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Ando T, Sasaki T, Abe Y, Nishimoto Y, Hirata T, Haruta J, Arai Y. Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan. J Gen Fam Med 2023; 24:343-349. [PMID: 38025930 PMCID: PMC10646296 DOI: 10.1002/jgf2.651] [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: 07/06/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
| | - Takashi Sasaki
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yukiko Abe
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yoshinori Nishimoto
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Department of NeurologyKeio University School of MedicineTokyoJapan
| | - Takumi Hirata
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Institute for Clinical and Translational ScienceNara Medical UniversityKashiharaJapan
| | - Junji Haruta
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
- Medical Education CenterKeio University School of MedicineTokyoJapan
| | - Yasumichi Arai
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
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Shaikh NF, Shen C, LeMasters T, Dwibedi N, Ladani A, Sambamoorthi U. Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Incidence of Depression Among Older Cancer Survivors With Osteoarthritis: A Machine Learning Analysis. Cancer Inform 2023; 22:11769351231165161. [PMID: 37101728 PMCID: PMC10123903 DOI: 10.1177/11769351231165161] [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: 07/27/2022] [Accepted: 03/05/2023] [Indexed: 04/28/2023] Open
Abstract
ObjectiveS This study examined prescription NSAIDs as one of the leading predictors of incident depression and assessed the direction of the association among older cancer survivors with osteoarthritis. Methods This study used a retrospective cohort (N = 14, 992) of older adults with incident cancer (breast, prostate, colorectal cancers, or non-Hodgkin's lymphoma) and osteoarthritis. We used the longitudinal data from the linked Surveillance, Epidemiology, and End Results -Medicare data for the study period from 2006 through 2016, with a 12-month baseline and 12-month follow-up period. Cumulative NSAIDs days was assessed during the baseline period and incident depression was assessed during the follow-up period. An eXtreme Gradient Boosting (XGBoost) model was built with 10-fold repeated stratified cross-validation and hyperparameter tuning using the training dataset. The final model selected from the training data demonstrated high performance (Accuracy: 0.82, Recall: 0.75, Precision: 0.75) when applied to the test data. SHapley Additive exPlanations (SHAP) was used to interpret the output from the XGBoost model. Results Over 50% of the study cohort had at least one prescption of NSAIDs. Nearly 13% of the cohort were diagnosed with incident depression, with the rates ranging between 7.4% for prostate cancer and 17.0% for colorectal cancer. The highest incident depression rate of 25% was observed at 90 and 120 cumulative NSAIDs days thresholds. Cumulative NSAIDs days was the sixth leading predictor of incident depression among older adults with OA and cancer. Age, education, care fragmentation, polypharmacy, and zip code level poverty were the top 5 predictors of incident depression. Conclusion Overall, 1 in 8 older adults with cancer and OA were diagnosed with incident depression. Cumulative NSAIDs days was the sixth leading predictor with an overall positive association with incident depression. However, the association was complex and varied by the cumulative NSAIDs days.
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Affiliation(s)
- Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Chan Shen, Department of Surgery, College of Medicine, The Pennsylvania State University, 700 HMC Crescent Road, Hershey, PA 17033-2360, USA.
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Amit Ladani
- Department of Medicine, Section of Rheumatology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Pharmacotherapy Department College of Pharmacy, “Vashisht” Professor of Health Disparities, HEARD Scholar, Institute for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, TX, USA
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Kaneko M, Shinoda S, Shimizu S, Kuroki M, Nakagami S, Chiba T, Goto A. Fragmentation of ambulatory care among older adults: an exhaustive database study in an ageing city in Japan. BMJ Open 2022; 12:e061921. [PMID: 35953252 PMCID: PMC9379480 DOI: 10.1136/bmjopen-2022-061921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
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 >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.
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Affiliation(s)
- Makoto Kaneko
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Satoru Shinoda
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Sayuri Shimizu
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Makoto Kuroki
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Sachiko Nakagami
- Medical Policy Division, Medical Care Bureau, City of Yokohama, Yokohama, Kanagawa, Japan
| | - Taiga Chiba
- Medical Policy Division, Medical Care Bureau, City of Yokohama, Yokohama, Kanagawa, Japan
| | - Atsushi Goto
- Department of Health Data Science, Yokohama City University, Yokohama, Kanagawa, Japan
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The Impact of COVID-19 Protocols on the Continuity of Care for Patients with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031735. [PMID: 35162758 PMCID: PMC8835649 DOI: 10.3390/ijerph19031735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study was to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the continuity of care (COC) for patients with hypertension. Additionally, the factor of whether participants were treated via telemedicine was also considered. This study used the National Health Insurance and Medical Aid claims data of the Republic of Korea between 2019 and 2020. Multivariable regression analysis was performed to identify the differences in the number of visits and the most frequent provider continuity (MFPC) of hypertensive patients before and after the appearance of COVID-19 in Korea. Additional analysis was performed with data that excluded cases of patients who received telemedicine services. A total of 5,791,812 hypertensive patients were included in this study. The MFPC decreased by 0.0031 points after the appearance of COVID-19, and it showed the same decrease even when telemedicine cases were excluded. The number of outpatient clinic visit days decreased by 0.2930 days after the appearance of COVID-19. Without the telemedicine cases, the number of outpatient clinic visit days decreased by 0.3330 days after the appearance of COVID-19. Accordingly, the COVID-19 protocols did not affect hypertension patients’ COC but impacted the frequency of their outpatient visits. In other words, with or without telemedicine, the utilization of healthcare was not disrupted, but there was a significant difference in the volume of healthcare use depending on the inclusion of telemedicine cases.
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Nili M, Dwibedi N, Adelman M, LeMasters T, Madhavan SS, Sambamoorthi U. Economic Burden of Asthma-Chronic Obstructive Pulmonary Disease Overlap among Older Adults in the United States. COPD 2021; 18:357-366. [PMID: 33902371 DOI: 10.1080/15412555.2021.1909549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.
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Affiliation(s)
- Mona Nili
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Megan Adelman
- Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - S Suresh Madhavan
- System College of Pharmacy, University of North Texas, Fort Worth, Texas, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Warren LR, Clarke J, Arora S, Darzi A. Improving data sharing between acute hospitals in England: an overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care. BMJ Open 2019; 9:e031637. [PMID: 31806611 PMCID: PMC7008454 DOI: 10.1136/bmjopen-2019-031637] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability. DESIGN Retrospective observational study using Hospital Episode Statistics. SETTING Acute hospital trusts in the NHS in England. PARTICIPANTS All adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Frequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems. RESULTS 21 286 873 patients were involved in 121 351 837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11 017 767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15 736 863 (73.9%) patients had two or more encounters with the included trusts and 3 931 255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system. CONCLUSIONS Each year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
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Affiliation(s)
- Leigh R Warren
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, UK
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
- Department of Biostatistics, Harvard University, Boston, United States
| | - Sonal Arora
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
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Variations in VA and Medicare Use Among Veterans With Diabetes: Impacts on Ambulatory Care Sensitive Conditions Hospitalizations for 2008, 2009, and 2010. Med Care 2019; 57:425-436. [PMID: 31045693 DOI: 10.1097/mlr.0000000000001119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION VA and Medicare use among older Veterans has been considered fragmented care, however, it may represent access to needed care. METHODS The population studied were Veterans with diabetes, age 66 years and older, dually enrolled in VA and Medicare. DATA SOURCE/STUDY SETTING We conducted a dynamic retrospective cohort study with 2008, 2009, and 2010 as the outcome years (Ambulatory Care Sensitive Conditions Hospitalization (ACSC-H) or not). We analyzed administrative data to identify comorbidities; ambulatory care utilization to identify variations in use before hospitalization. We linked 2007 primary care (PC) survey data to assess if organizational factors were associated with ACSC-H. MEASURES AND ANALYSIS We identified ACSC-Hs using a validated definition. We categorized VA/Medicare use as: single system; dual system: supplemental specialty care use; or primary care use. Using hierarchical logistic regression models, we tested for associations between VA/Medicare use, organizational characteristics, and ACSC-H controlling for patient-level, organizational-level, and area-level characteristics. RESULTS Our analytic population was comprised of 210,726 Medicare-eligible Veterans; more than one quarter had an ACSC-H. We found that single system users had higher odds of ACSC-H compared with dual system specialty supplemental care use (odds ratio, 1.14; 95% confidence interval, 1.09-1.20), and no significant difference between dual-system users. Veterans obtaining care at sites where PC leaders reported greater autonomy (eg, authority over personnel issues) had lower odds of ACSC-H (odds ratio, 0.74; 95% confidence interval, 0.59-0.92). DISCUSSION Our findings suggest that earlier assumptions about VA/Medicare use should be weighed against the possibility that neither VA nor Medicare may address complex Veterans' health needs. Greater PC leader autonomy may allow for tailoring of care to match local clinical contexts.
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Kailasam M, Guo W, Hsann YM, Yang KS. Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study. BMJ Open 2019; 9:e022965. [PMID: 30898796 PMCID: PMC6475441 DOI: 10.1136/bmjopen-2018-022965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care. DESIGN A retrospective cross-sectional study. SETTING Specialist outpatient clinics (SOCs) in a Singapore regional hospital. PARTICIPANTS A total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded. OUTCOME MEASURES The Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen. RESULTS About 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care. CONCLUSION Multispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients' age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.
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Affiliation(s)
| | - Wenjia Guo
- Epidemiology, Ng Teng Fong General Hospital, Singapore
| | - Yin Maw Hsann
- Epidemiology, Ng Teng Fong General Hospital, Singapore
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Wong SYS, Zou D, Chung RY, Sit RW, Zhang D, Chan D, Yeoh EK, Woo JW. Regular Source of Care for the Elderly: A Cross-National Comparative Study of Hong Kong With 11 Developed Countries. J Am Med Dir Assoc 2017. [PMID: 28647578 DOI: 10.1016/j.jamda.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to give an international perspective of health service gaps for caring for elderly individuals and explore the role of primary care for caring for elderly individuals with chronic conditions in Hong Kong. DESIGN Cross-sectional, telephone survey. SETTING Hong Kong. PARTICIPANT A sample of 1000 Chinese participants in Hong Kong aged 60 or older. MEASUREMENTS Questionnaire extracted from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. RESULTS Similar to the 11 countries, more than half (about 65%) of Hong Kong respondents suffered from chronic conditions, whereas approximately one-third of them had at least 2 chronic conditions. US respondents had highest rate of having chronic conditions. Only 65% of Hong Kong respondents reported having a regular source of care and a higher proportion of elderly reported having poor self-rated health when compared with overseas counterparts. However, the proportion of elderly individuals who could access same-day or next-day medical care was higher compared with findings of other countries. Both Hong Kong and US respondents were more likely to report cost-related problems when accessing care. Waiting time for specialists in Hong Kong was much longer and coordination between regular doctors was poorer than in all other countries. Although half of Hong Kong respondents had a management plan for chronic conditions, a smaller proportion of them considered it helpful. CONCLUSIONS Hong Kong has the lowest rate of regular source of care when compared with 11 developed countries, although people in Hong Kong were more likely to be able to access same-day or next-day medical care. To cope with increasing needs of chronic disease care, there may be a need to further develop the provision of regular source of care for elderly individuals, including the development of quality primary care in Hong Kong.
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Affiliation(s)
- Samuel Yeung-Shan Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Dan Zou
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Roger Y Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Regina W Sit
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Dexing Zhang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Dicken Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Eng Kiong Yeoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
| | - Jean W Woo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China
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Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care. Sci Rep 2015; 5:18853. [PMID: 26686267 PMCID: PMC4685421 DOI: 10.1038/srep18853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022] Open
Abstract
Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.
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