Abstract
BackgroundIn order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians' comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals.MethodsPatients with prescriptions for hypertensive drugs were approached sequentially at 13 pharmacies, and were administered a questionnaire on their perception of their physician's knowledge about them. Data were obtained for 687 patients (362 from clinics and 325 from hospitals). A physician's knowledge of his or her patients was assessed according to six aspects: their medical history, their current medications, history of allergy, what worries patients most about their health, patients' values and beliefs on their health, and patients' roles and responsibilities at work, home, or school. Responses were scored from 1 through 6 (1: knows very well; 6: doesn't know at all).ResultsPatients treated in clinics were seen more frequently, for a longer period, and had fewer complications than the patients who were treated in hospitals. Among the six aspects of physicians' knowledge assessed, 79.3% of the patients reported that their physicians knew their complete list of medications "very well or well," while 28.3% reported the same about their roles and responsibilities at work, home, or school. Physicians in clinics were considered to know their patients' worries about their health (p = 0.004) and the roles and responsibilities of the patients at work, home, or school (p = 0.028) well. Multiple regression analysis showed that the type of medical institutions remained as a significant variable only for the aspect of patients' worries about their health. The factor that consistently affected the patients' perception of physicians' knowledge about them was the patients' age.ConclusionsHypertensive patients' perceptions of their physicians' knowledge about them did not differ significantly between clinics and hospitals in Japan for most of the aspects. In order to differentiate the roles of physicians in hospitals and clinics better and ensure the quality of primary care, the establishment of a standardized educational system to train primary care physicians better is recommended.
Highlights
In order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians’ comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals
A total of 736 patients participated in the study, of whom 687 (362 from clinics and 325 from hospitals) had complete data of the types of institutions where they received their prescription
A higher percentage of female patients was seen at clinics (53.3% vs. 43.3%, p = 0.01), and had fewer hypertensive complications than those seen at hospitals (p < 0.001)
Summary
In order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians’ comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals. Japan’s universal health insurance system gives a person virtually free access to doctors in any type of medical institution [2,3] This system allows a patient to choose a specialist in a tertiary care center if he/she wishes for management of Second, medical education in Japan had traditionally placed little emphasis on primary care training; the reform of postgraduate medical education in 2004 has introduced a two-year compulsory internship [5,6]. Most graduates of medical schools trained as subspecialists and worked in universityaffiliated hospitals for 5-10 years where they conducted some basic research [7] Later in their careers, some of them opened their own private clinics [2,3,7,8,9]. Saigal and colleagues have called this a “Two Career” model of specialization [9], and the inadequacy of primary care training for Japanese physicians has been raised as a critical issue [10,11,12]
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