Objectives The aging of Japanese economy has been rapidly proccing and its population also started declining, and these phenomena are more noticeable in the less populated areas. Medical expenditures also have been increasing sharply, and the strengthening and promotion of telemedicine is mandatory.To reduce medical expenditures, shifting patients from medical institutions to their houses has been emphasizing and homecare becomes more important. In these circumstances, the new guideline on online clinic (online diagnosis) issued in March 2018aims to support this change and promote telemedicine. This study aims to analyze how online clinic transform Japanese patient healthcare and telemedicine further based on filed research on clinics and regional Medical Associations. Online clinic Online clinic (online diagnosis) is DtoP telemedicine which utilizes IT such as smartphones and tablets for real time diagnosis including medical treatment, informing its results, and prescription.Doctors at clinics can monitor patients for 24 hours or patients can send their biodata to doctors. Similarly by telepharmacy, pharmacists support patients at home to take medicine properlyand advise their families. Online clinic is thus complementary toface-to-face diagnosis, and it promotes efficiency of medicine, prevent of chorionic diseases and serious condition. The data obtained via the online clinic can be shared with other doctors and made fully to treat patients. Accordingly it reduces medical expenditures. Current issues of online clinic and obstacles for further implementation Since March 2018, more than 1,000 clinics have been implementing which is smaller than expected. The less popularity is summarized as follows: (1) diseases applied to online clinic are chronic such as diabetes, hypertension, and strokes, and other disease such as tele-psychiatrist, pediatrics, atopic dermatitis, and allergic rhinitiswhich are supposed to be more effective than face-to-face diagnosis are excluded; (2)although the reimbursement of online clinic from public medical insurance is firstly admitted,it is about JPY700 (USD6.40) per month per patient, which is the same as current telephone diagnosis. This is far smaller than promoting online clinic; (3) restructuring current medical system to promote telemedicine, since the incumbentsystem is too robust in all aspects; and (3) benefits of online clinic are not observable and its cost-benefit analysis is required.
Masatugu Tsji received PhD in Economics from Stanford University in 1976. He is currently working as a professor at Kobe international University. His serves include visiting professors of Carnegie Mellon University. US and National Cheng Kung University, Taiwan; Board of Director, International telecommunication Society; Editorial Board. Journal of International Society of Telemedicine and Health, and Smart homecare Technology and telehealth; Coordinator of e-Health Economics, ISfTeH. His current research focuses on economic evaluation of telemedicine and e-Health. He has been Japanese Government and local governments for implementing telemedicine projects.
As the IDF warns, diabetes mellitus (DM) is becoming a global issue. In Japan, the increase in dialysis patients especially due to diabetic nephropathy has become a social issue. Therefore, the prediction and prevention of the onset of DM as primary prevention are more important than the treatment for the prevention of its severity as third prevention. Recently, we developed the AminoIndexLifestyle-related Disease Risk Screening (AILS)to screen for the risk of lifestyle-related diseases by multivariate analysis of plasma free amino acid concentrations between lifestyle-related disease patients and healthy controls. In this study, we determinedwhether this AILS could screen for the risk of developing DM.The subjects were 7,703 people who took a health check-up as Ningen Dock without DM in the first year. Based on the AILS formula, when the specificity for developing DM within four years is 40%, the value is 5.0, and a specificity of 80% corresponds to a value of 8.0. The minimum and maximum values are 0.0 and 10.0, respectively. In addition, AILS values are classified as Rank A, for values lower than 5.0, Rank B, for values from 5.0 to less than 8.0, and Rank C for values of 8.0 or higher. The higher the AILS values, greater the risk for developing DM within four years. From 7,703 subjects, 215 (2.5%) persons developed DM, that in, DM occurred in 3,008 to 12 persons (0.4%) in rank A, 3,091 to 96 persons (3.1%) in rank B, and 1,604 to 107 persons (6.7%) in rank C. Assuming the odds ratio of rank A is 1.0, rank B is 8.0 (95% confidence interval 4.4 to 14.6), and rank C is 17.8 (9.8 to 32.5).These results which the risk of developing DM can be predicted by AILS level, may suggest that AILS prevents the onset of DM by lifestyle modification intervention according to AILS level, and that AILS may play a novel role in DM medical care.
Minoru Yamakado is Dean and Professor, Department of Nursing, Ashikaga University and Special Adviser, Health Care Center, Mitsui Memorial Hospital. He received his Medical Doctor’s degree from Department of Medicine, University of Gunma in 1972. After he was a Resident of Mitsui Memorial Hospital, 1972~1974, he was a Medical Staff, Department of Internal Medicine, Mitsui Memorial Hospital, 1974~1978 and a Medical Staff, Department of Internal Medicine, University of Tokyo School Of Medicine, 1978~1981. After receiving his PhD degree from University of Tokyo in 1981, he joined Professor PJ Mulrow’s Laboratory of Hypertension at Medical College of Toledo, Ohio, USA as a research fellow, 1981~1983. After returning Japan, he was a Chief Staff of Center for Kidney Diseases, 1983~1991, Director, Department of Preventive Medicine , 1991~1994, Director, Health Screening Center, 1994~2012, and Special Adviser of Health Screening Center of Mitsui Memorial Hospital from 2012. He is appointed Dean and Professor, Department of Nursing of Ashikaga University from 2014. His specialty is preventive medicine and hypertension. His board certifications are Fellows of Japanese Society of Internal Medicine, Councilor of Japanese Society of Anti-aging Society, Honorable Councilor of Japanese Society of Nephrology, Japanese Society of Endocrinology, Japanese Society of Atherosclerosis, Japanese Society of Obesity and Members of Internal Society of Nephrology and American Society of Hypertension.