急性冠症候群を発症した糖尿病患者がFirst Medical Contactに至るまでのプロセス

The Process Getting to the First Medical Contact in Diabetic People Who Developed Acute Coronary Syndrome

要旨

目的：急性冠症候群（以下ACS）を発症した糖尿病患者は受診までに多くの時間を費やす．そのため，発症からFirst Medical Contact（FMC）に至るまでのプロセスを明らかにする．

方法：ACSを発症した糖尿病患者6名に半構造化面接を行い，質的統合法（KJ法）を用いて分析を行った．本研究は著者の所属施設と対象施設の倫理委員会の承諾を得て実施した．

結果：【糖尿病との向き合い方：どうにもならない状況があっても自分なりに努力】【心筋梗塞への関心：糖尿病の教育を受けても，心筋梗塞の距離感がわからず他人事】【前駆症状の解釈：前駆症状を糖尿病や過労など他の原因と結びつける】【受診の決断：心筋梗塞と推察しているかどうかにかかわらずなんとなく「やばい」と察知】など8つのシンボルマークが明らかになった．

結論：【糖尿病との向き合い方】や【心筋梗塞への関心】がFMCに至るまでの基盤となっていることより，FMCまでのプロセスを含めた個別的な患者教育の必要性が示唆された．

Purpose: Diabetes patients who develop acute coronary syndrome (ACS) tend to waste much time before the first visit to hospitals. The purpose of this study was to clarify the process of getting the First Medical Contact (FMC) for patients with diabetes who developed ACS.

Method: A semi-structured interview was conducted for 6 patients with diabetes who developed ACS. An individual analysis and comprehensive analysis were carried out. Data was analyzed by using the qualitative synthesis method (KJ method). This study was conducted with the consent of the Ethics Committee of the author's affiliated institution and the targeted one.

Result: Our study has specified 8 symbolic marks of the process of getting the FMC for patients with diabetes who developed ACS. These included the followings: [how to deal with diabetes: making their efforts even in inescapable circumstances], [interests in myocardial infarction: the experience of learning about diabetes cannot lead to the understanding of the relationship between diabetes and myocardial infarction], [interpretation of prodromal symptoms: assuming the relationship between the symptoms and other causes], [decision that leads to hospital visit: sensing myocardial infarction is perceived as “dangerous”], and four others.

Conclusion: [how to deal with diabetes] and [interests in myocardial infarction] was the basis for getting the FMC. A need of the education for individual patient including the process to FMC was suggested.