the UK (54.5%). Mixed methods were used in 28 studies (51.9%), while only qualitative methods were used in 25 studies (46.2 %). Fourteen intervention aims and purposes were identified: improving dementia care, avoiding emergency admissions, preventing social isolation and promoting family involvement in the care of older adults. Conclusion RE is useful for promoting an understanding of how interventions work for addressing psychosocial healthcare issues in older adults. RE also promotes the updating of plausible theories that lead to improving interventions. Our findings show the implications of managing time and resources to address the challenge of RE’s time and resource intensiveness and carefully considering the data collection methods to reduce burdens on older adults.

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総合的に患者・生活者をみるために必要なコンピテンシーとは医学教育モデル・コア・カリキュラムへの新設

藤川裕恭, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 中山健夫, 錦織宏, 山梨啓友, 春田淳志

日本プライマリ・ケア連合学会学術大会（(一社)日本プライマリ・ケア連合学会） 15回 333 - 333 2024年06月

総合的に患者・生活者をみるために必要なコンピテンシーとは医学教育モデル・コア・カリキュラムへの新設

藤川裕恭, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 中山健夫, 錦織宏, 山梨啓友, 春田淳志

日本プライマリ・ケア連合学会学術大会（(一社)日本プライマリ・ケア連合学会） 15回 333 - 333 2024年06月

アレルギー領域における診療科・職種横断的リカレント教育の重要性　「出前授業による教育の機会創出事業」参加者データの分析

正木克宜, 坂下雅文, 小川靖, 猪俣武範, 貝沼圭吾, 神尾敬子, 佐藤さくら, 玉利真由美, 中島沙恵子, 森田英明, 倉島洋介, 二村昌樹, 高橋浩一郎, 春田淳志, 百武美沙, 門川俊明, 石塚全, 意元義政, 尾山徳孝, 神崎晶, 木戸口正典, 福島敦樹, 福永興壱, 藤枝重治, 安冨素子, 足立剛也, 免疫アレルギー疾患研究10か年戦略次世代タスクフォース(ENGAGE-TF)

アレルギー（(一社)日本アレルギー学会） 73 （ 4 ） 329 - 339 2024年06月

ISSN 0021-4884

【背景】多職種・複数診療科が関与するアレルギー診療水準の向上には,専門医以外も対象とした教育の必要性が考えられるが,そのニーズ調査と方法に関する検討は不十分である.【目的・方法】免疫アレルギー疾患研究10か年戦略次世代タスクフォース(ENGAGE-TF)は学会支援下に慶應義塾大学,福井大学と連携した複数回のバーチャル教育企画「出前授業」を企画した.そのニーズと有用性を検証するため,SNSや各大学・医師会等を通じて周知し,メーリングリストを用いてアンケート調査を行った.【結果】のべ1139人・回より回答を得た.半数以上が専門医以外の医師であり,幅広い医療関連職種も参加した.7割が「とても満足」,6割以上が「ちょうどよい」難易度と回答した.自由記載の感想から,職種毎の学びの焦点,経験年数による学びのスタンスの違いが見られた.【考察・結語】9割を占める専門医以外の参加者のプライマリケアにおけるアレルギー疾患対応ニーズの高さと,経験11年以上の医療関連職種の遠隔教育・リカレント教育の有用性が示唆された.(著者抄録)

大学病院における総合診療科臨床実習が医学生の総合診療の専門性への理解に及ぼす影響

安藤崇之, 百武美沙, 春田淳志, 藤川裕恭, 平橋淳一, 藤島清太郎

日本プライマリ・ケア連合学会誌（(一社)日本プライマリ・ケア連合学会） 47 （ 2 ） 63 - 66 2024年06月

ISSN 2185-2928

<p>大学病院における総合診療科の臨床実習において医学生が総合診療の専門性をどのように理解しているのかを明らかにするために，実習前後の「総合診療の専門性とは？」というアンケートの自由記載に対して内容分析を行った．大学病院での臨床実習を通して，診断学だけではなく心理・社会的側面を踏まえた診療や健康維持なども総合診療の専門性であることが学生により獲得されていることが明らかになった．</p>

Association of polydoctoring and mortality among very old persons with multimorbidity: a prospective cohort study in Japan.

Ando T, Sasaki T, Abe Y, Nishimoto Y, Hirata T, Tajima T, Oguma Y, Haruta J, Arai Y

BJGP open 8 （ 3 ） 2024年04月

Background: Polydoctoring can increase the risk of care fragmentation among patients with multimorbidity, but its impact on health outcomes remains unclear. Aim: To determine the effects of polydoctoring, as measured by the regularly visited facilities (RVF) indicator, on patient outcomes among older individuals with multimorbidity. Design & setting: Data from the ongoing prospective cohort study, Kawasaki Aging and Wellbeing Project (KAWP), was utilised in this study. Among the 1026 KAWP participants aged 85–89 years, those with two or more chronic conditions were enrolled in this study. Method: Care fragmentation and polydoctoring was evaluated using the RVF, which is a new indicator that measures the number of medical facilities consistently involved in a patient’s care. Based on RVF, mortality was analysed using the Cox proportional hazards model, with adjustments for age, sex, frailty, and number of comorbidities. Results: A significant reduction in mortality rates was observed in participants with an RVF of ≥3 and 2–4 comorbidities (hazard ratio [HR] 0.43, 95% confidence interval [CI] = 0.18 to 0.99, P value = 0.048). However, no significant difference in mortality based on RVF was observed for those with ≥5 comorbidities. Notably, individuals with ≥5 comorbidities and an RVF of 0 had a significantly higher HR for death (HR 2.68, 95% CI = 1.05 to 6.84, P value = 0.039). Conclusion: In older patients with multimorbidity, polydoctoring may reduce mortality in patients with ≤4 coexisting conditions, but it does not significantly impact mortality in those with ≥5 conditions. These findings provide insights for healthcare decision making in managing older patients with multimorbidity.

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Exploring factors associated with healthcare professionals' subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels.

Haruta J, Goto R

BMJ open 14 （ 3 ） e081328 2024年03月

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医療者教育学専攻修士課程の導入期に地域診断・フィールドワークを教育の一環として実施する意義 : 教員の視点でのふりかえり (<特集>大学と地域創生)

川上ちひろ, 後藤亮平, 今福輪太郎, 西城卓也, 早川佳穂, 春田淳志

地域志向学研究（地域協学センター） 8 112 - 119 2024年03月

ISSN 24328545

CiNii Research

特集総合理学療法総合的に患者・生活者をみる姿勢と多職種連携能力-モデル・コア・カリキュラムから紐解く

春田淳志

理学療法ジャーナル（株式会社医学書院） 58 （ 2 ） 166 - 171 2024年02月

ISSN 09150552

Laypeople's Perspective on Physician Work-Hour Restrictions in Japan: A Cross-Sectional Study

Fujikawa H., Haruta J.

Journal of Patient Experience 11 23743735241305337 2024年01月

ISSN 23743735

The aim of the study was to examine laypeople's perspectives on the impending implementation of physician work-hour restrictions in Japan, which had received limited research attention. We conducted a nationwide cross-sectional study in January 2024. The participants were monitors of an internet survey company who responded to closed questions regarding the expected effect of work-hour regulations, along with an open-ended question regarding their expectations or concerns about these restrictions. The data were analyzed using descriptive statistics for closed questions and content analysis for the open-ended questions. The study included 484 laypeople. A significant portion (25.4%) was unaware of the scheduled start of work-hour restrictions. Approximately half of the participants had a neutral view of the overall impact of the restrictions. Content analysis of the open-ended responses identified 130 (60.2%) comments as “expectations” and 70 (32.4%) as expressing “concerns,” with a notable number of comments deemed to indicate that the respondents were “unsure” or found the changes “irrelevant” to them. This study indicates a substantial gap between the views of physicians and laypeople on this issue.

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Re: Letter to the Editor of Public Health in response to'Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the …

T Ando, Y Ibuka, R Goto, J Haruta, DD Le, S Fujishima

Public health, S0033-3506 (23) 00489-4 2024年

Exploring factors associated with healthcare professionals’ subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence …

J Haruta, R Goto

BMJ Open 14 (3), e081328 2024年

Author reply to the definition and evaluation of uncoordinated involvement of multiple healthcare providers;“Polydoctoring” as a component of care fragmentation among patients …

T Ando, T Sasaki, Y Abe, Y Nishimoto, T Hirata, J Haruta, Y Arai

Journal of General and Family Medicine 25 (2), 116 2024年

地域の一般病院の緩和ケア外来における療養支援と患者の療養経過

大澤岳史, 春田淳志, 松浦みゆき, 上野晶香, 田直子

Palliative Care Research （日本緩和医療学会） 19 （ 1 ） 7 - 12 2024年

<p>【目的】地域一般病院の緩和ケア外来で療養支援した患者の経過を検討した．【方法】当院緩和ケア外来を受診しその後死亡した患者を後ろ向きに調査した．外来は週2回，がん治療状況に依らず診療した．【結果】対象93例中，病状悪化時の療養希望は72例に聴取し，療養から看取りまで緩和ケア病棟を希望（緩和ケア病棟希望）が25例，訪問診療を受けつつ自宅療養を行い最期は緩和ケア病棟での看取りを希望（訪問診療→緩和ケア病棟希望）が25例，療養から看取りまで自宅を希望（訪問診療希望）が17例だった．緩和ケア病棟希望患者の96%が緩和ケア病棟を利用し，84%が緩和ケア病棟で看取り，訪問診療→緩和ケア病棟希望患者の76%が訪問診療を利用し，80%が緩和ケア病棟で看取り，訪問診療希望患者の76%が自宅療養し，47%が自宅で看取られた．【結論】緩和ケア外来の療養支援にて希望場所での療養・看取りの実現可能性が示唆された．</p>

RECURRENT AND VIRTUAL EDUCATION FOR ALL DISCIPLINES AND OCCUPATIONS IN THE ALLERGY REALM：A SURVEY OF THE PARTICIPANTS FROM THE INITIATIVE 'OUTREACH LECTURES' TO CREATE EDUCATIONAL OPPORTUNITIES

Masaki K., Sakashita M., Ogawa Y., Inomata T., Kainuma K., Kan-O K., Sato S., Tamari M., Nakajima S., Morita H., Kurashima Y., Futamura M., Takahashi K., Haruta J., Hyakutake M., Monkawa T., Ishizuka T., Imoto Y., Oyama N., Kanzaki S., Kidoguchi M., Fukushima A., Fukunaga K., Fujieda S., Yasutomi M., Adachi T.

Japanese Journal of Allergology （一般社団法人日本アレルギー学会） 73 （ 4 ） 329 - 339 2024年

ISSN 00214884

Background: In the enhancement of allergy care involving multidisciplinary and multiple medical departments, there is a perceived need for education that targets not only specialists but also non-specialists. However, research on the need for and methods of such education remains inadequate. Objective: To design a remote allergy care education program for all medical practitioners and to validate its necessity and utility. Methods: The Empowering Next Generation Allergist/immunologist toward Global Excellence Task Force (ENGAGE-TF), supported by the Japanese Society of Allergology, initiated a virtual educational program called 'Outreach Lectures' in collaboration with Keio University and Fukui University. This initiative was widely promoted through social media and various institutions, and a survey was conducted through its mailing list. Results: 1139 responses were obtained. More than half were physicians from non-allergy specialties, representing a diverse range of healthcare professions. Over 70% expressed being 'very satisfied, ' and over 60% found the difficulty level 'appropriate. ' Free-form feedback revealed differences in learning focus based on profession and learning approach based on years of experience. Conclusion: The high participation rate (90%) of non-specialist physicians underscores the demand for addressing allergic conditions in primary care. The effectiveness of virtual/recurrent education, particularly for healthcare professionals with over 11 years of experience, was implied. Further follow-up investigation focusing on quantitative and objective assessment of educational effectiveness is indispensable.

Re: Letter to the Editor of Public Health in response to ‘Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the …

T Ando, Y Ibuka, R Goto, J Haruta, DD Le, S Fujishima

Public Health 227, e3-e4 2024年

Interprofessional competency in clinical students: validating the Clinical student version of the Japanese Self-assessment Scale of Interprofessional Competency (C-JASSIC)

Haruta J., Tomizaki E., Horiguchi T., Nakamura T., Ishikawa S., Monkawa T.

Journal of Interprofessional Care 38 （ 5 ） 1 - 8 2024年

ISSN 13561820

In this study, we developed and validated the Clinical Student Version of the Japanese Interprofessional Competency Self-Assessment Scale (C-JASSIC) for healthcare students in their clinical practice phase. Data obtained from 331 students (medical, 98; nursing, 99; pharmacy, 134) during orientation for interprofessional education (pre-IPE) and from 319 students (medical, 94; nursing, 93; pharmacy, 132) within a week following IPE (post-IPE) were analyzed. Exploratory pre-IPE and Confirmatory post-IPE factor analyses revealed a consistent 6-factor structure aligning with the Japanese Interprofessional Competency domains. The scale exhibited strong internal consistency, with Cronbach’s α values exceeding 0.8 for all factors both pre- and post-IPE. Scores for overall competency and individual domains increased post-IPE in 234 matched cases. A notable significant pre vs post difference concerned “Understanding of Others,” indicating enhanced interprofessional comprehension after clinical practice. There was a weak but significant positive correlation between IPE satisfaction and difference in pre- and post-IPE scores. However, no significant differences were observed among medical, nursing, and pharmacy students. Despite its strengths, such as its competency-based design and cultural relevance to Japan, a limitation of the study may be potential self-reporting bias. Nonetheless, C-JASSIC represents a valuable tool for seamless competency evaluations from student to professional stages, with implications for broader Asian contexts.

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Culture and context in Interprofessional education: Expectations in Australia and Japan

Kent F., Haruta J.

Medical Education 59 （ 1 ） 83 - 87 2024年

ISSN 03080110

The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.

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The impact of core curriculum revisions on Japanese medical schools: Navigating curriculum evolution

Haruta J., Urushibara-Miyachi Y., Ito S., Takamura A., Nitta Y., Moriya R., Yamawaki M.

Medical Teacher 46 （ sup1 ） S67 - S75 2024年

ISSN 0142159X

Purpose: This study examines the impact of the 2010 and 2016 Model Core Curriculum (MCC) revisions on medical education across all 82 medical schools in Japan. Methods: A cross-sectional survey was conducted in 2021, focusing on the response to the MCC revisions, curriculum changes, and factors influencing these changes. The survey included questions on approaches to implementing the MCC revisions, timing of curriculum updates, factors triggering these revisions, changes in student performance and career paths, and the introduction of new subjects. Results: The response rate was 100%. Most universities rapidly implemented changes following the 2016 MCC revision, demonstrating agility in adapting to national standards. Key factors influencing curriculum revisions included external evaluations and the MCC revisions themselves. Despite no significant changes in student performance or career paths from faculties’ perspective, an increase in scholarly activities was noted. The introduction of new subjects post-2016 reflects a shift toward holistic perspectives such as behavioral science, general medicine/community medicine, and professionalism. Conclusions: The findings highlight a commitment to maintaining educational quality in Japanese medical education. The responsiveness to MCC revisions suggests a growing interest in medical education among faculties and an alignment with global medical education trends to meet evolving healthcare needs.

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春田 淳志

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春田　淳志

論文 - 春田　淳志