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Kistler CE, Inoue M, Matsui T, Abe M, Le Donne M, Kiyota A, Lin FC, Yang Y, Hanson LC. Pre-post-evaluation of a dementia-specific advance care planning toolkit for Japanese primary care clinicians. J Am Geriatr Soc 2024. [PMID: 38895937 DOI: 10.1111/jgs.19040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The population of people living with dementia (PLwD) continues to grow in Japan where advance care planning (ACP) for PLwD is relatively new. Our aim was to evaluate the feasibility and cultural acceptability of a dementia-specific ACP communication skills toolkit for Japanese primary care clinicians. METHODS We delivered 13 training sessions in primary care clinics across central Japan and conducted a post-training survey to assess whether the toolkit increased confidence in dementia-specific ACP communication skills and the acceptability of the toolkit with the following four statements: (1) The language in the sessions was clear, (2) The sessions took an appropriate amount of time to complete, (3) The design of the sessions was an effective educational method, and (4) The sessions were culturally appropriate for communication with Japanese patients with dementia and their family members. We asked participants to respond using a 5-point Likert scale from strongly agree to strongly disagree. RESULTS All participants were Japanese and included 80 physicians (mean age 39.8 years), 33 nurses (mean age 45.7 years), and 58 other participants (mean age 42.9 years), who were 30.0%, 87.9%, and 55.2% female, respectively. Most participants practiced in rural settings. In pre- post-comparisons, participant confidence increased in determining capacity, understanding dementia prognosis, goals of care, eliciting surrogates, recommending self-care practices to families, and leading family meetings (all p < 0.001). Most participants strongly agreed or agreed that the toolkit was an effective method (96.9%), took an appropriate amount of time (94.5%), contained clear language (89.8%), and was culturally appropriate (73.6%). CONCLUSIONS Dementia-specific ACP communication skills toolkit can be delivered in Japan. Japanese primary care clinicians generally felt the dementia-specific ACP toolkit increased their confidence in ACP communication skills and was acceptable. The language, time, and design were well received, though further work is needed to improve the cultural appropriateness of the toolkit.
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Affiliation(s)
- Christine E Kistler
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoko Matsui
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Michiko Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Monique Le Donne
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Ayano Kiyota
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yumei Yang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura C Hanson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ingravallo F, Cerquetti I, Vignatelli L, Albertini S, Bolcato M, Camerlingo M, Corbi G, De Leo D, De Nicolò A, De Stefano F, Dell'Erba A, Di Giulio P, Domenici R, Fedeli P, Feola A, Ferrara N, Forti P, Frigiolini F, Gianniti P, Gili E, Iannone P, Lovato A, Lunardelli ML, Marengoni A, Marozzi F, Martelloni M, Mecocci P, Molinelli A, Polo L, Portas M, Rossi P, Scorretti C, Trabucchi M, Volpato S, Zoja R, Castellani GL. Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference. Int J Legal Med 2020; 134:2319-2334. [PMID: 32681208 PMCID: PMC7578136 DOI: 10.1007/s00414-020-02368-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.
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Affiliation(s)
- Francesca Ingravallo
- Ageing Research Centre, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Matteo Bolcato
- National Board of Young Medico-legal Experts, Legal Medicine, University of Padua, Padua, Italy
| | | | - Graziamaria Corbi
- Department of Medicine and Health Sciences "V. Tiberio" and Italian Society of Gerontology and Geriatrics, University of Molise, Campobasso, Italy
| | - Domenico De Leo
- College of Italian Professors of Legal Medicine, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | | | - Francesco De Stefano
- Italian Society of Legal and Insurance Medicine (SIMLA), Department of Science of Health (DISSAL), University of Genoa, Genoa, Italy
| | - Alessandro Dell'Erba
- Federation of the Italian Associations of Medico-Legal Experts (FAMLI), Department of Interdisciplinary Medicine (DIM), Section of Legal and Forensic Medicine, University of Bari, Bari, Italy
| | - Paola Di Giulio
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Piergiorgio Fedeli
- Italian Research Group on Personal Injury (GISDAP), University of Camerino, Camerino, Italy
| | - Alessandro Feola
- National Board of Young Medico-legal Experts, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences and Italian Society of Gerontology and Geriatrics, Federico II University of Naples, Naples, Italy
| | - Paola Forti
- Ageing Research Centre, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | | | | | - Enrico Gili
- National Association of Insurance Companies (ANIA), Rome, Italy
| | - Primiano Iannone
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Rome, Italy
| | - Alessandro Lovato
- The Surveillance and Cooperation Body on Civil Justice, Bologna, Italy
| | - Maria Lia Lunardelli
- Geriatric Unit, Orthogeriatric Ward, University Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Marozzi
- Federation of the Italian Associations of Medico-Legal Experts (FAMLI), Milan, Italy
| | - Massimo Martelloni
- Department of Legal Medicine, Local Health Trust Toscana Nordovest, Scientific Society of Forensic Medicine of Italian National Health Service Hospitals (COMLAS), Lucca, Italy
| | - Patrizia Mecocci
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Andrea Molinelli
- Italian Society of Legal and Insurance Medicine (SIMLA), Department of Science of Health (DISSAL), University of Genoa, Genoa, Italy
| | | | | | - Patrizio Rossi
- National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | - Marco Trabucchi
- Italian Association of Psychogeriatrics (AIP), University of Tor Vergata, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Riccardo Zoja
- Department of Health and Biomedical Sciences, Section of Legal Medicine, University of Milan, Milan, Italy
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Ozaki M, Matsumura S, Iwamoto M, Kamitani S, Higashi T, Toyama M, Bito S, Waza K. Quality of primary care provided in community clinics in Japan. J Gen Fam Med 2019; 20:48-54. [PMID: 30873304 PMCID: PMC6399592 DOI: 10.1002/jgf2.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. METHODS Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process-oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC-J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic. RESULTS A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%. CONCLUSIONS The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.
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Affiliation(s)
| | - Shinji Matsumura
- Division of Clinical EpidemiologyNational Hospital Organization Tokyo Medical leftTokyoJapan
- Matsumura ClinicTokyoJapan
| | - Momoko Iwamoto
- Division of Health Service Researchleft for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | | | - Takahiro Higashi
- Division of Health Service Researchleft for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan
| | | | - Seiji Bito
- Division of Clinical EpidemiologyNational Hospital Organization Tokyo Medical leftTokyoJapan
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Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, Holden J. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 2017; 7:e017902. [PMID: 29118053 PMCID: PMC5695512 DOI: 10.1136/bmjopen-2017-017902] [Citation(s) in RCA: 375] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. DESIGN AND OUTCOME MEASURES This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. RESULTS One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. CONCLUSION There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.
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Affiliation(s)
- Greg Irving
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Ana Luisa Neves
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Porto, Portugal
- Centre for Health Policy, Institute Global Health Innovation, Imperial College London, London, UK
| | - Hajira Dambha-Miller
- Primary Care Unit, University of Cambridge, Cambridge, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Ai Oishi
- The Usher Institute of Population Health and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Anistasiya Verho
- The University of Helsinki, Finland
- National Institutefor Health and Welfare (THL)
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Kajiwara N, Hayashi K, Misago M, Murakami S, Ueoka T. First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study. Int J Gen Med 2017; 10:335-345. [PMID: 29042808 PMCID: PMC5633273 DOI: 10.2147/ijgm.s146830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to profile first-time patients without a referral who sought medical care at the Department of Internal Medicine at a medium-sized acute care hospital in Japan. We anticipated that the analysis would highlight the demand for medical care needs from acute care hospitals and help confirm one of the problems associated with primary care in Japan. PATIENTS AND METHODS The study population comprised 765 patients who sought outpatient consultation without a referral at "the Department of General Internal Medicine" at the Ikeda City Hospital on Fridays over 4 years. Data on the following variables were collected: age, sex, examination date, reason for encounter (RFE), diagnosis, as well as history of consultation with or without antibiotic treatment at another medical institution for the same RFE. We used the International Classicication of Primary Care, Revised Second edition (ICPC-2-R) codes for RFEs and diagnoses. RESULTS The main RFE fields were digestive (ICPC-2-R Chapter D), general and unspecified (A), and respiratory (R). The main diagnosis fields were digestive (D), respiratory (R), general and unspecified (A), and musculoskeletal (L). In total, 27.6% of patients had sought consultation at another medical institution for the same RFE. Of these, 64.7% of patients for whom the RFE was cough (ICPC-2-R code, R05), and 72.0% for whom the RFE was fever (A03) were prescribed antibiotics. In total, 62.4% of patients underwent emergency investigations and waited for the results; 4.3% were hospitalized on the same day; and 60.5% were medicated at the initial examination. In 11.5%, the main underlying problem appeared to be psychosomatic. CONCLUSION We used the ICPC-2-R to analyze the state of first-visit patients without a referral visiting the Department of Internal Medicine at a medium-sized acute care hospital in Japan. Common RFEs were abdominal pain, cough, and fever. A tendency toward overprescription of antibiotics was observed among primary care physicians.
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Affiliation(s)
| | | | - Masahiro Misago
- Department of General Medicine, Ikeda City Hospital, Johnan, Osaka, Japan
| | | | - Takato Ueoka
- Department of General Medicine, Ikeda City Hospital, Johnan, Osaka, Japan
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Kron FW, Fetters MD, Scerbo MW, White CB, Lypson ML, Padilla MA, Gliva-McConvey GA, Belfore LA, West T, Wallace AM, Guetterman TC, Schleicher LS, Kennedy RA, Mangrulkar RS, Cleary JF, Marsella SC, Becker DM. Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:748-759. [PMID: 27939846 PMCID: PMC5385273 DOI: 10.1016/j.pec.2016.10.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 09/22/2016] [Accepted: 10/26/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group's experiences and learning preferences. METHODS A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR's intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. SECONDARY OUTCOMES student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. RESULTS MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. CONCLUSIONS MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. PRACTICE IMPLICATIONS MPathic-VR's virtual human simulation offers an effective and engaging means of advanced communication training.
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Affiliation(s)
- Frederick W Kron
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Mark W Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Casey B White
- Department of Medical Education, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
| | - Monica L Lypson
- Department of Internal Medicine, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, 48104, USA.
| | - Miguel A Padilla
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Gayle A Gliva-McConvey
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Lee A Belfore
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Temple West
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Amelia M Wallace
- Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA, 23501, USA.
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Lauren S Schleicher
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, 48104, USA.
| | - Rebecca A Kennedy
- Department of Psychology, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Rajesh S Mangrulkar
- Department of Internal Medicine, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, 48104, USA.
| | - James F Cleary
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, WI, 53706, USA.
| | - Stacy C Marsella
- Department of Computer Science, Department of Psychology, Northeastern University, Boston, MA, 02115, USA.
| | - Daniel M Becker
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, 22908, USA.
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Lee J, Choi YJ, An AR, Kim Y. Duration of and fee for comprehensive assessment and care planning for patients with hypertension and/or diabetes in primary care. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.1.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeehye Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jun Choi
- Department of Social and Preventive Medicine, College of Medicine, Hallym University, Chuncheon, Korea
- Health Services Research Center, Hallym University, Chuncheon, Korea
| | - Ah Reum An
- Public Health Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
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Saito AI, Suda M, Sasai K, Jagsi R. Satisfaction of breast cancer patients regarding surgery and radiation therapy: A survey in Japan. Adv Radiat Oncol 2016; 1:216-221. [PMID: 28740890 PMCID: PMC5514224 DOI: 10.1016/j.adro.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/31/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate patient satisfaction in Japan and factors, including timing factors, cost, and specific medical practices derived from Western influence (shared decision-making and second opinion), which might affect satisfaction. Methods and materials All patients who presented to 1 large Japanese department of radiation oncology for postoperative radiation therapy for breast cancer from September 2010 to November 2013 were included in this study. The questionnaire was distributed to patients after the radiation oncologist consultation, and patients were asked to complete it anonymously by the end of treatment. We measured patient satisfaction with overall treatment and for each treatment separately (surgery, radiation oncology). We further inquired regarding facts that could affect satisfaction, including time from diagnosis to treatment start, waiting time in waiting room for consultation, average length of consultations, out-of-pocket cost for breast cancer treatment, patients' opinion of the cost, level of inclusion of the patient in decision-making, level of the patient sharing her feelings with her physician, and whether the patients had asked for second opinion. Results Of 364 patients surveyed, 214 (58.5%) responded. Overall satisfaction and satisfaction with surgeon and with radiation oncologist were 95.7%, 98.5%, and 98.2%, respectively. Factors correlated with satisfaction were waiting time for the consult in the waiting room, treatment cost, and perceived degree of sharing feelings with physicians. Overall, 27 patients (12.6%) reported having asked for second opinions. Of those who did not seek a second opinion, most (173) indicated that they did not think it was necessary. Conclusions In a large, typical Japanese radiation oncology practice, breast cancer patients' satisfaction correlated with waiting time, cost, and the rate with which the patient shared her feelings with her physician. This illuminates targets for quality improvement within the Japanese system and provides interesting cross-cultural comparative data for other countries in which the context of care may differ.
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Affiliation(s)
- Anneyuko I Saito
- Division of Radiation Oncology, Department of Radiology, Juntendo University School of Medicine, Chibaken, Japan
| | - Masaru Suda
- Department of Surgery, Juntendo University School of Medicine, Chibaken, Japan
| | - Keisuke Sasai
- Division of Radiation Oncology, Department of Radiology, Juntendo University School of Medicine, Chibaken, Japan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Hayashino Y, Suzuki H, Yamazaki K, Goto A, Izumi K, Noda M. A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2). Diabet Med 2016; 33:599-608. [PMID: 26331280 PMCID: PMC5057414 DOI: 10.1111/dme.12949] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate the effect of multifaceted interventions using the Achievable Benchmark of Care (ABC) method for improving the technical quality of diabetes care in primary care settings. METHODS We conducted a 1-year cluster randomized controlled trial in 22 regions divided into an intervention group (IG) or control group (CG). Physicians in the IG received a monthly report of their care quality, with the top 10% quality of diabetes care scores for all physicians being the achievable benchmark. The change in quality-of-care scores between the IG and CG during follow-up was analysed using a generalized linear model considering clustering. RESULTS A total of 2199 patients were included. Their mean (sd) age was 56.5 ± 5.9 years and the mean (sd) HbA1c level was 56.4 ± 13.3 mmol/mol (7.4 ± 1.2%). The quality-of-care score in the CG changed from 50.2%-point at baseline to 51%-point at 12 months, whereas the IG score changed from 49.9%-point to 69.6%-point, with statistically significant differences between the two groups during follow-up [the effect of intervention was 19.0%-point (95% confidence interval 16.7%- to 21.3%-point; P < 0.001)]. CONCLUSIONS Multifaceted intervention, measuring quality-of-care indicators and providing feedback regarding the quality of diabetes care to physicians with ABC, was effective for improving the technical quality of care in patients with Type 2 diabetes in primary care settings. ( TRIAL REGISTRATION umin.ac.jp/ctr as UMIN000002186).
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Affiliation(s)
- Y Hayashino
- Department of Endocrinology, Tenri Hospital, Nara, Japan
| | - H Suzuki
- Japan Community Health Care Organization Takaoka Fushiki Hospital, Takaoka, Japan
| | | | - A Goto
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - K Izumi
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Noda
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
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Kanke S, Kawai T, Takasawa N, Mashiyama Y, Ishii A, Kassai R. Interventions for body weight reduction in obese patients during short consultations: an open-label randomized controlled trial in the Japanese primary care setting. ASIA PACIFIC FAMILY MEDICINE 2015; 14:5. [PMID: 26015773 PMCID: PMC4443656 DOI: 10.1186/s12930-015-0022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/12/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Family physicians should maintain regular contact with obese patients to ensure they effectively reduce their body weight. However, family physicians in Japan have on average only 6 (min) per consultation, and conventional interventions for body weight reduction require a longer consultation or additional manpower. A brief intervention within the limited consultation time available is therefore needed. Here we investigated the effectiveness of a brief weight reduction intervention for obese patients and the related factors for reducing body weight during routine consultations in the primary care setting. METHOD We conducted an open-label randomized controlled trial at a family medicine clinic in Fukushima, Japan from January 2010 to June 2011. Patients aged 30 to 69 years with body mass index ≥25 who were diagnosed with hypertension, dyslipidemia, and/or type 2 diabetes mellitus were randomly assigned to the intervention or control group. At every consultation, body weight in the intervention group was measured by a family physician who provided weight reduction advice in addition to usual care. The primary outcome was body weight change at 1-year follow up. Analysis was done by intention to treat. RESULT We randomly assigned 29 participants to the intervention group and 21 to the control group. Forty participants (80 %) remained in the trial until the 1-year follow up. At follow up, the median body weight change from baseline was not significantly different between the groups (p = 0.68), at -0.8 (interquartile range [IQR] -2.5 to 1.0) kg in the intervention group and 0.2 (IQR -2.4 to 0.8) kg in the control group. CONCLUSION We devised an intervention method for physicians to measure body weight and advise on weight reduction during routine consultations. In our setting, this method did not extend the consultation time, but also had no significant additional effects on body weight reduction in moderately obese patients. TRIAL REGISTRATION This trial is registered with the UMIN Clinical Trial Registry (UMIN000002967).
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Affiliation(s)
- Satoshi Kanke
- />Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture Japan
| | - Takumi Kawai
- />Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture Japan
| | - Naomi Takasawa
- />Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture Japan
| | - Yukiko Mashiyama
- />Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture Japan
| | - Atsushi Ishii
- />Department of Internal Medicine, Kashima Hospital, 22-1 Shimokuramochi Nakasawame, Kashima-machi, Iwaki City, Fukushima Prefecture Japan
| | - Ryuki Kassai
- />Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima Prefecture Japan
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Tabuchi T, Nakayama T, Fukushima W, Matsunaga I, Ohfuji S, Kondo K, Kawano E, Fukuhara H, Ito Y, Oshima A. Determinants of participation in prostate cancer screening: a simple analytical framework to account for healthy-user bias. Cancer Sci 2015; 106:108-14. [PMID: 25456306 PMCID: PMC4317786 DOI: 10.1111/cas.12561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/09/2014] [Accepted: 10/18/2014] [Indexed: 01/04/2023] Open
Abstract
In Japan at present, fecal occult blood testing (FOBT) is recommended for cancer screening while routine population-based prostate-specific antigen (PSA) screening is not. In future it may be necessary to increase participation in the former and decrease it in the latter. Our objectives were to explore determinants of PSA-screening participation while simultaneously taking into account factors associated with FOBT. Data were gathered from a cross-sectional study conducted with random sampling of 6191 adults in Osaka city in 2011. Of 3244 subjects (return rate 52.4%), 936 men aged 40-64 years were analyzed using log-binomial regression to explore factors related to PSA-screening participation within 1 year. Only responders for cancer screening, defined as men who participated in either FOBT or PSA-testing, were used as main study subjects. Men who were older (prevalence ratio [PR] [95% confidence interval (CI)] = 2.17 [1.43, 3.28] for 60-64 years compared with 40-49 years), had technical or junior college education (PR [95% CI] = 1.76 [1.19, 2.59] compared with men with high school or less) and followed doctors' recommendations (PR [95% CI] = 1.50 [1.00, 2.26]) were significantly more likely to have PSA-screening after multiple variable adjustment among cancer-screening responders. Attenuation in PR of hypothesized common factors was observed among cancer-screening responders compared with the usual approach (among total subjects). Using the analytical framework to account for healthy-user bias, we found three factors related to participation in PSA-screening with attenuated association of common factors. This approach may provide a more sophisticated interpretation of participation in various screenings with different levels of recommendation.
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Affiliation(s)
- Takahiro Tabuchi
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular DiseasesOsaka, Japan
- Urban Research Plaza, Osaka City UniversityOsaka, Japan
| | - Tomio Nakayama
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular DiseasesOsaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Faculty of MedicineOsaka, Japan
| | - Ichiro Matsunaga
- Department of Public Health, Osaka City University Faculty of MedicineOsaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Faculty of MedicineOsaka, Japan
| | - Kyoko Kondo
- Department of Public Health, Osaka City University Faculty of MedicineOsaka, Japan
| | - Eiji Kawano
- Department of Sociology, Osaka City UniversityOsaka, Japan
| | | | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular DiseasesOsaka, Japan
| | - Akira Oshima
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular DiseasesOsaka, Japan
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Inoue M, Takahashi M, Kai I. Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: a cross-sectional study of primary care in Japan. BMC FAMILY PRACTICE 2013; 14:40. [PMID: 23522359 PMCID: PMC3614433 DOI: 10.1186/1471-2296-14-40] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 03/19/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The role of a patient's functional health literacy (HL) has received much attention in the context of diabetes education, but researchers have not fully investigated the roles of communicative and critical HL, especially in primary care. Communicative HL is the skill to extract health information and derive meaning from different forms of communication, and to apply this information to changing circumstances. Critical HL allows the patient to critically analyze information and to use this information to achieve greater control over life events and situations. We examined how HL, particularly communicative and critical HL, is related to the patient's understanding of diabetes care and self-efficacy for diabetes management in primary care settings. We also examined the impact of patient-physician communication factors on these outcomes, taking HL into account. METHODS We conducted a cross-sectional observational study of 326 patients with type 2 diabetes who were seen at 17 primary care clinics in Japan. The patients completed a self-administered questionnaire that assessed their HL (functional, communicative, and critical), understanding of diabetes care, and self-efficacy for diabetes management. We also examined the perceived clarity of the physician's explanation to assess patient-physician communication. Multivariate regression analyses were performed to determine whether HL and patient-physician communication were associated with understanding of diabetes care and self-efficacy. RESULTS A total of 269 questionnaires were analyzed. Communicative and critical HL were positively associated with understanding of diabetes care (β = 0.558, 0.451, p < 0.001) and self-efficacy (β = 0.365, 0.369, p < 0.001), respectively. The clarity of physician's explanation was associated with understanding of diabetes care (β = 0.272, p < 0.001) and self-efficacy (β = 0.255, p < 0.001). In multivariate regression models, HL and perceived clarity of the physician's explanation were independently associated with understanding of diabetes care and self-efficacy. CONCLUSIONS Communicative and critical HL and clear patient-physician communication were independently associated with the patient's understanding of diabetes care and self-efficacy. The potential impact of communicative and critical HL should be considered in communications with, and the education of, patients with diabetes in primary care settings.
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Affiliation(s)
- Machiko Inoue
- Department of Community Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Miyako Takahashi
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Ichiro Kai
- School of Public Health, the University of Tokyo, Tokyo, Japan
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