往診から見る創傷外科の需要

The Demand for House Calls by Plastic Surgeons

はじめに

　厚生労働省が指導する病床数の減少や在宅医療の推進，そして特定行為の研修を受けた認定看護師による在宅ケアなど，本邦における医療の主体は病院の外へ移りつつある。総務省資料によると，わが国の高齢者人口の増加率は2019年を境に緩やかにはなるものの，その実数は2040年まで増加し続け,フレイルや認知症の患者も増加を続けることが予想されている 1）。実際に2019年までの統計では在宅訪問や往診および訪問看護の利用者数が増加し続けている 2）（図1）。加えてここ数年のコロナ禍においては，在宅療養患者対応のために開業医だけでなく総合病院からの往診も行われるようになり 3），在宅医療を受ける患者の数は高齢者に限らず膨大なものになっていると考えられる。しかし，形成外科領域において在宅医療や往診に関する報告はまだ少ない 4）。

　当院では，近隣の患者宅や施設の要請に応じ形成外科的な往診を行っている。形成外科医が地域に貢献する役割の1つとして当院の事例を報告する。

　Japanʼs elderly population is expected to continue growing until ~2040. In an aging society, the government is moving toward promoting home visitation and home nursing. Our clinic provides house calls at patientsʼ homes and facilities in the neighborhood. We report our clinicʼs experience as an example of a role that plastic surgeons can play in contributing to their communities. We investigated the total number of patients, diseases covered, distance traveled, and reimbursement for home visitations provided by our clinic during the period from January 2020 to December 2021. More than 70% of patientsʼ cases were related to foot care, including nail deformities, tinea pedis, calluses, and corns; this was followed by cases of skin rashes, pressure-sores, and chronic ulcers. In 2020, house-call patient number dropped in accord with a number of COVID infections, but by 2021, the number of house calls returned to the level observed before COVID. Foot care patients were the most common target of the house calls, and we speculate that the demand for plastic surgeons as a podiatrist is increasing. High demand may be seen not only for plastic surgeons as wound surgeons but also as dermatologists and preventive medicine physicians. The implementation of house calls may also help prevent disease aggravation, hospitalization, and amputation. House calls for foot care by plastic surgeons will be one of the important roles in the community in Japan.