title: Long-term management of chronic obstructive pulmonary disease: a survey of collaboration among physicians involved in pulmonary rehabilitation in Japan.
abstract: BACKGROUND
  This study evaluated the implementation of pulmonary rehabilitation (PR), and the extent of the collaboration between primary care and chest physicians involved in the management of chronic obstructive pulmonary disease (COPD) in Japan.
  
  
  METHODS
  The survey was conducted in 2006 via post and facsimile and included all medical institutions approved by the Japan Respiratory Society.
  
  
  RESULTS
  In total, 176 institutions responded (response rate, 27%); a PR program was conducted at 55.1% of these institutions throughout Japan, but with regional differences. The mean duration of each session in an outpatient setting was 30 min with 2 sessions per week, and the mean length of hospitalization was 2-3 weeks. Although 33% of the hospitals adopted PR programs, on a scale from none (0) to maximum achievement (100), the accomplishment score was 48. Similarly, the mean satisfaction level score for collaboration was 44. The main problem arising with regards to chest physicians' referral to general physicians was the reluctance of patients or family members (88%). Chest physicians believed that general physicians should perform early screening of patients and manage early exacerbations, including educating patients of the need to discontinue smoking.
  
  
  CONCLUSIONS
  Most chest physicians in Japan were not satisfied with the status of long-term COPD management. PR for COPD patients and collaboration between primary care physicians and specialists remain problematic in Japan. Moreover, there are widespread regional differences in terms of implementation. Sharing and implementing appropriate clinical information with primary care physicians according to current clinical guidelines should be emphasized.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary Medicine, Infectious Diseases and Oncology, Nippon Medical School, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Motegi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Yamada
authors.forename: Takeo
authors.initials: T
authors.lastname: Ishii
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
authors.forename: Kozui
authors.initials: K
authors.lastname: Kida
mesh_terms: D003625:Data Collection; D006801:Humans; D007400:Interprofessional Relations; D007564:Japan; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012143:Respiratory Physiological Phenomena