Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

File： J of Gen and Family Med - 2024 - Nomura - Utility of the rurality index for Japan for exploring good practice solutions for.pdf

DOI： 10.1002/jgf2.714

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Informa UK Limited  

DOI： 10.1080/0142159x.2024.2385133

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Background

Postpartum mental health care is a public health priority requiring interprofessional and interorganizational collaboration. Primary care physicians (PCPs) have the potential to play an essential role in facilitating access to health care and providing comprehensive and coordinated care for postpartum mental health problems. In Japan, however, there are no previous studies on the extent to which PCPs are involved in postpartum mental health care. Therefore, this study aimed to investigate the practices and experiences of Japanese PCPs in providing such care.

Methods

This study presents a subset of the findings from a cross‐sectional study using an online questionnaire on postpartum care among Japanese PCPs. We employed descriptive analysis to examine their practices and experiences in providing general and postpartum mental health care.

Results

We received 339 valid responses from 5811 PCPs. The median proportion of the outpatients with mental health problems that PCPs regularly saw was 15%. Approximately two out of three PCPs (68.7%) reported routinely performing screening for depression and anxiety. Seventy‐six percent of PCPs had the opportunity to provide care for postpartum women. Approximately one in two PCPs (47.8%) had managed cases of postpartum mental health problems and collaborated with various professionals and resources to provide care.

Conclusions

The majority of Japanese PCP participants in the study provide mental health care and have managed cases of postpartum mental health problems, collaborating with various health professionals.

File： J of Gen and Family Med - 2024 - Narumoto - Japanese primary care physicians postpartum mental health care A.pdf

DOI： 10.1002/jgf2.700

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s12928-024-01003-7

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Other Link： https://link.springer.com/article/10.1007/s12928-024-01003-7/fulltext.html

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： s12875-024-02397-2 (1).pdf

DOI： 10.1186/s12875-024-02397-2

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Language：English   Publishing type：Research paper (scientific journal)  

File： J of Gen and Family Med - 2024 - Kinoshita - Medical students impression of a generalist in Japan A cross‐sectional study.pdf

DOI： 10.1002/jgf2.692

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Patients with refractory cardiogenic shock (CS) necessitating peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) often require an intra-aortic balloon pump (IABP) or Impella for unloading; however, comparative effectiveness data are currently lacking.Methods and Results: Using Diagnosis Procedure Combination data from approximately 1,200 Japanese acute care hospitals (April 2018-March 2022), we identified 940 patients aged ≥18 years with CS necessitating peripheral VA-ECMO along with IABP (ECMO-IABP; n=801) or Impella (ECPella; n=139) within 48 h of admission. Propensity score matching (126 pairs) indicated comparable in-hospital mortality between the ECPella and ECMO-IABP groups (50.8% vs. 50.0%, respectively; P=1.000). However, the ECPella cohort was on mechanical ventilator support for longer (median [interquartile range] 11.5 [5.0-20.8] vs. 9.0 [4.0-16.8] days; P=0.008) and had a longer hospital stay (median [interquartile range] 32.5 [12.0-59.0] vs. 23.0 [6.3-43.0] days; P=0.017) than the ECMO-IABP cohort. In addition, medical costs were higher for the ECPella than ECMO-IABP group (median [interquartile range] 9.09 [7.20-12.20] vs. 5.23 [3.41-7.00] million Japanese yen; P<0.001). CONCLUSIONS: Our nationwide study could not demonstrate compelling evidence to support the superior efficacy of Impella over IABP in reducing in-hospital mortality among patients with CS necessitating VA-ECMO. Further investigations are imperative to determine the clinical situations in which the potential effect of Impella can be maximized.

DOI： 10.1253/circj.CJ-23-0758

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：S. Karger AG  

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Food protein-induced enterocolitis syndrome (FPIES) is a form of non-IgE-mediated gastrointestinal food allergy. FPIES is considered a rare food allergy disorder and is often under-recognized. Therefore, clinicians should have a better understanding of its manifestations and maintain a high index of suspicion for a correct diagnosis. To this end, information about differences in the characteristics of caregiver-reported and physician-diagnosed FPIES is important. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; The present, national, multicentric, prospective birth cohort study, called the Japan Environment and Children’s Study (JECS), enrolled a general population of 104,062 fetal records. The characteristics of FPIES in 1.5-year-old children were categorized as cases reported by caregivers or as those diagnosed by a physician using questionnaire data. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The prevalence of caregiver-reported and physician-diagnosed FPIES cases was 0.69% and 0.06%, respectively. Among the former, the most common causative food was hen’s egg (HE), and the second most common causative food was cow’s milk (CM) (51.0% and 17.1% of patients responded to HE and CM, which accounted for 46% and 15% of all the causative foods, respectively). Conversely, among the physician-diagnosed cases, the most common causative food was CM followed by HE (57.7% and 36.5% of patients responded to CM and HE, which accounted for 46% and 29% of all the causative foods, respectively). CM accounted for a significantly higher proportion of causative foods in physician-diagnosed FPIES while HE accounted for a significantly higher proportion of caregiver-reported FPIES (&lt;i&gt;p&lt;/i&gt; &amp;lt; 0.05). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; A discrepancy was found in reports of the most common causative food between caregiver-reported and physician-diagnosed cases of FPIES.

File： 000535751.pdf

DOI： 10.1159/000535751

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： s12875-023-02250-y.pdf

DOI： 10.1186/s12875-023-02250-y

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Language：English   Publishing type：Research paper (scientific journal)  

File： advpub_CJ-23-0537.pdf

DOI： 10.1253/circj.CJ-23-0537

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Preconception care is not widespread in Japan and there is a pressing need to improve the practice. The present study assessed the knowledge and behavior of preconception care among women to seek effective intervention. Our research questions were: 1) How much do women know about preconception care? 2) How much are they practicing preconception care and what are the information sources of their behavior? 3) Do the women's preconception care behavior associated with accurate knowledge? METHODS: The research was conducted in a rural town in central Japan. Using an exploratory sequential mixed methods design, we undertook interviews, developed a survey based on the qualitative results, and then conducted a survey. The interviews explored how preconception care was perceived and practiced in women of childbearing age. The survey was designed to investigate the knowledge of preconception care among women with and without pregnancy experience, their practice behavior of preconception care, and whether the behavior is associated with knowledge. RESULTS: The participants were 13 for the interview and 232 for the survey. They had limited access to preconception care recommendations and advice for specific actions was given by obstetricians and gynecologists after pregnancy. There was a large gap in knowledge about preconception care between parous and nulliparous women, especially about the need for folic acid supplementation. Practices that were manageable in their daily lives, such as cessation of smoking and alcohol, diet, and weight management, were considered common sense. In contrast, recommended practices that require medical attention, such as screening for sexually transmitted diseases and cervical cancer, tended to be less accurately known and practiced. Participants' sources of information about preconception care were the Internet, family and friends and mass media. CONCLUSION: In rural Japan, women of childbearing age lack knowledge about preconception care, especially before their first pregnancy. Primary care providers should try outreach to schools and women's groups in the community, promote information sharing among family and close friends, and utilize information technology to enhance the knowledge and practice of preconception care.

File： s12884-023-05940-8.pdf

DOI： 10.1186/s12884-023-05940-8

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Association of Rehabilitation Medicine  

File： 8_20230033.pdf

DOI： 10.2490/prm.20230033

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

Diagnostic delay in cancer is a challenge in primary care. Although screening tests are effective in diagnosing some cancers such as breast, colorectal and cervical cancers, symptom-based cancer diagnosis is often difficult due to its low incidence in primary care and the influence of patient anxiety, doctor–patient relationship and psychosocial context. A general practitioner’s gut feeling for cancer may play a role in the early diagnosis of cancer in primary care where diagnostic resources are limited. The aim of this study is to summarise existing evidence about the test accuracy of gut feeling (index test) in symptomatic adult patients presenting to general practice, compared with multidisciplinary team-confirmed diagnosis of cancer (reference standard).

Design

Diagnostic accuracy review following Cochrane methods was performed.

Data sources

MEDLINE, EMBASE, Cochrane Library, the Database of Abstracts of Reviews of Effects and Medion databases.

Eligibility criteria

Cross-sectional, cohort and randomised studies of test accuracy that compared gut feeling (index test) with an appropriate cancer diagnosis (reference standard). No language or publication status restrictions were applied. We included all studies published before 25 March 2022.

Data extraction and synthesis

Methodological quality was appraised, using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Meta-analysis with hierarchical summary receiver operating characteristic (HSROC) models was used.

Results

Of 1286 potentially relevant studies identified, six met the inclusion criteria. For two of the six studies, data could not be extracted despite contacting authors. No studies satisfied all QUADAS-2 criteria. After meta-analysis of data from the remaining studies, the summary point of HSROC had a sensitivity of 0.40 (95% CI: 0.28, 0.53) and a specificity of 0.85 (95% CI: 0.75, 0.92).

Conclusions

Gut feeling for cancer when used in symptomatic adult patients in general practice has a relatively low sensitivity and high specificity. When the prevalence of cancer in the symptomatic population presenting in general practice exceeds 1.15%, the performance of gut feeling reaches the National Institute for Health and Care Excellence 3% positive predictive value threshold for action, which recommends urgent access to specialist care and further investigations. The findings support the continued and expanded use of gut feeling items in referral pathways.

DOI： 10.1136/bmjopen-2022-068549

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：F1000 Research Ltd  

<p>Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians ‘in the field’, this paper elucidates how in practice the vaccinations were carried out in Japan in 2021. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls ‘scalability’. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts.</p>

File： f7f3154a-7f2d-4aa4-99cf-23f92e44c8d1_126366_-_shuhei_kimura.pdf

DOI： 10.12688/f1000research.126366.2

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Other Link： https://f1000research.com/articles/11-1268/v1/pdf

Language：Japanese  

File： 4_4.3_1.pdf

DOI： 10.34458/jahcm.4.3_1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Korean Academy of Family Medicine  

File： kjfm-22-0189.pdf

DOI： 10.4082/kjfm.22.0189

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

Rural–urban healthcare disparities exist globally. Various countries have used a rurality index for evaluating the disparities. Although Japan has many remote islands and rural areas, no rurality index exists. This study aimed to develop and validate a Rurality Index for Japan (RIJ) for healthcare research.

Design

We employed a modified Delphi method to determine the factors of the RIJ and assessed the validity. The study developed an Expert Panel including healthcare professionals and a patient who had expertise in rural healthcare.

Setting

The panel members were recruited from across Japan including remote islands, mountain areas and heavy snow areas. The panel recruited survey participants whom the panel considered to have expertise.

Participants

The initial survey recruited 100 people, including rural healthcare providers, local government staff and residents.

Primary outcome measures

Factors to include in the RIJ were identified by the Expert Panel and survey participants. We also conducted an exploratory factor analysis on the selected factors to determine the factor structure. Convergent validity was examined by calculating the correlation between the index for physician distribution and the RIJ. Criterion-related validity was assessed by calculating the correlation with average life expectancy.

Results

The response rate of the final survey round was 84.8%. From the Delphi surveys, four factors were selected for the RIJ: population density, direct distance to the nearest hospital, remote islands and whether weather influences access to the nearest hospital. We employed the factor loadings as the weight of each factor. The average RIJ of every zip code was 50.5. The correlation coefficient with the index for physician distribution was −0.45 (p&lt;0.001), and the correlation coefficients with the life expectancies of men and women were −0.35 (p&lt;0.001) and −0.12 (p&lt;0.001), respectively.

Conclusion

This study developed the RIJ using a modified Delphi method. The index showed good validity.

File： e068800.full.pdf

DOI： 10.1136/bmjopen-2022-068800

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Background

Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.

Methods

This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20–74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.

Results

Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was −0.34 (95% confidence interval (CI): −0.57 to −0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was −0.56 (P &amp;lt; 0.001, 95% CI: −0.78 to −0.35).

Conclusions

Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.

File： cmad049 (1).pdf

DOI： 10.1093/fampra/cmad049

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Language：Japanese   Publisher：(一社)日本医学教育学会  

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00050&link_issn=&doc_id=20230516210002&doc_link_id=10.11307%2Fmededjapan.54.2_142&url=https%3A%2F%2Fdoi.org%2F10.11307%2Fmededjapan.54.2_142&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：English   Publisher：(一社)日本循環器学会  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本疫学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Despite extensive vaccination campaigns to combat the coronavirus disease (COVID-19) pandemic, variants of concern, particularly the Omicron variant (B.1.1.529 or BA.1), may escape the antibodies elicited by vaccination against SARS-CoV-2. Therefore, this study aimed to evaluate 50% neutralizing activity (NT50) against SARS-CoV-2 D614G, Delta, Omicron BA.1, and Omicron BA.2 and to develop prediction models to predict the risk of infection in a general population in Japan. METHODS: We used a random 10% of samples from 1,277 participants in a population-based cross-sectional survey conducted in January and February 2022 in Yokohama City, the most populous municipality in Japan. We measured NT50 against D614G as a reference and three variants (Delta, Omicron BA.1, and BA.2) and immunoglobulin G against SARS-CoV-2 spike protein (SP-IgG). RESULTS: Among 123 participants aged 20-74, 93% had received two doses of SARS-CoV-2 vaccine. The geometric means (95% confidence intervals) of NT50 were 65.5 (51.8-82.8) for D614G, 34.3 (27.1-43.4) for Delta, 14.9 (12.2-18.0) for Omicron BA.1, and 12.9 (11.3-14.7) for Omicron BA.2. The prediction model with SP-IgG titers for Omicron BA.1 performed better than the model for Omicron BA.2 (bias-corrected R 2 with bootstrapping: 0.721 vs. 0.588). The models also performed better for BA.1 than for BA.2 (R 2 = 0.850 vs. 0.150) in a validation study with 20 independent samples. CONCLUSION: In a general Japanese population with 93% of the population vaccinated with two doses of SARS-CoV-2 vaccine, neutralizing activity against Omicron BA.1 and BA.2 were substantially lower than those against D614G or the Delta variant. The prediction models for Omicron BA.1 and BA.2 showed moderate predictive ability and the model for BA.1 performed well in validation data.

File： fmicb-14-1126527.pdf

DOI： 10.3389/fmicb.2023.1126527

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Despite the broad global use of antibiotics, there is no established definition of early antibiotic treatment failure (EATF) to aid clinical evaluation of treatment, which leads to inconsistent assessments of drug effectiveness. AIM: This scoping review aims to identify common components of EATF definitions by synthesizing studies mentioning EATF and its relevant thesaurus matches. DESIGN: Scoping review. METHODS: This scoping review was conducted following the PRISMA Scoping review guidelines. A systematic literature search was conducted using MEDLINE (PubMed), CENTRAL, CINAHL, and Web of Science, as well as a manual Google search. Search terms were EATF and its thesaurus matches. After removing duplications, candidate studies were screened by title and abstract prior to full text searches, and quality analysis was performed on eligible studies using the Critical Appraisal Skills Programme. From each eligible study, the timing of evaluation, basic components, and detailed information for each definition of EATF were collected. The components of each definition for EATF were then summarized and counted, and finally the most common essential components were identified. RESULTS: Our systematic literature search found 2,472 candidate studies. After title and abstract screening, full text search and quality assessment, 61 studies, including 56 original studies and five reviews, were eligible for our analysis. Of these 56 original studies, 43 mentioned the timing of EATF evaluation 72 hours after the start of treatment with antibiotics. From these 43 studies, the most common indicators of EATF were extracted, among which a set of essential components for a definition of EATF were identified: mortality, vital signs, fever, symptoms, and additional treatment. CONCLUSIONS: Our scoping review uncovered five essential factors for EATF. Further study is needed to evaluate the validity of our findings.

File： journal.pone.0283417.pdf

DOI： 10.1371/journal.pone.0283417

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

File： Geriatrics Gerontology Int - 2022 - Watanabe - Death at home versus other locations in older people receiving physician‐led.pdf

DOI： 10.1111/ggi.14496

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.14496

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

SARS-CoV-2 infection (COVID-19) has affected tertiary medical institutions and primary care. Admission for ambulatory care sensitive conditions (ACSCs) is an important indicator of primary care quality. However, no nationwide study, especially in Asia, has examined the association between admissions for ACSCs and local surges in COVID-19. This study aimed to examine how the number of admissions for ACSCs has changed in Japan between the areas with higher and lower rates of COVID-19 infection.

Design

This was a retrospective two-stage cross-sectional study. We employed a difference-in-difference design to compare the number of hospital admissions for ACSCs between the areas with higher and lower rates of COVID-19 infection in Japan.

Setting

The study used a nationwide database in Japan.

Participants

All patients were aged 20 years and above and were admitted due to ACSCs during the study period between March and September 2019 (before the pandemic) and between March and September 2020 (during the pandemic).

Results

The total number of ACSC admissions was 464 560 (276 530 in 2019 and 188 030 in 2020). The change in the number of admissions for ACSCs per 100 000 was not statistically significant between the areas with higher and lower rates of COVID-19 infection: 7.50 (95% CI −87.02 to 102.01). In addition, in acute, chronic and preventable ACSCs, the number of admissions per 100 000 individuals did not change significantly.

Conclusion

Although admissions for ACSCs decreased during the COVID-19 pandemic, there was no significant change between the areas with higher and lower rates of COVID-19 infection. This implies that the COVID-19 pandemic affected the areas with higher infection rates and the areas with lower rates.

File： e001736.full.pdf

DOI： 10.1136/fmch-2022-001736

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Heart Journal (Japanese Heart Journal)  

In patients with atrial septal defect (ASD), atrial left-to-right shunting causes left atrial (LA) remodeling and dysfunction, leading to atrial fibrillation (AF). In adults with ASD and concomitant AF, LA function should be evaluated after ASD closure plus AF radiofrequency catheter ablation (RFCA).This multicenter retrospective cohort study included patients who underwent transcatheter ASD closure at one of the four leading hospitals. Patients with a history of AF also underwent preceding RFCA. The association between AF history and LA ejection fraction (EF) (indicating LA global function) at 6-12 months following ASD closure was evaluated. To account for differences in baseline characteristics between patients with and without a history of AF, we conducted the following statistical methods: (1) multivariate regression analysis in the prepropensity score (PS)-matched cohort and (2) univariate comparisons in the PS-matched cohort.Overall, this study included 231 patients (30 with AF history, 201 without). Multiple regression analysis showed that AF history was independently associated with impaired LAEF (β = -10.425, P < 0.001, model created prior to propensity matching). A one-to-one PS matching (25 pairs) showed that the LAEF at 6-12 months following ASD closure was significantly impaired in patients with ASD and AF history compared to that in patients without history of AF (median LAEF, 37.5% (interquartile range [IQR] 29.4%-48.5%) versus 52.3 [IQR 50.0%-56.6%]; P < 0.001).LA function was impaired in patients with ASD and a history of AF at 6-12 months after successful transcatheter ASD closure and on maintenance of sinus rhythm by RFCA.

File： 63_22-265.pdf

DOI： 10.1536/ihj.22-265

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Guidelines worldwide recommend that physicians should not treat their family members. However, studies in the U.S. have shown that approximately 74–83% of physicians have experience of treating family members. Primary care physicians were more likely to have such experiences than other specialists. In Japan, physicians do not have any guidelines regarding treating family members, and little is known about the experiences of primary care physicians. Therefore, we investigated the experience of treating family members or relatives among primary care physicians in Japan.

Methods

This cross-sectional study used an online questionnaire. We recruited 2,000 physicians who were members of the Japan Primary Care Association using random sampling. Data were collected from February 10 to March 10, 2021. We compare the experiences of treating family members between clinic-based doctors and hospital-based doctors using the chi-square test. We performed logistic regression analysis to adjust for gender, age, presence of a doctor in family, and physician’s geographic location (rural or not rural).

Results

A total of 466 physicians (response rate = 23.3%) completed the survey. Of the sample, 79.8% had experience of treating family members or relatives. In the univariate analysis, being a clinic-based physician was associated with experience in treating family members compared to hospital-based physicians (87.6% vs. 74.9%, p = 0.001). Multivariable analysis showed that being a clinic-based physician (odds ratio 2.30, 95% confidence interval 1.31–4.04) and age of 45–64 years (odds ratio 2.93, 95% confidence interval 1.74–4.93) were significantly related to experience treating family. Gender and geographic location were not statistically significant factors.

Conclusions

A high percentage of Japanese primary care physicians, especially those who worked in clinics, reported experience treating family members or relatives. These findings will serve as basic data for future studies regarding the care of families and relatives of physicians in Japan.

File： s12875-022-01848-y.pdf

DOI： 10.1186/s12875-022-01848-y

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Other Link： https://link.springer.com/article/10.1186/s12875-022-01848-y/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Many women face a variety of barriers to seeing obstetricians and gynecologists (OB/GYNs). Primary care physicians (PCPs) in Japan are not well equipped to address and adequately handle women’s health issues. Hence, opportunities for women to consult PCPs about women’s health issues are often limited during busy outpatient encounters. It is essential to explore PCP’s roles in women’s health care by examining women’s health needs in a primary care setting. The aim of the study is to describe the prevalence and distribution of women’s health issues and help-seeking intentions among women visiting a primary care clinic.

Methods

This was a cross-sectional study using a questionnaire. We included women aged 20–60 years who visited a primary care clinic for any reason. The questionnaire comprised a list of women’s health issues, the General Help Seeking Questionnaire to assess help-seeking intentions, and participants’ demographics including their reasons for visiting and regularity of OB/GYN visits.

Results

We distributed the questionnaire to 294 women and analyzed 260 valid responses. The average age of the respondents was 40.5 years old, and they had an average of 5.2 clinic visits a year. Approximately half of them (50.4%) visited for their own care. One hundred thirty-nine (53.9%) reported at least one women’s health issue, and 73.9% of them had no regular visit to an OB/GYN. The major concerns of women’s health issues included gynecological cancer screenings and menstrual problems. The distribution of help-seeking intentions for each source of care appeared to be classified into three patterns. One fifth of the women indicated high help-seeking intentions for PCPs, and a greater number of women expressed higher help-seeking intentions for PCPs when they did not regularly see an OB/GYN.

Conclusions

A significant number of women who visited a primary care clinic had a specific concern about women’s health issues, and a majority of them had not regularly visited their OB/GYN. PCPs may have an important role in providing an opportunity for women to discuss their concerns about women’s health issues as part of comprehensive care during a daily clinical encounter.

File： s12875-022-01862-0 (1).pdf

DOI： 10.1186/s12875-022-01862-0

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Other Link： https://link.springer.com/article/10.1186/s12875-022-01862-0/fulltext.html

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

Continuity of care is a core dimension of primary care, and better continuity is associated with better patient outcomes. Therefore, care fragmentation can be an indicator to assess the quality of primary care, especially in countries without formal gatekeeping system, such as Japan. Thus, this study aimed to describe care fragmentation among older adults in an ageing city in Japan.

Design

Cross-sectional study.

Setting

The most populated basic municipality in Japan.

Participants

Older adults aged 75 years and older.

Interventions

This study used a health claims database, including older adults who visited medical facilities at least four times a year in an urban city in Japan. The Fragmentation of Care Index (FCI) was used as an indicator of fragmentation. The FCI was developed from the Continuity of Care Index and is based on the total number of visits, different institutions visited and proportion of visits to each institution. We employed Tobit regression analysis to examine the association between the FCI and age, sex, type of insurance and most frequently visited facility.

Results

The total number of participants was 413 600. The median age of the study population was 81 years, and 41.6% were men. The study population visited an average of 3.42 clinics/hospitals, and the maximum number of visited institutions was 20. The proportion of patients with FCI &gt;0 was 85.0%, with a mean of 0.583. Multivariable analysis showed that patients receiving public assistance had a lower FCI compared with patients not receiving public assistance, with a coefficient of 0.137.

Conclusions

To our knowledge, this is the first study to demonstrate care fragmentation in Japan. Over 80% of the participants visited two or more medical facilities, and their mean FCI was 0.583. The FCI could be a basic indicator for assessing the quality of primary care.

File： e061921.full.pdf

DOI： 10.1136/bmjopen-2022-061921

PubMed

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Background

Although primary care (PC) is an indispensable part of the health system, measuring its quality is challenging. A recent measure of PC, Person-Centered Primary Care Measure (PCPCM), covers 11 important domains of PC and has been translated into 28 languages. This study aimed to develop a Japanese version of the PCPCM and assess its reliability and validity.

Methods

We employed a cross-sectional mail survey to examine the reliability and content, structure, criterion-related, and convergent validity of the Japanese version of the PCPCM. This study targeted 1000 potential participants aged 20–74 years, selected by simple random sampling in an urban area in Japan. We examined internal consistency, confirmatory factor analysis, correlation between the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF), and the association between the PCPCM score and influenza vaccine uptake.

Results

A total of 417 individuals responded to the survey (response rate = 41.7%), and we used the data of 244 participants who had the usual source of care to assess the reliability and validity of the PCPCM. Confirmatory factor analysis demonstrated sufficient structural validity of the original one-factor structure. The overall Cronbach’s alpha was 0.94. The Spearman correlation coefficient between PCPCM and JPCAT-SF was 0.60. Influenza vaccine uptake was not significantly associated with total PCPCM score.

Conclusions

The study showed that the Japanese version of the PCPCM has sufficient internal consistency reliability and structural- and criterion-related validity. The measure can be used to compare the quality of primary care in Japan and other countries.

File： s12875-022-01726-7.pdf

DOI： 10.1186/s12875-022-01726-7

PubMed

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Other Link： https://link.springer.com/article/10.1186/s12875-022-01726-7/fulltext.html

Language：Japanese   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

AIM: Urbanization and ageing are worldwide issues for healthcare providers. In particular, older adults aged 90 years and older have increased cognitive impairment and lower daily functioning than younger adults. However, the healthcare use of the oldest old remains unclear. This study aimed to describe the healthcare use of the oldest old compared with younger older adults in a city using the ecology of medical care model. METHODS: We conducted a cross-sectional study. This study targeted all residents aged 75 years and older registered in a city in Japan for one year. We described healthcare use per 1000 inhabitants over a 1-month period and included: outpatient visits, emergency department visits, hospitalizations, home visits, home care services, and facility services. We also compared healthcare use among older adults aged 75-89 years and 90 years and older. RESULTS: We described the healthcare use of 454 366 (male/female: 186 177/268 189) older adults. The numbers of persons per 1000 residents who used healthcare resources at least once in 1 month (75-89 years/90 years and older) were: outpatient clinic visits, 622/570; hospital outpatient visits, 300/263; advanced treatment hospital outpatient visits, 16/6; emergency department visits, 10/27; hospitalizations, 45/96; advanced treatment hospital hospitalizations, 2/1; planned home visits, 36/228; urgent home visits, 6/38; home care services, 173/533; and facility services, 32/178. CONCLUSIONS: The results revealed that older adults over 90 years had more hospitalizations, emergency department visits and home visits, and used facility/home care services more compared with older adults aged 75-89 years. The results provide a useful benchmark for healthcare use estimation. Geriatr Gerontol Int 2022; 22: 483-489.

DOI： 10.1111/ggi.14387

PubMed

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.14387

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
The number of women with congenital heart disease (CHD) who are of childbearing age is increasing due to advancements in medical management. Nonetheless, data on the outcomes of delivery in women with CHD remain limited. Therefore, we conducted a retrospective cohort study using a nationwide database of deliveries by women with CHD.


</sec><sec>
<title>Methods</title>
Deliveries by women with CHD discharged from acute-care hospitals between April 2017 and March 2018 were identified based on the Diagnosis Procedure Combination database which covers almost all acute-care hospitals in Japan. By using this database, we tried to include relatively high-risk deliveries by women with CHD. Subjects were divided into three groups according to the underlying disease complexity: simple, moderate, and great complexity. The clinical characteristics and incidence of peripartum cardiovascular events were compared among the three groups.


</sec><sec>
<title>Results</title>
A total of 249 deliveries from 107 hospitals were included. The largest facility had 29 deliveries per year. Given the uncertainty of underlying cardiac anomalies, 48 women were excluded, and the remaining 201 women (median age, 32 years) were analyzed. In-hospital maternal death, use of extracorporeal membrane oxygenation, intra-aortic balloon pump, pacemaker, and direct current cardioversion were not observed. Nine patients (4.5%) required intravenous diuretic administration. However, the difference in the frequency of diuretic use was not significant among the three groups (simple, 1.9%; moderate, 7.2%; great, 6.9%; <italic>P</italic> = 0.204). One participant required valve replacement surgery at 22 days after a successful cesarean section. As the disease complexity increased, deliveries occurred more frequently at university hospitals (simple, 41.7%; moderate, 52.2%; great, 72.4%; <italic>P</italic> = 0.013) and the length of hospitalization was significantly longer, with median durations of 9.0 (interquartile range [IQR] 7.0–11.0) days, 10.0 (IQR 8.0–24.0) days, and 11.0 (IQR 8.0–36.0) days in the simple, moderate, and great complexity groups, respectively (<italic>P</italic> = 0.002).


</sec><sec>
<title>Conclusions</title>
Appropriate patient selection and management by specialized tertiary institutions may contribute to positive outcomes in pregnancies in women with CHD.


</sec>

File： s12872-021-02222-z (1).pdf

DOI： 10.1186/s12872-021-02222-z

PubMed

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Other Link： https://link.springer.com/article/10.1186/s12872-021-02222-z/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

File： jgf2.452 (1).pdf

DOI： 10.1002/jgf2.452

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Language：Japanese   Publisher：(一社)日本プライマリ・ケア連合学会  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Royal College of General Practitioners  

<sec><title>Background</title>Expert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators’ perceptions of EGP.

</sec><sec><title>Aim</title>To explore Japanese family doctor educators’ perceptions of EGP

</sec><sec><title>Design &amp; setting</title>A qualitative study among family doctor educators in Japan

</sec><sec><title>Method</title>We conducted focus group interviews using a semi-structured interview guide following a short lecture on EGP. We adopted a qualitative description method and used the framework method to conduct thematic analysis.

</sec><sec><title>Results</title>Participants included 17 family medicine trainers in Japan, including 11 directors and five associate directors of family medicine training programmes. The results suggested that the concept of EGP was important and applicable to primary care in Japan. Participants’ perceptions on EGP pertained to the following four areas: impact of EGP, triggers for EGP, enablers for EGP, and educational strategies for EGP.

</sec><sec><title>Conclusion</title>The concept of EGP may be useful in clinical practice in Japan, especially in complex patient care. A clearer framework for or description of EGP, and of non-traditional methods such as ascetic practice and awareness of the self, were proposed as possible educational strategies.

</sec>

File： BJGPO.2021.0011.full.pdf

DOI： 10.3399/bjgpo.2021.0011

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

File： hakusanjinruigaku24_101-114.pdf

CiNii Books

CiNii Research

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Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18K18590/

Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
Rural-urban health care disparities are an important topic in health services research. Hence, developing valid and reliable tools to measure rurality is needed to support high quality research. However, Japan, has no index to measure rurality for health care research. In this study, we conducted a systematic scoping review to identify the important factors and methodological approaches to consider in a rurality index to inform the development of a rurality index for Japan.


</sec><sec>
<title>Methods</title>
For our review, we searched six bibliographic databases (MEDLINE, PubMed, CINAHIL, ERIC, Web of Science and the Grey Literature Report) and official websites of national governments such as Government and Legislative Libraries Online Publications Portal (GALLOP), from 1 January 1989 to 31 December 2018. We extracted relevant variables used in the development of rurality indices, the formulas used to calculate indices, and any measures for reliability and validity of these indices.


</sec><sec>
<title>Results</title>
We identified 17 rurality indices from 7 countries. These indices were primarily developed to assess access to health care or to determine eligibility for incentives for health care providers. Frequently used factors in these indices included population size/density and travel distance/time to emergency care or referral centre. Many indices did not report reliability or validity measures.


</sec><sec>
<title>Conclusions</title>
While the concept of rurality and concerns about barriers to access to care for rural residents is shared by many countries, the operationalization of rurality is highly context-specific, with few universal measures or approaches to constructing a rurality index. The results will be helpful in the development of a rurality index in Japan and in other countries.


</sec>

File： Kaneko2021_Article_SystematicScopingReviewOfFacto.pdf

DOI： 10.1186/s12913-020-06003-w

Web of Science

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Other Link： http://link.springer.com/article/10.1186/s12913-020-06003-w/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

<sec><title>Objectives</title>The primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the validity and reliability in the primary care setting.

</sec><sec><title>Design</title>Cross-sectional study.

</sec><sec><title>Setting</title>Three family physician teaching clinics located in urban residential areas in Tokyo, Japan.

</sec><sec><title>Participants</title>Patients who were aged 20 years or older, and who had an appointment with physicians at the three participating clinics.

</sec><sec><title>Main outcome measures</title>Patient complexity measured by PCAM and complexity/burden level measured by a Visual Analogue Scale (VAS).

</sec><sec><title>Results</title>Although confirmatory factor analysis using a model described in a previous study revealed that the indices did not meet the criteria for good fit, exploratory factor analysis revealed a new three-factor structure of ‘Personal well-being,’ ‘Social interaction’ and ‘Needs for care/service.’ Cronbach’s alpha of PCAM was 0.86. Spearman’s rank correlation coefficients between PCAM scores and VAS scores were 0.51 for complexity (p&lt;0.001) and 0.41 for burden (p&lt;0.001). There were 42 patients (14.3% of total patients) with PCAM scores greater than its mean of 16.5 but with complexity VAS scores less than its mean of 20.8.

</sec><sec><title>Conclusions</title>The Japanese version of PCAM and its user guide were developed through Japanese translation and cultural adaptation by cognitive debriefing. PCAM is a valid and reliable tool to assess patient complexity in the primary care settings in Japan. Additionally, although the correlation between total PCAM scores and complexity/burden as assessed by VAS was moderate, PCAM can more precisely identify patient complexity than skilled physician’s intuition.

</sec>

File： e037282.full.pdf

DOI： 10.1136/bmjopen-2020-037282

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<sec><title>Objectives</title>Although frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital.

</sec><sec><title>Design</title>A prevalence study for a period of 1 year.

</sec><sec><title>Setting</title>A secondary hospital and a tertiary hospital in central Japan.

</sec><sec><title>Participants</title>All patients who presented to the EDs.

</sec><sec><title>Primary outcome measures</title>We defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures.

</sec><sec><title>Results</title>Of 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits—0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits.

</sec><sec><title>Conclusion</title>The proportion of frequent ED users, of total visits, and of expenditures attributable to them—while still in the low end of the distribution of published ranges—are lower in this study from Japan than in reports from many other countries.

</sec>

File： e039030.full.pdf

DOI： 10.1136/bmjopen-2020-039030

PubMed

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults：Multicentered Cross-sectional Study (1).pdf

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Authorship：Lead author   Language：Japanese   Publishing type：Part of collection (book)  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Primary Care Association  

File： 青木さん_インターネット依存.pdf

DOI： 10.14442/generalist.43.44

J-GLOBAL

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/ped.14193

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ped.14193

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The objective of this study was to assess the impact of a 2010 community-based participatory research (CBPR) reporting guideline on the quality of reporting a CBPR on smoking cessation. We searched the MEDLINE, Embase, the Cochrane Central Register for Controlled Trials (CENTRAL), PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and included articles published up to December 2019 (PROSPERO: CRD42019111668). We assessed reporting quality using the 13-item checklist. Of the 80 articles identified, 42 (53%) were published after 2010. The overall reporting quality before and after 2010 was poor and did not differ significantly (mean difference: 0.66, 95% confidence interval [CI]: −0.21 to 1.53). The total reporting scores of the studies did not differ significantly according to the effect size of the intervention (beta coefficient: −2.86, 95% CI: −5.77 to 0.04). This study demonstrates the need to improve the quality of reporting CBPRs. We recommend that journal editors endorse the CBPR reporting guideline to encourage its use by more researchers.

File： ijerph-17-03898 (2).pdf

DOI： 10.3390/ijerph17113898

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Language：Japanese   Publisher：Japanese Society of Cultural Anthropology  

DOI： 10.14890/jjcanth.85.3_566

CiNii Books

CiNii Research

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

<sec><title>Objectives</title>The rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX.

</sec><sec><title>Design</title>Multicentred, prospective, cohort study

</sec><sec><title>Setting</title>This study was conducted on five rural islands in Okinawa, Japan.

</sec><sec><title>Participants</title>The study participants were all island inhabitants aged 65 years or older.

</sec><sec><title>Primary outcome measures</title>This study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1 year.

</sec><sec><title>Results</title>Of 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient’s PX scores (OR per 1 SD increase=1.62, 95% CI 1.02–2.61).

</sec><sec><title>Conclusions</title>Physicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient–doctor relationships on the rural islands.

</sec>

File： e030101.full.pdf

DOI： 10.1136/bmjopen-2019-030101

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： cmz056.pdf

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： bjgpopen19X101650.full.pdf

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Language：English   Publishing type：Research paper (scientific journal)  

File： Kato_et_al-2019-Journal_of_General_and_Family_Medicine.pdf

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To determine the presence and predictors of depression and anxiety in pet owners after a diagnosis of cancer in their pets. DESIGN: Cross-sectional study. SETTING: A veterinary medical centre specialised in oncology for dogs and cats and two primary veterinary clinics in Japan. PARTICIPANTS: The participants for analysis were 99 owners of a pet with cancer diagnosis received in the past 1-3 weeks and 94 owners of a healthy pet. MAIN OUTCOME MEASURES: Self-reported questionnaires were used to assess depression and anxiety. Depression was assessed using the Center of Epidemiologic Studies Depression Scale, and anxiety was measured by using the State-Trait Anxiety Inventory-Form JYZ. RESULTS: Depression scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders (p<0.001). Within the owners of a pet with cancer, depression was significantly more common in those who were employed than those who were unemployed (p=0.048). State anxiety scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders, including trait-anxiety scores (p<0.001). Furthermore, in owners of a pet with cancer, state anxiety was higher in owners with high trait anxiety (p<0.001) and in owners whose pets had a poor prognosis (p=0.027). CONCLUSION: The results indicate that some owners tended to become depressed and anxious after their pets had received a diagnosis of cancer. Employment may be a predictor of depression. High trait anxiety and a pet with a poor prognosis may increase owners' state anxiety. Including the pet in a family genogram and attention to the pet's health condition may be important considerations for family practice.

File： bmjopen-2018-024512.full.pdf

DOI： 10.1136/bmjopen-2018-024512

PubMed

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

File： Kaneko_et_al-2018-The_Journal_of_Rural_Health.pdf

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Authorship：Lead author,　Corresponding author   Language：English  

File： cmy084.pdf

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer New York LLC  

Background: To discuss how best to implement the gatekeeping functionality of primary care
identifying the factors that cause patients to bypass their primary care gatekeepers when seeking care should be beneficial. Objective: To examine the association between patient experience with their primary care physicians and bypassing them to directly obtain care from higher-level healthcare facilities. Design and Methods: This prospective cohort study was conducted in 13 primary care clinics in Japan. We assessed patient experience of primary care using the Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was the patient bypassing their usual primary care physician to seek care at a hospital, with this occurring at least once in a year. We used a Bayesian hierarchical model to adjust clustering within clinics and individual covariates. Key Results: Data were analyzed from 205 patients for whom a physician at a clinic served as their usual primary care physician. The patient follow-up rate was 80.1%. After adjustment for patients’ sociodemographic and health status characteristics, the JPCAT total score was found to be inversely associated with patient bypass behavior (odds ratio per 1 SD increase, 0.44
95% credible interval, 0.21–0.88). The results of various sensitivity analyses were consistent with those of the primary analysis. Conclusions: We found that patient experience of primary care in Japan was inversely associated with bypassing a primary care gatekeeper to seek care at higher-level healthcare facilities, such as hospitals. Our findings suggest that primary care providers’ efforts to improve patient experience should help to ensure appropriate use of healthcare services under loosely regulated gatekeeping systems
further studies are warranted.

File： 11606_2017_Article_4245.pdf

DOI： 10.1007/s11606-017-4245-1

Scopus

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Background: As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recommendations for primary care research. Methods: A repeated cross-sectional study (2012-2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan. Results: There were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan's proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan. Conclusions: QR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care.

File： s12930-018-0048-8.pdf

DOI： 10.1186/s12930-018-0048-8

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Language：English   Publishing type：Research paper (scientific journal)  

File： Shibata_et_al-2018-BMC_Family_Practice.pdf

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Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

Objective: To explore how rural physicians practicing in the remote islands of Okinawa, Japan experience and manage their negative emotions. Materials and Methods: We conducted semi-structured interviews with doctors who had worked in a clinic on a remote island in Okinawa prefecture for 2 years. The interviews were conducted using an Internet video conferencing system, and were recorded and transcribed. The transcribed data were then analyzed using the Steps Coding and Theorization method as a framework. Results: All four participants were male. The mean interview time was 61 minutes. In the category of induction of negative emotions, we extracted five themes: differences in recognition between rural physicians and patients, invasion of professionalism, suppression by one's role as a rural physician, discordance with multiple occupations, and relationships with unfamiliar hospital physicians. In the category of controlling negative emotions, we also extracted five themes: time flow, reflection, acceptance of islanders' characteristics, and growth through their role. Conclusion: Rural physicians in the remote islands of Okinawa experienced negative emotions in relation to patients, other islanders, and medical staff. They deepened their understanding of the islanders, including the cultural background, over time and through discussion and reflection with other medical professionals. In this way, they realized their potential for growth and how to control negative emotions. Thus, rural physicians may be able to effectively control their negative emotions through recognizing temporal changes in human relations and their own adaptation to the remote island life.

DOI： 10.2185/jrm.2934

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. METHODS: We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. RESULTS: We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. CONCLUSIONS: This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with "non-internal-medicine-related" RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.

File： s12875-017-0658-5.pdf

DOI： 10.1186/s12875-017-0658-5

PubMed

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Authorship：Last author   Language：Japanese   Publishing type：Research paper (scientific journal)  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05620&link_issn=&doc_id=20180522270005&doc_link_id=10.14442%2Fgeneralist.40.143&url=https%3A%2F%2Fdoi.org%2F10.14442%2Fgeneralist.40.143&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)島根県医師会  

高齢化に伴いポリファーマシーの問題が取り上げられている。ポリファーマシーが患者の予後に関係する可能性が指摘されているが,雲南市立病院でのポリファーマシーの現状は明らかにされていない。目的:雲南市立病院入院患者のポリファーマシーの現状を調査する。方法:平成28年10月の雲南市立病院の全入院患者のデータをもとに入院時内服数と年齢,性別,入院時診療科,在住地域の関係を横断的に調べた。結果:当研究参加は総数193人で男性78人,女性115人,平均年齢は75.5歳であった。平均入院時内服数は5.15剤,43%の入院患者が6剤以上の内服薬を処方されていた。70歳代以上の入院時内服数が最大で,入院診療科,在住地域による平均入院時内服数の差は見られなかった。結論:70歳以上の高齢者でポリファーマシーが問題となっており,すべての診療科がこの問題を意識して処方内容を検討する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00609&link_issn=&doc_id=20170705360008&doc_link_id=%2Fdm6shima%2F2017%2F003701%2F008%2F0042-0046%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdm6shima%2F2017%2F003701%2F008%2F0042-0046%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: We aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island's primary care clinic through comparison with a previous nationwide survey.
Methods: We conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island's clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003.
Results: Iheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0-369.7). Of these, 18.4 (16.3-20.5) were referred off-island, with 4.1 (3.1-5.1) referrals to emergency departments and 3.6 (2.6-4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study.
Conclusions: This suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting.

File： 12913_2017_Article_1979.pdf

DOI： 10.1186/s12913-017-1979-8

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Faculty of Medicine, Shimane University  

CiNii Books

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English  

File： bjgpjan-2017-67-654-29.pdf

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：JAPAN PRIMARY CARE ASSOCIATION  

<b>Introduction</b> : This study was conducted to estimate actual reasons for encounters and health problems, which is difficult to assess in a free-access system, in an area with limited access to advanced care by using the International Classification of Primary care second edition (ICPC-2).<br><b>Methods</b> : We conducted a retrospective open cohort study on an isolated island in Okinawa Prefecture, Japan. We encoded reasons for encounter (RFE) and health problems of all patients using ICPC-2.<br><b>Results</b> : The total number of visits to the clinic was 5682 a year (age 0-14 years, n=862 ; age 15-64 years, n=2205 ; age 65 or older, n=2615). The top 3 RFE classified by organic systems were R (respiratory), S (skin) and L (musculoskeletal). Dementia (ICPC-2 code : P-70) was eighth in the rank of chronic health problem among elderly people. Visits due to health maintenance/prevention (ICPC-2 code : A-98) was third in the rank of new health problem among children.<br><b>Conclusion</b> : In the present study, rankings of major RFE and health problems are similar to those in previous studies. Among elderly people, however, the rank order of dementia among chronic health problems was higher than that in previous studies. In addition, among children, the rank order of health maintenance/prevention among new health problems was higher than that in previous studies.

File： 39_144.pdf

DOI： 10.14442/generalist.39.144

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Other Link： http://search.jamas.or.jp/link/ui/2017043870

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Language：Japanese   Publisher：(一社)日本医学教育学会  

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

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File： Media_1034689_smxx.docx

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File： Media_900527_smxx.pdf

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File： e001930.full.pdf

DOI： 10.1136/fmch-2022-001930.

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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File： DE BULLETIN 7.pdf

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Language：English   Publisher：American Academy of Family Physicians  

DOI： 10.1370/afm.20.s1.3192

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Authorship：Last author   Language：Japanese  

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Language：English   Publisher：Japanese Society of Internal Medicine  

File： advpub_9338-22.pdf

DOI： 10.2169/internalmedicine.9338-22

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Authorship：Lead author,　Corresponding author   Language：Japanese  

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Language：Japanese   Publisher：日本文化人類学会  

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File： lte-sept-21 (1).pdf

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Language：Japanese   Publisher：(株)羊土社  

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Royal College of General Practitioners  

DOI： 10.3399/bjgp17X688669

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：JAPAN PRIMARY CARE ASSOCIATION  

<p>We, the delegates of the 2016 Japan-UK exchange, herein report our experiences and impressions of British primary care: "the difference between the career paths of general practitioners from Japan and UK", "medical interpreters and care in a multicultural society" and "framework for development of clinical research". We described our experiences in UK with a literature review. The authors wish for the article to support the advancement of Japanese primary care.</p>

File： 40_160.pdf

DOI： 10.14442/generalist.40.160

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