Clinical and experimental nephrology · 2025
Participation of physical therapists in medical fee-based dialysis-prevention interventions: a nationwide survey in Japan.
СтатьяНазвание и аннотация: Перевод в очереди
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Hirano Yuma, Kono Kenichi, Takahashi Ren, Tamura Yuma, Takahashi Momo, Imaoka Shinsuke, Nomura Takuo, Igaki Makoto
Аннотация
BACKGROUND: Exercise is recommended to prevent dialysis; however, the involvement of physical therapists is not a criterion for reimbursable medical fee calculation in Japan. Consequently, eligible patients may not receive appropriate exercise guidance. We aimed to clarify the extent of physical therapist participation in dialysis-prevention interventions reimbursed under the current Japanese healthcare system and to identify reasons for non-participation related to reimbursement criteria.
METHODS: In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.
RESULTS: Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were "Inclusion of physical therapists is not a strict requirement for medical fee reimbursement," "Insufficient personnel or time," and "No role assigned by the dialysis-prevention team."
CONCLUSION: Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.
METHODS: In January 2025, a 30-item questionnaire was distributed to all facility representatives registered with the Japan Physical Therapist Association to investigate medical fees and physical therapist involvement in dialysis prevention. Dialysis-prevention interventions were defined as those reimbursed under the Japanese healthcare system: Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management (including Guidance of Patients with Severe Renal Impairment), and Chronic Kidney Disease (CKD) Dialysis Prevention Guidance and Management.
RESULTS: Of the 10,285 facilities surveyed, 1322 (12.9%) responded. Among these, physical therapists participated in Lifestyle-Related Disease Management, Diabetes Dialysis Prevention Guidance and Management, and CKD Dialysis Prevention Guidance and Management in 4.8%, 3.5%, and 2.3% of facilities, respectively. The most frequently cited reasons for exclusion were "Inclusion of physical therapists is not a strict requirement for medical fee reimbursement," "Insufficient personnel or time," and "No role assigned by the dialysis-prevention team."
CONCLUSION: Physical therapist involvement in dialysis-prevention interventions was limited, primarily due to current medical fee reimbursement criteria. Revising the healthcare system to facilitate their inclusion may enhance the delivery of exercise-based preventive care.