臨牀透析 Vol.31 No.9(8)


特集名 維持透析患者の「満足度」を検証する
題名 透析医療の質,患者のQOLと満足度
発刊年月 2015年 08月
著者 政金 生人 医療法人社団清永会矢吹病院腎臓内科
【 要旨 】 近年,医療のさまざまな領域において,治療の質を患者のQOLや満足度を考慮に入れて総合的に評価しようとする試みがなされている.慢性透析においても例外ではないが,患者QOLや満足度を考慮した透析医療の質的評価の手法は確立されていない.透析患者には透析低血圧,うつ,不眠,瘙痒などQOLを低下させる愁訴が広く認められ,これらは予後を悪化させる因子である.透析患者は顕性・非顕性に透析不足の状態にあり,愁訴は透析不足のサインである.ターゲットとする愁訴を決め,患者と相談しながら愁訴を一つひとつ消していくことが大切である.患者の愁訴を中心に据えた透析治療は,治療の質を担保して,患者のQOLの高い長期生存を可能にする治療ストラテジーであるといえる.
Theme Evaluating the chronic dialysis patients satisfaction
Title Assuring QOL for chronic dialysis patients
Author Ikuto Masakane Department of Internal Medicine, Yabuki Hospital
[ Summary ] The current trend in most medical fields is to provide quality assurance (QA) concerning the acceptance of treatment and QOL for patients. QOL must be considered a priority in the chronic dialysis field. However, representative strategies for achieving this purpose have not been established for chronic dialysis treatment. Chronic dialysis patients experience a number of uncomfortable dialysis related symptoms such as intra-dialytic hypotension, depression, insomnia and pruritus. Some of these symptoms may be independent factors related to patient survival. The mechanisms of these symptoms have been recognized in association with dialysis. Related symptoms are usually observed in standard dialysis programs. These programs consist of treatments three times a week for 3 to 4 hours per session. We have established a therapeutic concept that focuses on these symptoms and helps to ameliorate them, primarily through adjusting dialysis prescriptions. Therapeutic strategies must guarantee high quality dialysis therapy and longer survival of dialysis patients with higher QOL and acceptance by patients.
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