Physician characteristics associated with antiviral prescriptions for older adults with COVID-19 in Japan: an observational study

OBJECTIVES

Although guidelines recommend antiviral therapy for outpatients with COVID-19 who are at high risk of progressing to severe conditions, such as older adults, many patients do not receive appropriate treatment. Little is known, however, about the physician factors associated with the prescription of guideline-recommended antiviral therapy for patients with COVID-19.

DESIGN

A cross-sectional study.

SETTING

Data including outpatient visits in primary care clinics in Japan from April to August 2023.

PARTICIPANTS

We analysed 30 953 outpatients aged ≥65 years treated with COVID-19 (mean (SD) age, 75.0 (7.6) years; 17 652 women (57.0%)) in 1394 primary care clinics.

OUTCOME MEASURES

The primary outcome was the prescription of guideline-recommended antivirals (ie, nirmatrelvir-ritonavir or molnupiravir), adjusted for patient characteristics, months of visits and regions.

RESULTS

Antiviral prescriptions were concentrated among a small proportion of physicians; for example, the top 10% of physicians that had the largest number of nirmatrelvir-ritonavir prescriptions accounted for 92.4% of all nirmatrelvir-ritonavir prescriptions. After adjusting for potential confounders, physicians with higher patient volumes were more likely to prescribe guideline-recommended antivirals to their patients (adjusted OR (aOR) for high vs low volume, 1.76; 95% CI 1.31 to 2.38; adjusted p<0.001). We found no evidence that the likelihood of guideline-recommended antiviral prescription differed based on physicians' gender (aOR for women vs men, 1.24; 95% CI 0.88 to 1.74; adjusted p=0.48) or age (aOR for 45-59 vs <45 years, 1.16; 95% CI 0.87 to 1.54; adjusted p=0.48; aOR for ≥60 vs <45 years, 0.88; 95% CI 0.66 to 1.16; adjusted p=0.48). These patterns were similar when examining nirmatrelvir-ritonavir and molnupiravir separately.

CONCLUSIONS

Our findings suggest that provider-level factors, such as the clinical experience of treating the patients with COVID-19, play an important role in the appropriate prescription of antiviral medications for COVID-19 in the primary care setting.

Exploring the Varying Interest in Rural Medicine and Associated Factors Among Medical Students in Japan: A Cross-Sectional Study

Background and objective Examining the factors influencing the career aspirations of medical students is imperative for understanding their orientation toward rural medicine. Such an investigation can serve as a basis for shaping medical education curricula dedicated to nurturing rural focus. Although previous studies have categorized students based on the presence or absence of orientation toward rural medicine and explored their sociodemographic characteristics, these students may not constitute a homogeneous group; their interests can range from aspiring to establish residence and professional practice in a specific region to being merely willing to endure brief regional placements. There is a scarcity of comprehensive examination of the extent and potential variations of rural orientation in the literature. Our survey addresses this gap by exploring the variations in rural orientation among medical students and the differences in their sociodemographic characteristics and preferred specialties based on their degree of rural orientation. Methods We classified medical students into four groups according to their levels of rural orientation: demonstrating proactive engagement towards it, considering it for a defined duration, indicating a preference for avoiding it, and considering it unfeasible. The distribution within each group was investigated. A subsequent analysis of rural orientation and its associated sociodemographic characteristics was performed: a conventional dichotomous study was conducted based on the presence or absence of rural orientation, and a focused study compared students actively interested in rural healthcare with other students. This approach enabled us to explore differences in the degree of rural orientation and associated factors. Results The study included 531 students, with 89 participants demonstrating proactive engagement towards rural medicine, 283 considering it for a defined period, 95 indicating an inclination to avoid it, and 63 students stating that it is unfeasible for them. Associated sociodemographic characteristics were explored based on the presence or absence of rural orientation and included recommendations for admission by a designated high school, the presence of a physician role model, and aspirations for obstetrics and gynecology departments. Conversely, when exclusively focusing on students with a desire for proactive engagement in rural medicine, positive correlations were observed with characteristics such as being from the same non-urban prefecture as that of the university where the study was conducted, having a history of residing in a rural area, having a physician role model, and expressing aspirations for general practice or family medicine. Aspiring to be an organ-specific specialist showed a negative correlation with high levels of rural orientation. Conclusions Based on our findings, rural orientation is not uniform among medical students; distinct levels of this aspect were observed, each associated with different sociodemographic factors.

What are the impacts of setting up new medical schools? A narrative review

BACKGROUND

The growth of the UK's population together with an aging society with increasingly complex health and social care needs has placed a greater demand on statutory care services. In view of this emerging landscape, the UK Government has sought to increase its medically trained workforce in order to better respond to the demands placed on the health service. Five universities were announced as homes to new medical schools offering undergraduate places to boost the numbers of doctors training in England. The aim of this narrative review was to explore how new medical schools could improve the health outcomes of the local population and evaluate the potential contribution it may make to the local economy, workforce and to research and innovation.

METHODS

A narrative review was undertaken using a systematic approach for the search literature strategy. The articles were evaluated by undertaking a critical assessment evaluating the fitness of a paper for review according to results, methods used to test the hypothesis, conclusions and impact and limitations. Thematic analysis was employed to organise and summarise the findings across a heterogeneous body of literature included in the review. The analysis was developed in an inductive manner and there were not any predefined themes to guide data extraction and analysis.

RESULTS

Thirty-six articles were selected for inclusion for this narrative review. The review identified six key themes: influence of prior rural exposure, medical school environment and rural enrichment programmes, workforce, health outcomes of local populations, social accountability, economic contribution of medical schools to communities and impact on rural research.

CONCLUSIONS

The studies included found a wealth of information on a wide-range of topics on the expansion of undergraduate education and its implications on the future medical workforce. It was shown that medical schools can have a positive effect on the health, social, economic and research activity of a region, but this literature tended to be heterogeneous in focus without consideration of the inter-connections between the wider societal and economic impacts arising from long-term sustainable change being brought to a region.

Factors Associated with Motivation for General Medicine among Rural Medical Students: A Cross-Sectional Study

General medicine, as the Japanese version of primary care or family medicine, is critical for healthcare in aging societies. Medical students’ perceptions of general medicine and education might be associated with changes in the number of general physicians. This study aimed to clarify the association between these perceptions and students’ preferences for general medicine. A cross-sectional survey was conducted among Japanese medical students using a questionnaire on their perceptions regarding general medicine, background, and preferences for general medicine (knowledge, interest, motivation, and intention). The response rate was 70.3% (490/697). There was a large percentage gap between interest and motivation; therefore, a logistic regression analysis was performed to investigate the cause of this difference. The perceptions that general medicine meets the needs of society and the lack of general medicine educators were positively associated with motivation to become a general physician. In contrast, perceptions of lack of exposure to general medicine beyond the curriculum and inaccessibility were negatively associated with motivation. Medical students’ motivation to pursue general medicine may increase with improvements in flexible general medicine education and accessibility. Future research should investigate the relationship between students’ perceptions of general medicine and their motivation to become general physicians through longitudinal studies.

The Perception of Rural Medical Students Regarding the Future of General Medicine: A Thematic Analysis

Although the demand for general physicians has increased in Japan because of its aging population, medical universities primarily provide organ-based education; thus, medical students do not receive sufficient general medical education. The number of residents focusing on general medicine remains low; therefore, to understand the present situation regarding general medicine education, we attempted to clarify the views of medical students and the factors influencing them. In this qualitative study, semi-structured interviews were conducted in 12 medical students at Shimane University, and the results were analyzed through thematic analysis. The results indicated the emergence of three themes and 14 concepts. The three overarching themes were as follows: hopes for the field of general medicine, gaps between ideal and reality of general medicine, and factors affecting students’ motivation for specialization in general medicine. Medical students had a positive impression of general medicine and believed that it has potential for further development; however, they felt a gap between their ideals and reality (i.e., unclear expertise). Factors creating this gap included poorly developed education and medical policies. We need to restructure general medicine education based on the participants’ perceptions by establishing collaborative curricula between universities and community hospitals and by increasing students’ exposure to general medicine.

Students' perceptions of general medicine following community-based medical education in rural Japan

BACKGROUND

Japan's population is rapidly aging, and at the same time, the number of medical students interested in general or family medicine is declining. Community-based medical education (CBME) programs may be used to promote interest and competencies in general medicine among medical students.

METHOD

This mixed-method study investigated the perceptions of fifth- and sixth year undergraduate medical students who completed a two week CBME course in Unnan, a small city in rural Japan. The participants completed two survey questionnaires: (a) The achievement questionnaire administered pre- and posttraining, and (b) the curriculum content questionnaire administered posttraining. To understand the students' perceptions about general medicine further, semistructured interviews were conducted with each participant post-CBME training.

RESULTS

The participants' ratings on the achievement survey improved significantly from pre- to posttraining. The average ratings for the curriculum content survey indicated that the educational objectives were met in all but one area. A qualitative analysis of the interview data revealed that the participants had little exposure to general medicine at their university hospital, and there was a lack of understanding in other medical professionals regarding the roles of general medicine physicians.

CONCLUSION

This study demonstrates that there are educational gaps between medical universities and community hospitals regarding general medicine. Increased exposure, early exposure, and a clarification of the competencies were noted as areas to improve the students' understanding of general medicine. Undergraduates should be exposed to general medicine more frequently and from early training stages through effective collaborations between universities and hospitals.