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The Importance of History in Understanding Local Conditions for the Implementation of Community-based Integrated Care


Saori Takama

Onomichi City University, Onomichi, Hiroshima, JP
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Introduction: Following a trend of decentralization, the Japanese government has been promoting community-based integrated care since 2014, “taking into account each region’s conditions.” The government has given the initiative to local communities without, however, giving guidance on how to understand actual area conditions. Previous research has pointed out several obstacles to the provision of community-based integrated care, but it too has neglected the examination of regional conditions. As a result, gaps have widened between better and worse performers. This study proposes that regional history is one method of understanding how area conditions and assets can help with the implementation of community-based integrated care.

Methods: This study focuses on the Onomichi Method, used in Onomichi, a provincial city experiencing aging and depopulation. The special feature of this method is its care conference system, which brings together diverse stakeholders: local medical practitioners, hospital doctors, social workers, patients, families, residents, and government officials. The system has been recognized to be superior, and adopted as national policy. This study uses field research to determine how Onomichi was able to construct its unique version of community-based integrated care. Research mainly consists of investigations into local history, using historical documents and statistics, and semi-structured interviews with relevant parties.

Results and Discussions: Upon inquiry, this study reveals that Onomichi’s integrated care system is structured on a traditional network of local medical practitioners, going back to the 1890s. Area physicians have, historically, advanced various projects through this network, such as infectious disease control, the distribution of doctors to schools, revisions of local medical fees, and so on.

The inventor of the Onomichi Method first appealed to the network of area doctors to cooperate with various interested parties to support patients with chronic diseases or disabilities. Most doctors agreed, having already recognized the need to make changes in patient care. These physicians’ local authority easily attracted other shareholders. Credit for the success of the Onomichi Method is shared among its numerous participants. 

Conclusions and Lessons learned: This study concludes that identifying and utilizing local organizations and networks is beneficial in the construction of broadly-supported community-based integrated care. Essential to this is the proper understanding of a given region’s history and traditions, i.e. its “conditions.”

Limitations and Suggestions for future research: Lessons taken from this study are meaningful for historic rural communities with little migration. Area history and local networks may produce different effects in urban environments with shorter histories and higher flows of migration. Accordingly, field studies in cities are needed in order to assess the importance of history and networks.

Keywords: local conditions; local history; local networks

How to Cite: Takama S. The Importance of History in Understanding Local Conditions for the Implementation of Community-based Integrated Care. International Journal of Integrated Care. 2021;20(S1):27. DOI:
Published on 26 Feb 2021.


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