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Aoki T, Zukeran S, Matsushima M. The role of primary care attributes in preventing loss or change of usual source of care: a nationwide cohort study. Fam Pract 2024:cmae006. [PMID: 38382048 DOI: 10.1093/fampra/cmae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The existence of a stable usual source of care (USC) is fundamental to the provision of quality health care. However, no longitudinal studies have examined whether core primary care attributes influence the stability of USC status. OBJECTIVES We aimed to examine the association between primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) and the loss or change of USC. METHODS This nationwide cohort study was conducted during the coronavirus disease 2019 pandemic using a representative sample of the Japanese adult population aged 40-75 years. The primary outcome measures were loss of USC and voluntary change in USC during the 12-month follow-up period. Primary care attributes were evaluated in the baseline survey using the Japanese version of Primary Care Assessment Tool (JPCAT). RESULTS Data were analyzed for 725 participants who had a USC at baseline. Among them, 93 (12.8 %) lost their USC and 46 (6.3%) changed their USC during the follow-up period. Multivariable multinominal logistic regression analyses showed that the JPCAT total score was associated with decreased loss of USC and change in USC. Among the JPCAT domains, longitudinality, comprehensiveness (services available), and community orientation were associated with reductions in both USC loss and change. CONCLUSIONS Our study indicates that primary care attributes play an important role in preventing the loss or change of USC and contribute to the stability of USC status. These findings provide additional rationale for policymakers, healthcare providers, and managers to seek to strengthen core attributes of primary care.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sota Zukeran
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
- Department of General Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, 904-2293, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Croke K, Moshabela M, Kapoor NR, Doubova SV, Garcia-Elorrio E, HaileMariam D, Lewis TP, Mfeka-Nkabinde GN, Mohan S, Mugo P, Nzinga J, Prabhakaran D, Tadele A, Wright KD, Kruk ME. Primary health care in practice: usual source of care and health system performance across 14 countries. Lancet Glob Health 2024; 12:e134-e144. [PMID: 38096885 PMCID: PMC10716626 DOI: 10.1016/s2214-109x(23)00513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.
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Affiliation(s)
- Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Mosa Moshabela
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Damen HaileMariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Sailesh Mohan
- Public Health Foundation of India, Gurugram, India; Centre for Chronic Conditions and Injuries, Gurgaon, Haryana, India; Deakin University, Geelong, VIC, Australia; Centre for Chronic Disease Control, New Delhi, India
| | - Peter Mugo
- Health Policy and Systems Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurugram, India; Centre for Chronic Disease Control, New Delhi, India
| | - Ashenif Tadele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Katherine D Wright
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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Aoki T, Matsushima M. Factors associated with the status of usual source of care during the COVID-19 pandemic: a nationwide survey in Japan. BMC PRIMARY CARE 2023; 24:193. [PMID: 37752415 PMCID: PMC10523671 DOI: 10.1186/s12875-023-02148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/02/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND To ensure that high-quality primary care is available to every individual, increasing the proportion of residents with a usual source of care (USC) is a challenge for each country. However, the status of USC after the spread of COVID-19 and the factors associated with it remain unclear internationally. Therefore, we aimed to explore the associations of sociodemographic and clinical factors with the presence and type of USC (kakaritsukei in Japanese) during the pandemic in Japan. METHODS We conducted a nationwide cross-sectional survey of a representative sample of the general Japanese adult population in May 2021. The main outcome measures were the presence and type of USC. We assessed sociodemographic and clinical factors, including age, gender, marital status, years of education, employment status, annual household income, social isolation, health literacy, number of chronic conditions, and health-related quality of life. RESULTS Of the 1,757 participants, 1,011 (57.5%) had a USC. There were 769 (76.1%) participants who had a USC in a clinic and 227 (22.5%) in a hospital. As a result of multivariable modified Poisson regression analysis, male gender, no chronic condition, lower health literacy, and social isolation were significantly associated with not having a USC. Among participants with a USC, male gender, the presence of one or more chronic conditions, and lower health-related quality of life were associated with having a hospital-based USC. CONCLUSIONS We identified factors associated with the status of USC during the COVID-19 pandemic, including health literacy and social isolation. These findings provide primary care providers and policymakers with insight into the potential barriers to having a USC in the aftermath of the pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-28-5, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-28-5, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Ie K, Kushibuchi M, Tsuchida T, Motohashi I, Hirose M, Albert SM, Kimura M. The relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy: A nationwide survey among Japanese mothers. J Gen Fam Med 2023; 24:215-222. [PMID: 37484125 PMCID: PMC10357099 DOI: 10.1002/jgf2.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/18/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
Background Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy has not been fully investigated. The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID-19 parental vaccine hesitancy among mothers in Japan. Method This cross-sectional survey-based study included 4516 mothers. Using a chi-square test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID-19 vaccine hesitancy. Results Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID-19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine-hesitant (IRR = 0.90, 95% CI = 0.84-0.96) after adjusting for potential confounders. Conclusion This study suggested that having a usual source of primary care may contribute to lower parental COVID-19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.
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Affiliation(s)
- Kenya Ie
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
- Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvaniaUSA
| | - Mio Kushibuchi
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
| | - Tomoya Tsuchida
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
| | - Iori Motohashi
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
- Department of General Internal MedicineKawasaki Municipal Tama HospitalKawasaki‐shiJapan
| | - Masanori Hirose
- Department of General Internal MedicineSt. Marianna University School of MedicineKawasaki‐shiJapan
| | - Steven M. Albert
- Department of Behavioral and Community Health SciencesUniversity of Pittsburgh Graduate School of Public HealthPittsburghPennsylvaniaUSA
| | - Miyako Kimura
- Department of Preventive MedicineSt Marianna University School of MedicineKawasaki‐shiJapan
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Aoki T, Sugiyama Y, Mutai R, Matsushima M. Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan. Ann Fam Med 2023; 21:27-32. [PMID: 36690482 PMCID: PMC9870632 DOI: 10.1370/afm.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE During a pandemic, when there are many barriers to providing preventive care, chronic disease management, and early response to acute common diseases for primary care providers, it is unclear whether primary care attributes contribute to reducing hospitalization. We aimed to examine the association between core primary care attributes and total hospitalizations during the COVID-19 pandemic. METHODS We conducted a nationwide prospective cohort study during the pandemic using a representative sample of the Japanese adult population aged 40 to 75 years. Primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) were assessed using the Japanese version of Primary Care Assessment Tool (JPCAT). The primary outcome measure was any incidence of hospitalization during a 12-month period from May 2021 through April 2022. RESULTS Data from 1,161 participants were analyzed (92% follow-up rate). After adjustment for possible confounders, overall primary care attributes (assessed by the JPCAT total score) were associated in a dose-dependent manner with a decrease in hospitalizations (odds ratio [OR] = 0.37, 95% CI, 0.16-0.83 for the highest score quartile, compared with no usual source of care). All associations between each domain score of the JPCAT and hospitalization were statistically significant when comparing the highest quartile with no usual source of care. CONCLUSIONS Our study revealed that the provision of primary care, particularly high-quality primary care, was associated with decreased total hospitalization, even during a pandemic when there are many barriers to providing usual medical care. These findings support policies that seek to strengthen primary care systems during and after the COVID-19 pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Tokyo, Japan
| | - Rieko Mutai
- Department of Adult Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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Li H, Chen X, Pan J, Li M, Wang M, Wang W, Wang Y. Impact of the COVID-19 Pandemic on Utilization of Inpatient Mental Health Services in Shanghai, China. Healthcare (Basel) 2022; 10:healthcare10081402. [PMID: 36011058 PMCID: PMC9407850 DOI: 10.3390/healthcare10081402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
(1) Purpose: The ongoing COVID-19 pandemic has had an impact on mental health and the utilization of hospital-based inpatient mental health care worldwide. The aim of this study was to determine the impact of this pandemic on the utilization of this service in Shanghai by comparison with hospital-based health care records during the preceding 4 years. (2) Methods: The medical records were provided by the Shanghai Municipal Health Insurance Bureau. Diagnostic coding was based on International Classification of Diseases-10th revision (ICD-10), and inpatients with codes from F00 to F99 were examined. (3) Results: Inpatients were compared according to gender, age, pandemic stage, and type of mental disease. Utilization of psychiatric inpatient care in Shanghai during each of the four stages of the pandemic (1 January 2016 to 21 January 2020; 22 January 2020 to 9 February 2020; 10 February 2020 to 1 March 2020; 2 March 2020 to 31 July 2020) was analyzed. Before the lockdown, the utilization of psychiatric inpatient care had an overall upward trend; after the lockdown, the number of inpatients dropped sharply; as of 31 July 2020, it has not been restored. The utilization of this service for most types of mental disease declined rapidly during the pandemic; for vascular dementia (VAD, F01), it was relatively steady. The observed number of inpatient patients was about 51.07% lower than the predicted number in 2020. (4) Conclusions: The COVID-19 pandemic led to the implementation of prevention and control measures that reduced the utilization of psychiatric inpatient care in Shanghai. The use of inpatient services for categories F20–F29 had the greatest decline, and VAD (F01) had the smallest change during the pandemic. This service consequence of COVID-19 is apparent; to assure access to adequate service during a pandemic, health care professionals should pay close attention to changes in the utilization of different mental health services.
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Affiliation(s)
- Hao Li
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Xiaoli Chen
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Jinhua Pan
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
| | - Mengying Li
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Meng Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
| | - Weibing Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China
- Correspondence: (W.W.); (Y.W.)
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (H.L.); (X.C.); (J.P.); (M.L.); (M.W.)
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Correspondence: (W.W.); (Y.W.)
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Aoki T, Fujinuma Y, Matsushima M. Patient experience of residents with restricted primary care access during the COVID-19 pandemic. Fam Med Community Health 2022; 10:fmch-2022-001667. [PMID: 35688482 PMCID: PMC9189542 DOI: 10.1136/fmch-2022-001667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate primary care access for COVID-19 consultation among residents who have a usual source of care (USC) and to examine their associations with patient experience during the pandemic in Japan. DESIGN Nationwide cross-sectional study. SETTING Japanese general adult population. PARTICIPANTS 1004 adult residents who have a USC. MAIN OUTCOME MEASURES Patient experience assessed by the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF). RESULTS A total of 198 (19.7%) reported restricted primary care access for COVID-19 consultation despite having a USC. After adjustment for possible confounders, restricted primary care access for COVID-19 consultation was negatively associated with the JPCAT-SF total score (adjusted mean difference = -8.61, 95% CI -11.11 to -6.10). In addition, restricted primary care access was significantly associated with a decrease in all JPCAT-SF domain scores. CONCLUSIONS Approximately one-fifth of adult residents who had a USC reported restricted primary care access for COVID-19 consultation during the pandemic in Japan. Our study also found that restricted primary care access for COVID-19 consultation was negatively associated with a wide range of patient experience including first contact. Material, financial and educational support to primary care facilities, the spread of telemedicine and the application of a patient registration system might be necessary to improve access to primary care during a pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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