Atsushi Obata
Asahigawaso (Social Welfare Corporation),
Planning and Public Relations Office

“I’m worried about lifestyle-related diseases, but I haven’t had the opportunity to undergo a comprehensive medical examination ...” Many homebound persons with disabilities and their families have such concerns, I believe.  Therefore, we at Asahigawaso are working on simple yet comprehensive medical examinations for persons with severe disabilities.

1. Background

In recent years, more regular hospitals offer comprehensive medical examinations to persons with disabilities in wheelchairs.  However, some of them still cannot accept persons with disabilities, particularly those with severe disabilities, due to the limitations of their facilities.  There have been many cases where some persons with disabilities refrain from seeing a doctor because they are worried, they might inconvenience the others; others left their subjective symptoms unresolved for they were unable to explain it, which caused any cancer to progress.

Compared with people housed in institutions who are under daily health management and receive regular health examinations, homebound persons with disabilities are more likely to fall into the above-stated situation of unresolved symptoms because they do not have many opportunities to receive medical attention.

Doctors at the Asahigawaso Rehabilitation & Medical Centre shared a common determination to implement regular and comprehensive medical examinations for persons with disabilities.  In Japan, the National Rehabilitation Centre for Persons with Disabilities conducts comprehensive medical examinations for persons with severe disabilities, although there have been some precedents found in national institutions and local governments.  While studying and observing these, we also consulted with the hospitals that implement comprehensive medical examinations in Okayama Prefecture and mapped out a framework.

As a result, in April 2019 we started implementing comprehensive medical examinations under a unique framework of collaboration where Asahigawaso conducts examinations utilizing our know-how as a hospital specializing in persons with disabilities, while our regular partner hospitals conduct the analysis of test results, detailed tests, and treatments.

2. Contents of Comprehensive Medical Examinations

(1) Implementation System

The Asahigawaso Rehabilitation & Medical Centre, which is the main implementing body of comprehensive medical examinations, has about 400 beds for children and adults with severe physical and mental disabilities, and children with orthopaedic impairments.  It also has an outpatient department where homebound persons with disabilities undergo examinations and basic medical treatments.  Our doctors and nurses have extensive experience in treating people with disabilities.

However, we had had no experience with comprehensive medical examinations, and due to staffing constraints, it was necessary to implement the check-ups within the usual outpatient clinic system.  For this reason, we decided to start by accepting a limited number of people, and for the time being, to limit the date of implementation to once a month and the number of examinees to one person each month, and to study the flow of the check-ups and the reaction of the examinees in order to identify the issues to resolve.

(2) Sensitivity towards Persons with Disabilities

We are devising ways of accepting persons with disabilities based on the characteristics of their disabilities.  In particular, persons with intellectual disabilities who visit us for the first time are often baffled by the examination room and staff, so we start by building a relationship of trust with the examinees in advance.  A public health nurse visits the examinee about one month before the examination date to deepen communication with the examinee and his/her guardians.  At the same time, the guardians are also asked to accompany the examinee on the day of the comprehensive medical examination.  In doing so, the check-ups can be done smoothly.

Some persons do not like entering laboratories and blood-taking procedures.  In such cases, we try to devise other good means, such as changing the order of the tests and letting the examinees hold their favourite books.

(3) Test Items

In the mornings, we conduct interviews, physical measurements, blood sampling, urine/stool tests, electrocardiogram/chest X-rays, internal medicine, otolaryngology, orthopaedics and dental examinations. 　In addition, tumour markers, BNP, and bone density tests are available as options (refer to Table 1 for items).

There are some items that cannot be performed, such as abdominal X-ray, endoscopy, and breast cancer examination.  On the other hand, for persons with disabilities who have few opportunities to see a doctor, we offer special items that are not available in general comprehensive medical examinations, such as otolaryngology, orthopaedics and dental examinations.  The otolaryngology department also accepts consultation on allergies in addition to checking the ears, nose and throat.  In orthopaedics, we check for scoliosis and ingrown nails, and in dentistry, we use a special dental chair equipped with a transfer lift to check for tooth decay and periodontal disease, test for feeding and swallowing functions, and provide nutritional advice.

In these departments, if any abnormality is found, you may undergo treatment at a later date.

(4) Creation of Result Sheet

Since our centre is not a medical institution that specializes in comprehensive medical examinations, we do not have the know-how to comprehensively analyse and evaluate diagnostic results.  For this reason, we send measurement data and samples to an external medical institution (Junpukai Health Maintenance Centre) and outsource the creation of a result sheet that describes the comprehensive evaluation.  About one month later, the doctor will hand over the result sheet directly to the guardians, explain the test results and future treatment protocols, and render advice on lifestyle improvement, etc.

(5) Thorough Examinations

Since our centre cannot perform thorough examinations such as gastric endoscopy and breast cancer/gynaecological examinations, we have established a system to refer examinees to an external general hospital (Kawasaki Medical School General Medical Centre).  By sharing the test results and important notes of the medical examination with the Regional Liaison Office of the hospital, the acceptance of the examinee is facilitated smoothly.

(6) Follow-up

After the examination, public health nurses and doctors follow up on each examinee by telephone, etc. to give health management advice and arrange the next examination.

(7) Examination Fees

The out-of-pocket amount to be paid is ¥20,000 for standard procedures (estimation based on medical remuneration points).  The optional tumour marker tests and bone density tests are separately charged (¥2,200-4,500).  There is no government subsidy for this cost.

3. Outcome of Implementation until the Present

Since the start in April 2019, eight persons have undergone comprehensive medical examinations in eight months (since 2020, it has been suspended due to the COVID-19 pandemic).  All were persons with intellectual disabilities or severe physical and mental disabilities, and their residences were widespread among four cities.  Their ages were from the 20s to the 60s.

As a result of the examination, no one showed “no abnormality” -- five persons required follow-ups and three persons required thorough examinations.  Five of them tested positive for Helicobacter pylori, and four needed follow-ups for blood pressure and blood sugar levels, so it seems that they had more health concerns than others.

In some cases, the results led to gastric endoscopy and eradication treatment for Helicobacter pylori at partner medical institutions.  In other cases, we have treated allergies and a dermatologist provided consultation at our centre.  We believe that the intended purpose of expanding consultation opportunities has been achieved to a certain extent.

According to the responses to the questionnaires from the examinees, six persons were satisfied, and two persons were almost satisfied with high satisfaction levels, and there were comments such as, “My anxiety has been resolved,” and “I want to undergo the examination again.”  On the other hand, many people hesitate to undergo the examination because the fee of ¥20,000 is high, and not all of them need to undergo the optional tumour marker test.  We have to say that there are still many issues that need to be resolved before we can secure examination opportunities for persons with disabilities and lead them to an early detection of cancer and other diseases.

In July, we are scheduled to make an online presentation at the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD) in Amsterdam to exchange opinions with experts from each country.

We would like to secure a “healthy life expectancy” for everyone.  We have to wait for the end of COVID-19 pandemic to resume comprehensive medical examinations.  We will continue to make further improvements even after the resumption, and with the understanding of the government agencies, we would like to make comprehensive medical examinations easy to undergo.

Table 1:  List of Examination Items for Comprehensive Medical Examinations