Development of a Community-Complete Rehabilitation System Based on Patient Decision-Making Support in Depopulated Rural Areas: Patient-Centered Care from Physicians’ Perspectives

過疎地域における患者の意思決定支援を基盤とした地域完結型リハビリテーションシステムの構築 ―医師の視点からみた患者中心のケア―

Development of a Community-Complete Rehabilitation System Based on Patient Decision-Making Support in Depopulated Rural Areas: Patient-Centered Care from Physicians’ Perspectives

Degree Grantors Yamaguchi Prefectural University

In depopulated rural areas, the provision of healthcare and long-term care services is severely constrained by shortages of medical and care resources as well as geographic barriers to access. As a result, there is an urgent need to reconstruct support systems that are grounded in patients’ everyday living environments. The purpose of this study was to clarify the current status and challenges of community-based rehabilitation in depopulated rural areas from physicians’ perspectives and to develop a locally appropriate, community-complete rehabilitation model.
Semi-structured interviews were conducted with four physicians working in depopulated rural regions, and the interview transcripts were analyzed using qualitative content analysis. As a result, six categories relevant to the development of a community-complete rehabilitation system were generated. Category I, Structural Challenges and Innovation in the Regional Healthcare System, highlighted the need to reconceptualize the entire community as a healthcare space under conditions of limited human resources. Category II, Specialized Assessment and Service Delivery System, indicated the necessity of establishing evaluation and support systems to compensate for shortages of rehabilitation professionals. Category III, Home-Based Living Support and Rehabilitation Practice, emphasized the importance of home-based support including environmental assessment and preventive intervention. Category IV, Interprofessional Collaboration and Communication, demonstrated the need for effective mechanisms of information sharing and collaborative practice. Category V, Patient-Centered Support Philosophy, underscored the importance of respecting patients’ choices and sharing and documenting their preferences. Category VI, Professional Competence and Regional Culture, suggested that adaptation to local culture and cooperative attitudes among professionals are essential conditions for sustainable support.
By integrating these six categories, this study proposed a community-based rehabilitation model designed to operationalize patient-centered decision-making support in depopulated rural areas. The model places patient-centered decision- making at its core and identifies spatial continuity, which conceptualizes the entire community as a support space, and temporal flexibility, which enables continuous support regardless of disease stage, as essential conditions. Furthermore, the model demonstrates a structure in which professional development, practical interprofessional collaboration, and preventive and comprehensive care function as key elements supporting patient decision-making.
In particular, ICT-enabled collaborative frameworks such as the D/N with P model facilitate effective interprofessional practice, enhance the quality of comprehensive support, and expand patients’ available options, thereby increasing autonomy in decision-making. This model provides a systematic framework that enables individuals to continue living in their familiar communities until the end of life, even in depopulated rural areas, and offers important implications for future regional healthcare policy and the development of community-based rehabilitation systems.

Creators Hayashi Mizue