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Faculty of Medicine School of Medicine Community health study course |
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ISHISAKA Mariko
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Papers 【 display / non-display 】
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石坂 真梨子
Rural and remote health 25 ( 3 ) 2025.8
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：James Cook University
Introduction: Deterioration of chronic conditions and serious acute illnesses are major factors preventing older individuals from remaining within their local communities, which may be significant burdens for islanders. The specific reasons and risk factors associated with non-returned off-island referrals remain insufficiently investigated. This study aims to describe cases of non-return after off-island referrals and to examine the relationship between polypharmacy and non-returned off-island referral among older residents regularly attending remote island clinics.
Methods: We conducted a retrospective cohort study across 14 solo-practice outpatient clinics on the remote islands of Okinawa Prefecture, Japan. The study participants were island residents aged 65 years or older who were regularly visiting clinics between 1 April 2015 and 31 March 2020. Exposure was defined as polypharmacy, specified as the use of five or more chronic medications at baseline. The outcome was defined as non-returned off-island referrals, encompassing emergent transfer or scheduled referrals from island clinics to off-island core institutions or specialists, which resulted in relocation outside the islands or death off-island, as confirmed by medical records or referral letter responses. The analysis for the association between polypharmacy and non-returned off-island referral was adjusted for age, sex, activities of daily living, dementia, multimorbidity, and the presence of specific medical conditions, including coronary artery disease, stroke and malignancy at baseline.
Results: A total of 1566 patients regularly visiting clinics were included in the analysis. At baseline, 41.9% of all participants classified as having polypharmacy. During a median follow-up of 5 years, 181 of 1566 (11.6%) participants resulted in non-returned off-island referrals. The most frequent health events resulting in them were bone fracture, pneumonia/bronchitis and acute heart failure. Among the 656 polypharmacy participants, 112 experienced non-returned off-island referrals with an adjusted odds ratio of 1.98 (95% confidence interval: 1.38–2.85).
Conclusion: A significant association was observed between polypharmacy and non-returned off-island referrals on the remote islands of Okinawa Prefecture, Japan. Older island residents with polypharmacy are at a higher risk of non-returned off-island referrals than those with non-polypharmacy, and physicians managing these patients in remote primary care settings should be aware of this risk. This awareness may promote physician responses to other modifiable risk factors and potentially mitigate the consequences. -
Ishisaka M, Hanamoto A, Kaneko M, Kato D, Motomura K, Kataoka Y
Korean journal of family medicine 44 ( 4 ) 215 - 223 2023.6
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Korean Journal of Family Medicine
Background: There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students’ amount of GP-related education and their subsequent choice of GP majors. Methods: A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency. Results: Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88–8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87–6.68). Conclusion: The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.
DOI： 10.4082/kjfm.22.0189
Presentations 【 display / non-display 】
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離島医療の課題と解決に向けた提言
石坂真梨子
第17回ITヘルスケア学会学術大会
Event date： 2024.8.29 - 2024.8.31
Presentation type：Oral presentation (general)
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沖縄の離島における島外紹介搬送とポリファーマシーとの関連
石坂真梨子
第15回 日本プライマリ・ケア連合学会学術大会
Event date： 2024.6.7 - 2024.6.9
Presentation type：Oral presentation (general)