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Lim JH, Kim JH, Jeon Y, Kim YS, Kang SW, Yang CW, Kim NH, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. The benefit of planned dialysis to early survival on hemodialysis versus peritoneal dialysis: a nationwide prospective multicenter study in Korea. Sci Rep 2023; 13:6049. [PMID: 37055558 PMCID: PMC10102303 DOI: 10.1038/s41598-023-33216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023] Open
Abstract
Optimal preparation is recommended for patients with advanced chronic kidney disease to minimize complications during dialysis initiation. This study evaluated the effects of planned dialysis initiation on survival in patients undergoing incident hemodialysis and peritoneal dialysis. Patients newly diagnosed with end-stage kidney disease who started dialysis were enrolled in a multicenter prospective cohort study in Korea. Planned dialysis was defined as dialysis therapy initiated with permanent access and maintenance of the initial dialysis modality. A total of 2892 patients were followed up for a mean duration of 71.9 ± 36.7 months and 1280 (44.3%) patients initiated planned dialysis. The planned dialysis group showed lower mortality than the unplanned dialysis group during the 1st and 2nd years after dialysis initiation (1st year: adjusted hazard ratio [aHR] 0.51; 95% confidence interval [CI] 0.37-0.72; P < 0.001; 2nd year: aHR 0.71; 95% CI 0.52-0.98, P = 0.037). However, 2 years after dialysis initiation, mortality did not differ between the groups. Planned dialysis showed a better early survival rate in hemodialysis patients, but not in peritoneal dialysis patients. Particularly, infection-related mortality was reduced only in patients undergoing hemodialysis with planned dialysis initiation. Planned dialysis has survival benefits over unplanned dialysis in the first 2 years after dialysis initiation, especially in patients undergoing hemodialysis. It improved infection-related mortality during the early dialysis period.
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Affiliation(s)
- Jeong-Hoon Lim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Ji Hye Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yena Jeon
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Yon Su Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Woo Yang
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Nam-Ho Kim
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee-Yeon Jung
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.
- Clinical Research Center for End Stage Renal Disease, Daegu, South Korea.
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Wang Z, Fukayama K, Niu B. Does Long-Term Care Literacy Matter in Evaluating Older Care Recipients' Satisfaction with Care Managers? Empirical Evidence from Japanese Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2456. [PMID: 36767824 PMCID: PMC9916366 DOI: 10.3390/ijerph20032456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
In this study, we focused on the long-term care literacy of care recipients (older adults currently receiving formal care services) and examined its relationship with satisfaction with their care managers by using a unique individual dataset of Japanese people aged 65 years and older. To address the problem of non-respondent bias, we applied inverse probability weighting and the Heckman probit model for estimation. We found that the probability of older adults evaluating their satisfaction regarding the six aspects of care manager measurement increased with an increasing level of care literacy. However, concerning the level of satisfaction with their care managers, we only observed significant increases in the aspects of "Explanation power" and "Attitude and manners" as the level of care literacy increased. Covariates, such as age, gender, family structure, level of certification for long-term care, reasons for choosing the care manager, utilization of long-term care services, and the manner in which older respondents answered the survey questions, also mattered regarding the evaluation process of satisfaction of older adults. In Japan, utilizing formal care services based on the long-term care insurance system is complicated and sometimes difficult for older adults to understand. In this survey, 35% of older care recipients had inadequate care literacy. Improving the care literacy of older adults is important for better use of formal care services and increased satisfaction.
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Affiliation(s)
- Ziyan Wang
- Graduate School of Economics, Osaka Metropolitan University, Osaka 599-8531, Japan
| | - Kaori Fukayama
- Graduate School of Nursing, Osaka Metropolitan University, Osaka 553-8555, Japan
| | - Bing Niu
- Graduate School of Economics, Osaka Metropolitan University, Osaka 599-8531, Japan
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Zhu Y, Li Y, Wu M, Fu H. How do Chinese people perceive their healthcare system? Trends and determinants of public satisfaction and perceived fairness, 2006-2019. BMC Health Serv Res 2022; 22:22. [PMID: 34983522 PMCID: PMC8725557 DOI: 10.1186/s12913-021-07413-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The public's perception of the health system provides valuable insights on health system performance and future directions of improvement. While China's health care reform was a response to people's discontent in the health care system due to the lack of accessibility and affordability, little is known on changes in public perception of China's health system. This paper examines trends in public perception of the health system between 2006 and 2019 and assesses determinants of public perception in China's health system. METHODS Seven waves of the China Social Survey, a nationally representative survey, were used to examine trends in public satisfaction with health care and perceived fairness in health care. Chi-square tests were used to examine differences across waves. Logistic regression models were used to explore determinants of public perception, including variables on sociodemographic characteristics, health system characteristics, and patient experience. RESULTS Satisfaction with health care increased from 57.76% to 77.26% between 2006 and 2019. Perceived fairness in health care increased from 49.79% to 72.03% during the same period. Both indicators showed that the major improvement occurred before 2013. Sociodemographic characteristics are weakly associated with public perception. Financial protection and perceived medical safety are strongly associated with public perception, while accessibility is weakly associated with public perception. Patient experience such as perceived affordability and quality in the last medical visit are strongly associated with public perception of the health care system, while the accessibility of the last medical visit shows no impacts. CONCLUSION Public satisfaction on health care and perceived fairness in health care in China improved over 2006-2019. The main improvement occurred in accordance with huge financial investments in public health insurance before 2013. Financial protection and perceived quality play significant roles in determining public perception, whereas accessibility and sociodemographic characteristics have limited influence on people's perception of China's health system. To achieve higher satisfaction and a higher sense of fairness in health care, China's health system needs to continue its reforms on hospital incentives and integrated delivery system to control health expenditure and improve health care quality.
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Affiliation(s)
- Yishan Zhu
- National School of Development, Peking University, Beijing, China
| | - Yuanyuan Li
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ming Wu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
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Shimizu Y, Nakata J, Yanagisawa N, Shirotani Y, Fukuzaki H, Nohara N, Suzuki Y. Emergent initiation of dialysis is related to an increase in both mortality and medical costs. Sci Rep 2020; 10:19638. [PMID: 33184445 PMCID: PMC7661714 DOI: 10.1038/s41598-020-76765-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/02/2020] [Indexed: 01/23/2023] Open
Abstract
The number of patients with end-stage renal disease (ESRD) has been increasing, with dialysis treatment being a serious economic problem. To date, no report in Japan considered medical costs spent at the initiation of dialysis treatment, although some reports in other countries described high medical costs in the first year. This study focused on patient status at the time of initiation of dialysis and examined how it affects prognosis and the medical costs. As a result, all patients dying within 4 months experienced emergent dialysis initiation. Emergent dialysis initiation and high medical costs were risk factors for death within 2 years. High C-reactive protein levels and emergent dialysis initiation were associated with increasing medical costs. Acute kidney injury (AKI) contributed most to emergent dialysis initiation followed by stroke, diabetes, heart failure, and short-term care by nephrologists. Therefore, emergent dialysis initiation was a contributing factor to both death and increasing medical costs. To avoid the requirement for emergent dialysis initiation, patients with ESRD should be referred to nephrologists earlier. Furthermore, ESRD patients with clinical histories of AKI, stroke, diabetes, or heart failure should be observed carefully and provided pre-planned initiation of dialysis.
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Affiliation(s)
- Yuki Shimizu
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Junichiro Nakata
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | | | - Yuka Shirotani
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Haruna Fukuzaki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nao Nohara
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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Tsuzuki S, Kimura Y, Ishikane M, Kusama Y, Ohmagari N. Cost of inappropriate antimicrobial use for upper respiratory infection in Japan. BMC Health Serv Res 2020; 20:153. [PMID: 32111202 PMCID: PMC7048145 DOI: 10.1186/s12913-020-5021-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotics are often prescribed inappropriately to patients with upper respiratory infection (URI) in ambulatory care settings; however, the economic burden of such prescription has not been quantitatively assessed. Here, we aimed to evaluate the additional cost of antimicrobial prescription for URI at the population level in Japan. METHODS We conducted a retrospective observational survey using longitudinal claims data between 2013 and 2016 obtained from JMDC Claims Database, which contains data from 5·1 million corporate employees and family members under the age of 65 years. Appropriateness of antibiotic prescription was assessed by a panel of six infectious disease physicians according to ICD-10 code in JMDC Claims Database. Total additional cost of antibiotic prescription for URI at the national level was estimated by weighting of age-structured population data. RESULTS The annual additional cost of inappropriate antibiotic prescription for URI was estimated at 423·6 (95% CI: 416·8-430·5) million USD in 2013, 340·9 (95% CI: 335·7-346·2) million USD in 2014, 349·9 (95% CI: 344·5-355·3) million USD in 2015, and 297·1 (95% CI: 292·4-301·9) million USD in 2016. Three classes of broad-spectrum oral antibiotics (third-generation cephalosporins, macrolides, and fluoroquinolones) accounted for > 90% of the total additional cost. CONCLUSIONS Although a decreasing trend was observed, annual additional costs of inappropriate antibiotic prescriptions for URI could be a substantial economic burden in Japan. Appropriately prescribing broad-spectrum oral antibiotics might be an important issue to reduce unnecessary medical costs in Japanese ambulatory care.
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Affiliation(s)
- Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Yuki Kimura
- AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masahiro Ishikane
- AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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East Asia – A look at selected health policy developments and health care assessments in universal health coverage systems. Health Policy 2019; 123:343-344. [DOI: 10.1016/j.healthpol.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rheumatology practice in Japan: challenges and opportunities. Rheumatol Int 2019; 39:1499-1505. [PMID: 30888472 DOI: 10.1007/s00296-019-04281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
This article aims to and describes the characteristics of rheumatology practice in Japan, focusing on the medical environment for the treatment of rheumatoid arthritis (RA). In Japan, the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) has led to a significant paradigm shift in medical care; satisfactory safety outcomes have been demonstrated by periodic analysis, post-market surveillance and the development of guidelines via an industry-academia-government collaboration. Drug discontinuation is also considered an option, as well as medical economic analysis of any increase in the financial burden engendered by use of bDMARDs. Tocilizumab, a bDMARD established in Japan, was developed in an environment that facilitates translational research. The rheumatology community in Japan is expected to continue to develop novel therapies, while ensuring consistent quality of medical care despite limited healthcare resources.
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