論文 - 安藤　崇之

Determinants of polydoctoring among multimorbid older adults; a cross-sectional study in an urban area of Japan.

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

Journal of general and family medicine 25 （ 6 ） 376 - 383 2024年11月

ISSN  2189-6577

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Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study

Fujikawa, H; Aoki, T; Ando, T; Haruta, J

JOURNAL OF GENERAL AND FAMILY MEDICINE 2024年10月

ISSN  2189-7948

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特集 総合的な診療能力を高める　診断推論戦略Up To Date 各論Ⅰ　診断推論戦略-Classical Strategy 診断の不確実性

安藤 崇之

診断と治療 （診断と治療社）  112 （ 10 ） 1241 - 1245 2024年10月

ISSN  0370999X

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Associations of clinical context-specific ambiguity tolerance with burnout and work engagement among Japanese physicians: a nationwide cross-sectional study.

Fujikawa H, Aoki T, Ando T, Haruta J

BMC medical education 24 （ 1 ） 660 2024年06月

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Competencies related to generalism for Japanese medical undergraduates: Essential skills for comprehensive care.

Fujikawa H, Ando T, Endo A, Kaneko M, Shikino K, Nagamine Y, Nakayama T, Nishigori H, Yamanashi H, Haruta J

Medical teacher （Informa UK Limited）  46 （ sup1 ） S21 - S30 2024年06月

ISSN  0142-159X

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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

　概要を見る

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.(著者抄録)

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Association of polydoctoring and mortality among persons over 85 years 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

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BACKGROUND: Polydoctoring is a crucial aspect 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 Facility (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 utilized in this study. Among the 1,026 KAWP participants aged 85-89 years, those with two or more chronic conditions were enrolled in this study. METHOD: Care fragmentation or polydoctoring, was evaluated using the RVF, 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-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] 0.46, 95% confidence interval [CI]: 0.18-0.99). 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 1.05-6.84). CONCLUSIONS: In older patients with multimorbidity, polydoctoring reduces 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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Public Health Outreach in Impoverished Areas of Cambodia: Addressing the Issues Related to Prescription Practices

Chisato Iba, Mira Namba, Yudai Kaneda, Takayuki Ando

International Journal of Medical Students 2024年04月

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Author reply to the definition and evaluation of uncoordinated involvement of multiple healthcare providers; "Polydoctoring" as a component of care fragmentation among patients with multimorbidity.

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

Journal of general and family medicine 25 （ 2 ） 116 - 117 2024年03月

ISSN  2189-6577

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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 COVID-19 pandemic: An ecological study in Japan’

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

Public Health 224   152 - 158 2024年02月

筆頭著者, 責任著者

　概要を見る

OBJECTIVE: We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. STUDY DESIGN AND METHODS: This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. RESULTS: The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. CONCLUSION: Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

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一般内科外来、ひとりでできますか? : よく出合う慢性疾患への評価・処方・指導と、診察時間を最大限に活かすコツ

安藤 崇之

レジデントノート （東京 : 羊土社）  25 （ 17 ） 2993 - 3252 2024年02月

ISSN  13446746

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A Case of Focal Seizures Presented With Recurrent Sweating and Chills.

Ando T, Fujikawa H

Cureus 16 （ 1 ） e53139 2024年01月

ISSN  2168-8184

　概要を見る

Focal seizures, characterized by excessive electrical excitation in a brain region, present diagnostic challenges due to diverse manifestations, particularly with non-motor symptoms. Here, we present a 69-year-old Japanese woman experiencing unexplained recurrent episodes of sweating, chills, and shivering. Despite exhaustive investigations that identified no abnormalities, her symptoms remained unalleviated by symptomatic treatments. The episodic nature of her presentations subsequently prompted a clinical suspicion of seizures, leading to further neurological evaluations. Magnetic resonance imaging (MRI) of the brain and electroencephalography (EEG) revealed chronic ischemic changes in the cerebral white matter and intermittent sharp and slow wave bursts in the frontal regions. These findings led to a diagnosis of focal seizures manifesting as autonomic symptoms. The patient's symptoms were successfully treated with carbamazepine. This case illustrates the importance of considering non-motor focal seizures in patients with episodic symptoms, even when routine tests show no abnormalities.

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Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan.

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

Public health 224   152 - 158 2023年11月

　概要を見る

OBJECTIVE: We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. STUDY DESIGN AND METHODS: This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. RESULTS: The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. CONCLUSION: Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

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Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.

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

Journal of general and family medicine 24 （ 6 ） 343 - 349 2023年11月

筆頭著者, 最終著者,  ISSN  2189-6577

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特集 都市のプライマリ・ケア-「見えにくい」を「見えやすく」 【セクション2】実践!　都市のプライマリ・ケア-4つの現場から ＠教育 ❼都市での卒前教育の実践

安藤 崇之

総合診療 （株式会社医学書院）  33 （ 8 ） 924 - 926 2023年08月

ISSN  21888051

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都市での卒前教育の実践

安藤 崇之

総合診療 = Journal of generalist medicine : ジェネラルに診ることが求められる時代の臨床誌 （東京 : 医学書院）  33 （ 8 ） 924 - 926 2023年08月

ISSN  21888051

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食物アレルギー診断・検査2 思春期・成人食物アレルギー診療支援アプリの開発と有用性の検証

小西 駿一郎, 正木 克宜, 上條 慎太郎, 安藤 崇之, 冨保 紗希, 小山 薫, 大津 陽, 林 玲奈, 松山 笑子, 栗原 桃子, 加畑 宏樹, 宮田 純, 寺井 秀樹, 佐藤 泰憲, 森田 久美子, 伊藤 潤, 原田 紀宏, 鈴木 慎太郎, 藤澤 隆夫, 福永 興壱

アレルギー （(一社)日本アレルギー学会）  72 （ 6-7 ） 895 - 895 2023年08月

ISSN  0021-4884

食物アレルギーの社会的対応 アレルギー専門医を対象とした思春期・成人食物アレルギーの診療内容の均質性に関する調査研究

冨保 紗希, 正木 克宜, 上條 慎太郎, 鈴木 慎太郎, 伊藤 潤, 安藤 崇之, 加畑 宏樹, 宮田 純, 森田 久美子, 明石 真幸, 原田 紀宏, 藤澤 隆夫, 福永 興壱

アレルギー （(一社)日本アレルギー学会）  72 （ 6-7 ） 909 - 909 2023年08月

ISSN  0021-4884

食物アレルギーの社会的対応 アレルギー専門医を対象とした思春期・成人食物アレルギーの診療内容の均質性に関する調査研究

冨保 紗希, 正木 克宜, 上條 慎太郎, 鈴木 慎太郎, 伊藤 潤, 安藤 崇之, 加畑 宏樹, 宮田 純, 森田 久美子, 明石 真幸, 原田 紀宏, 藤澤 隆夫, 福永 興壱

アレルギー （(一社)日本アレルギー学会）  72 （ 6-7 ） 909 - 909 2023年08月

ISSN  0021-4884

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田 淳志, 安藤 崇之, 遠藤 周, 金子 惇, 鋪野 紀好, 長嶺 由衣子, 錦織 宏, 藤川 裕恭, 山梨 啓友

医学教育 （(一社)日本医学教育学会）  54 （ 2 ） 142 - 148 2023年04月

ISSN  0386-9644

　概要を見る

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)