Primary Care Physicians In Japan Research Articles

Prevalence of functional dyspepsia in an outpatient clinic with primary care physicians in Japan

Since little is known about the prevalence of patients with functional gastrointestinal disorders (FGID), this study was performed to clarify the prevalence of FGID, especially functional dyspepsia (FD), in new patients of an outpatient clinic with primary care physicians in Japan. We analyzed consecutive outpatients (n = 5183) who first visited the Department of General Medicine, Asahikawa Medical College Hospital, between April 2004 and March 2009. Out of 5813 patients, 818 (14.1%) visited because of abdominal symptoms. Final diagnoses of the 818 patients were FGID (n = 320, 39.1%), organic gastrointestinal diseases (n = 237, 28.9%), organic non-GI disease (n = 135, 16.5%), and others (n = 126, 15.4%). The 320 patients with FGID had FD (n = 170), irritable bowel syndrome (IBS) (n = 68), and other FGIDs (n = 88). The rate of FGID or FD in all patients was 5.5% or 2.9%, respectively. Among outpatients (n = 381) who complained of upper abdominal symptoms, approximately 45% had FD. There was no gender difference in the frequency of FGID, FD, or IBS in all ages of patients. A lower incidence of FD was shown in female patients over 70 years old and a higher incidence of IBS in male patients under 29 years old. These results suggest that the prevalence of FGID, especially FD, is very high in an outpatient clinic with primary care physicians in Japan.

Geographic distribution of primary care physicians in Japan and Britain

Geographic distributions of primary care physicians in Japan and Britain were compared with each other. Regional variation in the number of primary care physicians per unit population was larger in Japan than in Britain. The Gini coefficient of primary care physicians against population in Japan (0.1755) was more than twice that observed for Britain (0.0837), indicating a substantially less equal distribution in Japan. The results can probably be explained by differences in the primary care systems of the two countries.

Evidence-based clinical practice guidelines for hepatocellular carcinoma in Japan: the J-HCC guidelines

The "Clinical Practice Guidelines for Hepatocellular Carcinoma (HCC)," the first evidence-based guidelines for the treatment of HCC in Japan, were compiled by an expert panel supported by the Japanese Ministry of Health, Labour, and Welfare. The English translation has been completed (http://www.jsh.or.jp), and its summary has just been published (Hepatol Res 38:37-51, 2008). This set of guidelines covers six research fields: prevention, diagnosis and surveillance, surgery, chemotherapy, transarterial chemoembolization, and percutaneous local ablation therapy. For the users' convenience, practical algorithms for the surveillance and treatment of HCC were also created, which are based on evidence from articles selected for the guidelines and modified according to the current status of medical practice in Japan. One year after their publication, the J-HCC Guidelines have become well disseminated among both specialists and primary care physicians in Japan. As expected, these guidelines have begun to be applied at every level of clinical decision making for HCC. The first revision of the J-HCC Guidelines is now in process, and it is scheduled to be completed by March 2009.

HIV and the primary care physician in Japan.

Primary care physicians in Japan must provide comprehensive medical care and counseling for persons both infected with and at risk for HIV/AIDS. Despite existing activities and education programs, HIV case numbers continue to rise in Japan, and only a limited number of hospitals and physicians offer care to those with HIV/AIDS. Some doctors in Japan refuse to accept patients with HIV/AIDS because of the complex treatment often involved, prejudice regarding AIDS, and fear of transmission. Other impediments to effective treatment of HIV/AIDS in Japan include insufficient risk evaluation through outpatient services, lack of privacy, and restrictions and policies at medical facilities. If Japan's primary care physicians cannot participate in caring for those with HIV/AIDS, it will be impossible for every patient with HIV/AIDS to receive correct and adequate medical care. To enable primary care physicians to provide high-quality service and prevention counseling to those with HIV/AIDS, prejudice, fear, and logistic impediments must be eradicated. Comprehensive practice guidelines that protect patients' rights and privacy should be established immediately. The guidelines should direct primary care physicians toward a logical and proper approach to HIV/AIDS care by addressing fundamental treatment and effective prevention counseling as well as the social problems surrounding HIV/AIDS. In addition, research on the general knowledge level and prevalent attitudes among Japan's primary care physicians regarding HIV/AIDS would clarify which specific issues the guidelines should emphasize.