Primary Care Setting In Japan Research Articles

Detection of hypertension from pharyngeal images using deep learning algorithm in primary care settings in Japan

BackgroundThe early detection of hypertension using simple visual images in a way that does not require physical interaction or additional devices may improve quality of care in the era of...

Antibiotic Prescription for Outpatients With COVID-19 in Primary Care Settings in Japan

This cross-sectional study assesses the characteristics of patients and physicians associated with antibiotic prescription for COVID-19.

Effectiveness of Pregabalin Treatment for Neuropathic Pain in Patients with Spine Diseases: A Pooled Analysis of Two Multicenter Observational Studies in Japan.

PurposeNeuropathic pain (NeP) is common among patients with chronic pain associated with spine diseases. Practical effectiveness of pregabalin, one of the first-line treatments for NeP, has not been evaluated in an entire population of patients with spine diseases, including various pathophysiological conditions. This pooled analysis aimed to evaluate the therapeutic value of pregabalin for chronic pain with NeP component in patients with spine diseases in routine primary care settings.Patients and MethodsWe pooled data from two 8-week prospective observational cohort studies for patients with chronic low back pain with accompanying lower limb pain (NeP component), and patients with chronic cervical pain and accompanying upper limb radiating pain (NeP component) in routine primary care settings in Japan. For both studies, patients were treated for 8 weeks with pregabalin (alone/with other analgesics) or usual care with conventional analgesics (eg, non-steroidal anti-inflammatory drugs). Changes in pain numerical rating scale (NRS), Pain-Related Sleep Interference Scale (PRSIS), and EuroQol 5-dimension 5-level (EQ-5D-5L) scores from baseline to week 8 were summarized and compared between the pregabalin and usual care groups, and also for subgroups of primary diagnosis. Safety was evaluated by adverse events (AEs) in the pregabalin group.ResultsThe pooled dataset comprised 700 patients (pregabalin group: 302; usual care group: 398). All patient-reported outcomes (PRO) scores significantly improved from baseline to week 8 in the pregabalin than in the usual care group (NRS: P<0.0001; PRSIS: P<0.0001, and EQ-5D-5L: P=0.0006). Overall, all three PRO measures showed greater improvement in the pregabalin than in the usual care group, irrespective of the primary diagnosis. AEs were reported in 36.1% of the pregabalin group.ConclusionThis analysis suggested multi-faceted effectiveness of treatment with pregabalin from the patient’s perspectives under a “real-world” practice in all patients with chronic NeP from various spine diseases.

Association between physicians' and patients' perspectives of shared decision making in primary care settings in Japan: The impact of environmental factors.

PurposeShared decision-making (SDM) has only lately begun attaining recognition from the Japanese medical community. The purpose of this study was to create a Japanese version of the SDM-Q-Doc, which is a scale that measures SDM from the perspective of physicians, and to clarify its psychometric characteristics and identify the issues and factors that affect SDM.MethodsThe participants were 23 physicians and 130 patients who visited primary care clinics in Japan for the first time. Immediately following physician–patient interviews, the Japanese version of SDM-Q-9 and SDM-Q-Doc were administered to patients and physicians, respectively. For convergent validity, physician confidence in the medical interview (PCMI) was used. After the determination of internal consistency and validity of the SDM-Q-Doc, the relations among each item of SDM-Q-Doc, SDM-Q-9, physicians’ sociodemographic attributes, and a presence or absence of nurse’s attendance during outpatient consultation were assessed by a multiple regression analysis and structural equation modeling (SEM).ResultsA factor analysis confirmed that the Japanese version of the SDM-Q-Doc displays a one-factor structure with a high internal consistency (Cronbach’s α = 0.87, ω = 0.88). The correlation between the PCMI and SDM-Q-Doc confirmed an appropriate convergent validity (r = 0.406; p < 0.001).Multiple regression analyses showed that the attendance of a nurse during consultation significantly affected one item of the SDM-Q-Doc, which in turn affected one item of the SDM-Q-9. SEM showed a good fit of model for these three items.ConclusionThe Japanese version of the SDM-Q-Doc’s internal consistency and validity in the outpatient medical consultations in Japan were confirmed. Further, this study suggests the role of a nurse’s attendance during a physician–patient consultation on facilitating the SDM. Further, using the Japanese version of the SDM-Q-Doc will promote communication skills training for medical professionals by checking the quality of SDM.

Development and validation of a Japanese version of the Patient Centred Assessment Method and its user guide: a cross-sectional study

ObjectivesThe primary objective of this study was to develop the Japanese version of the Patient Centred Assessment Method (PCAM) and its user guide. The secondary objective was to examine the...

Initial assessment of femoral proximal fracture and acute hip arthritis using pocket-sized ultrasound: a prospective observational study in a primary care setting in Japan

BackgroundAcute hip pain caused by femoral proximal fractures or acute hip arthritis requires imaging for accurate diagnosis. Although pocket-sized ultrasound (PsUS) offers several advantages over other imaging modalities, there is limited information regarding its use in diagnosing femoral proximal fractures or acute hip arthritis. Thus, we aimed to validate the diagnostic accuracy of PsUS for both disorders.MethodsIn this prospective observational study, outpatients with acute hip pain were diagnosed according to a fixed procedure of the PsUS probe handling. We verified the diagnostic accuracy of PsUS findings (cortical discontinuity and joint fluid retention) and compared it with that of radiography, computed tomography, and magnetic resonance imaging.ResultsOur study included 52 outpatients (mean age, 78.0 years; female, 88.5%). Of 26 patients diagnosed with femoral proximal fractures, 14 had femoral neck fractures and 12 had femoral trochanteric fractures. The sensitivity and specificity for identifying cortical discontinuity in femoral proximal fractures were 0.96 and 0.92, respectively. The sensitivity for identifying either cortical discontinuity or joint fluid retention in femoral proximal fractures or acute hip arthritis was 0.97.ConclusionsNegative PsUS findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. PsUS and radiography have comparable diagnostic accuracies, and PsUS could aid in the initial assessment of acute hip pain among the elderly in primary care settings.

Report of the Lecture "Approaches to Promote Evidence-based Preventive Care and Health Promotion in a Primary Care Setting in Japan"

Report of the Lecture "Approaches to Promote Evidence-based Preventive Care and Health Promotion in a Primary Care Setting in Japan"

Early Detection of Chronic Obstructive Pulmonary Disease in Primary Care.

Objective To evaluate the effectiveness of an early detection program for chronic obstructive pulmonary disease (COPD) in a primary care setting in Japan. Methods Participants of ≥40 years of age who regularly visited a general practitioner's clinic due to chronic disease were asked to complete a COPD screening questionnaire (COPD Population Screener; COPD-PS) and undergo simplified spirometry using a handheld spirometric device. Patients who showed possible COPD were referred to a respiratory specialist and underwent a detailed examination that included spirometry and chest radiography. Results A total of 111 patients with possible COPD were referred for close examination. Among these patients, 27 patients were newly diagnosed with COPD. The patients with COPD were older, had lower BMI values, and had a longer smoking history in comparison to non-COPD patients. COPD patients also had more comorbid conditions. A diagnosis of COPD was significantly associated with a high COPD-PS score (p<0.001) and the detection of possible airflow limitation evaluated by the handheld spirometric device (p<0.01). An ROC curve analysis demonstrated that 5 points was the best COPD-PS cut-off value for the diagnosis of COPD. The combination of both tools showed 40.7% of sensitivity and 96.4% of specificity. Conclusion The use of the COPD-PS plus a handheld spirometric device could facilitate the early detection of undiagnosed COPD in primary care.

Screening for major depressive disorder with the Patient Health Questionnaire (PHQ-9 and PHQ-2) in an outpatient clinic staffed by primary care physicians in Japan: a case control study.

ObjectiveThe Patient Health Questionnaire (PHQ-9) is a self-report questionnaire commonly used to screen for depression, with ≥8–11 generally recommended as the cut-off. In Japan, studies of the validity of the PHQ-9 and PHQ-2 have been limited. In this study, we examined the utility of the PHQ-9 and PHQ-2 at an outpatient clinic in a Medical University Hospital in Japan.MethodsNew consecutive outpatients were included in the study. We administered the PHQ-9 to 574 patients, and acquired complete PHQ-9 and PHQ-2 data for 521 patients. Major depressive disorders were diagnosed according to the DSM-IV-TR.ResultsForty-two patients were diagnosed with major depressive disorders. The mean PHQ-9 (15.7) and PHQ-2 (3.8) scores of the patients with major depressive disorders were significantly higher than the scores of the patients without depression (6.0 (PHQ-9) and 1.8 (PHQ-2)). The best cut-off points for the PHQ-9 and PHQ-2 summary scores were ≥11 (sensitivity 0.76, specificity 0.81) and ≥3 (sensitivity 0.76, specificity 0.82), respectively. No relationship was observed between the age and PHQ-9 scores.ConclusionThe PHQ-9 and PHQ-2 were useful instruments for screening for major depressive disorders. The best cut-off point for the PHQ-9 summary score should be ≥11 to detect depression in the primary care setting in Japan.

High rate of smoking in female patients with Mondor's disease in an outpatient clinic in Japan

Purpose:Little is known about the epidemiology of Mondor’s disease. The aim of this study was to analyze the clinical features of Mondor’s disease in an outpatient clinic where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease.Patients and methods:The data for consecutive outpatients who were new visitors to the Department of General Medicine in the teaching hospital (Asahikawa Medical University Hospital) at Asahikawa Medical University, Asahikawa, Hokkaido, Japan, between April 2004 and March 2012 were analyzed. Parameters such as age, sex, diagnosis, and clinical presentation were investigated.Results:During the 8-year period covered in this study, six (0.07%) out of 8767 patients were diagnosed as having Mondor’s disease. All of these patients with Mondor’s disease were female, and the mean age was 41 plus or minus 12 years; the overall rate of Mondor’s disease in all female patients involved in this study was 0.12%. The patients complained of pain and a cord-like structure in the anterolateral thoracoabdominal wall. The painful mass had persisted for 1–4 weeks before presenting at the Department of General Medicine and it disappeared within a couple of weeks. Current smoking was significantly higher in the patients with Mondor’s disease than in the age-matched female patients without Mondor’s disease who were also evaluated in this study.Conclusion:These results suggest that a high rate of smoking in middle-aged females may be a characteristic feature of Mondor’s disease. These epidemiological data may be useful in detection of the disease in the primary care setting in Japan.

The rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a clinic where primary care physicians are working in Japan

We analyzed the rate of polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, both characterized as seronegative inflammatory arthritis in elderly, in an outpatient unit where primary care physicians are working in Japan to better understand the epidemiological characteristics of the diseases in Japan. Consecutive outpatients who newly visited at Department of General Medicine, Asahikawa Medical University Hospital, Japan, between April 2004 and March 2010 were analyzed. Each parameter such as age, sex, diagnosis, and biochemical examination was investigated. During the 6 years, 10 or 3 patients were diagnosed as PMR or RS3PE syndrome, respectively. The patients with PMR were 7 women and 3 men, and the average age at diagnosis was 69. Out of all patients aged over 50 (n = 3,347), the rate of PMR was 0.22% in men or 0.36% in women, respectively. On the other hand, RS3PE syndrome was diagnosed in 3 men (76, 76, and 81 years old). The rate of patients with RS3PE syndrome was 0.09% among outpatients aged over 50 indicating that the rate of PMR in an outpatient clinic in Japan is not far from previous findings reported from western countries. When compared with PMR, the rate of RS3PE syndrome was approximately one-third, providing for the first time the rate of RS3PE syndrome when compared with PMR. These epidemilogical data might help us pick up the diseases in primary care setting in Japan.

Influence of home blood pressure measuring conditions in the evening on the morning–evening home blood pressure difference in treated hypertensive patients: the J-HOME study

The objective of this study was to clarify the factors affecting the morning-evening home systolic blood pressure (BP) difference (home systolic ME dif) in treated hypertensive patients, including evening home BP measuring conditions, based on the data from the Japan Home versus Office BP Measurement Evaluation study. The study participants were 3303 essential hypertensive patients (mean age 66.2+/-10.5 years; females 55.3%) treated using antihypertensive drug therapy in primary care settings in Japan. Multivariate regression analysis including the variables that were significantly associated with the home systolic ME dif on the univariate analysis was performed. The mean of the home systolic/diastolic ME dif was 6.1+/-10.8/4.8+/-6.5 mmHg. The proportion of patients measuring evening BP after drinking alcohol was 20.5%, and the proportion of patients measuring evening BP after bathing was 76.8%. Uncontrolled morning systolic BP (morning systolic BP > or =135 mmHg), controlled evening systolic BP (evening systolic BP <135 mmHg), older age (> or =65 years), measurement of evening BP after drinking, and measurement of evening BP after bathing were positively associated with the home systolic ME dif on multivariate regression analysis. Measurement of evening BP after drinking and measurement of evening BP after bathing were strongly associated with an increased home systolic ME dif, independent of morning and evening home BP levels. Therefore, evening home BP measuring conditions (before or after drinking alcohol and bathing) should be taken into account while evaluating the home systolic ME dif.

Blood Pressure-Lowering Effects of Angiotensin Receptor Antagonist Monotherapy and in Combination with Other Anti-Hypertensive Drugs in Primary Care Settings in Japan

Combination therapy with multiple anti-hypertensives is required to achieve target blood pressure (BP) control and is recommended as the first-line therapy in hypertension. Although angiotensin receptor blockers (ARBs) may be combined with other anti-hypertensives, it is unclear how the effects of ARBs are influenced by co-administered anti-hypertensives. We investigated the effect of olmesartan medoxomil (OLM) when it is given alone (monotherapy) or concomitantly with other anti-hypertensives in 6507 OLM-naïve Japanese in “real world” clinical practice. After a 12-week treatment, BP was significantly reduced from baseline in both the monotherapy group and the combination therapy group (P < 0.0001). The BP-lowering efficacy after treatment and achievement rates of target BP were similar in both groups. In the combination therapy group, no significant difference of achieved BP level was detected between patients taking Calcium channel blockers and any other class of anti-hypertensive drugs. This study suggests that ARBs such as OLM-elicits BP-lowering efficacy as either a first- or second-line agent and its effects are minimally influenced by co-administered anti-hypertensives.

Difference between Home and Office Blood Pressures among Treated Hypertensive Patients from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

This study sought to clarify the factors associated with the magnitude of the difference between home and office blood pressures in treated hypertensive patients. Study subjects consisted of 3,308 essential hypertensive patients (mean age, 66 years; males, 44%) receiving antihypertensive treatment in primary care settings in Japan. Patients were classified into 3 groups (the home effect group, small difference group, and office effect group) according to tertiles of the magnitude of the office-home systolic blood pressure difference. Compared to the other two groups, the home effect group patients were significantly and independently older, were more often habitual drinkers, had a greater family history of cerebrovascular disease or personal history of ischemic heart disease, and were prescribed a greater number of antihypertensive drugs, non-amlodipine calcium channel blockers, and alpha-blockers as antihypertensive drugs. Compared to the other two groups, the office effect group patients were significantly and independently younger, included more females, less frequently had a family history of cerebrovascular disease or personal history of ischemic heart disease, and were less often prescribed alpha-blockers as antihypertensive drugs. The characteristics of home effect group patients and the factors negatively affecting the blood pressure difference were the same. Among treated hypertensive patients, compared to patients in the other groups, office effect group patients had a lower-risk profile, whereas home effect group patients had a higher-risk profile. These predictive factors might be useful clinically to help identify patients who may have a large difference between home and office blood pressures.

Time and cost involved in the care of newly registered patients with diabetes mellitus and other lifestyle diseases at diabetes clinics in Japan (JDDM 4)

To study the time and cost involved in the care of newly registered outpatients with Type 2 diabetes mellitus (DM), compared with patients with hypertension and/or hyperlipidaemia (HTL). A total of 313 patients with DM and 58 patients with HTL without diabetes were registered on their first visits to 11 diabetes clinics across Japan. The time and cost involved in their care was recorded over the following 5 months. In the first 3 months, there was an extensive time commitment to both groups. The time spent by physicians was 1.5 times longer for DM than for HTL. The total care time spent by all the care providers for DM was twice that for HTL. The cost of DM care was twice that for HTL, with the cost of medicines excluded. However, half of the cost for DM was for laboratory tests. When these were excluded, and the remaining cost divided by the time spent, the amount for DM was half of that for HTL. Over the 5 months, mean glycated haemoglobin (HbA(1c)) in DM patients improved from 8.0% to 6.5%, and 72% of DM patients achieved the glycaemic target of HbA(1c) < or = 6.5%. DM care in a diabetes clinic requires a great deal more time and resources than HTL to achieve the best outcome. An educational system for self care, presently lacking in the primary care setting in Japan, would improve glycaemic control for DM patients in the community.

Out-of-Office Blood Pressure Control Among Treated Subjects

To the Editor: We read with great interest the article by Banegas et al1 dealing with the control of office blood pressure (BP) and daytime ambulatory BP in 12 897 treated patients with hypertension in primary care settings in Spain. They found that office BP was adequately controlled (<140/90 mm Hg) in only 23.6% of their patients. In contrast, daytime ambulatory BP was adequately controlled (<135/85 mm Hg) in 51.6% of patients. We previously conducted a comparable survey in primary care settings in Japan, …

Patient Autonomy Preferences among Hypertensive Outpatients in a Primary Care Setting in Japan

To investigate autonomy preferences and the factors to promote active patient participation in a primary care setting in Japan. Ninety-two hypertensive outpatients who consecutively visited a Japanese hospital between January and May of 2005 in Tokyo, Japan. This cross-sectional study was conducted by using a self-administered questionnaire. The main outcome measures were patient preferences for autonomy (i.e., decision-making and information-seeking preferences), measured by the Autonomy Preference Index (API). The variables studied were patient sociodemographic characteristics, physician characteristics based on patient preference (i.e., ability to communicate, extent of clinical experience, qualifications, educational background, gender, and age), and the Multidimensional Health Locus of Control. On the API scale from 0 to 100, the patients had an intermediate desire for decision-making (median: 51) and a greater desire for information (median: 95). A multivariate regression model indicated that decision-making preference increased when patients were woman and decreased as physician age increased, and information-seeking preference was positively associated with good communication skills, more extensive clinical experience, physicians of middle age, and patient beliefs that they were responsible for their own health, and was negatively associated with a preference for man physicians. Physicians may need to understand that patient autonomy preferences pertain to physician age and gender, physician communication ability and extent of clinical experience, and patient beliefs about self-responsibility toward health, and could use the information to promote reliable patient-physician relationships.

Cost-Effectiveness of Including Salmeterol in Asthma Therapy in a Primary Care Setting in Japan

To discuss and estimate the clinical and economic benefits obtained during combination therapy with inhaled corticosteroids (ICS) plus salmeterol (SLM) for Japanese patients with asthma on the basis of the Global Initiative for Asthma (GINA) Guidelines. Fifty-four cases aged>16 years with either moderate persistent asthma (step 3) or severe persistent asthma (step 4) were assessed in a retrospective survey. Participants must have been a patient at the author's clinic continuously from June 2001 and been users of SLM for more than one year. Signed informed consent was obtained. Both clinical and economic components of SLM use in asthma therapy over the past two years were evaluated. Cost analyses revealed that SLM use significantly reduced medical costs of leukotriene receptor antagonist and short-acting inhaled beta(2)-agonists. Moreover, clinical outcomes (e.g. symptom-free day) were significantly improved after initiation of SLM. Sensitivity analyses confirmed that use of SLM is cost-effective. Combination therapy with inhaled corticosteroids and SLM on the basis of GINA guidelines appears to be efficacious and cost effective for the treatment of moderate or severe persistent asthma in Japanese patients.

A Pilot Study on Using the Patient Health Questionnaire in the Primary Care Setting in Japan

jects with mood disorders, sensitivity was 75%, specificity was 88%, and the positive predictive value was 47%. The kappa reliability coefficients between the PHQ and psychiatrist diagnoses were 0.53 for any mental disorder and 0.51 for any mood disorder. In the case of any mental disorder, the Likelihood Ratio of a positive test (LR+) for the PHQ was 4.8. In the case of any mood disorder, the LR+ for the PHQ was 6.5.

Control of Blood Pressure as Measured at Home and Office, and Comparison with Physicians' Assessment of Control among Treated Hypertensive Patients in Japan: First Report of the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study was conducted to measure the control of blood pressure (BP) as evaluated by home BP measurement among 3,400 patients with essential hypertension (mean age: 66 years; females: 55%) receiving antihypertensive treatment in primary care settings in Japan. The purpose of this first report was to compare characteristics of BP control as measured at home and in the clinic (office) and define their association with BP control as evaluated by physicians. Mean systolic/diastolic BP (SBP/DBP) values were 140/82 mmHg for home BP and 143/81 mmHg for office BP. BP levels were not adequately controlled among approximately 60% of the patients, according to reference values described in the national guidelines (office BP: <140/90 mmHg; home BP: <135/85 mmHg). Even among patients evaluated by physicians as having excellent or fairly good BP control, office and home SBP values were insufficiently controlled in approximately 50%. Although the tendency was more remarkable among older patients, whose recommended target BP levels are higher than those of middle-aged patients in the Japanese Hypertension Society 2000 criteria, office and home BP values were not adequately controlled in approximately 50% of the middle-aged patients whose BP control was evaluated as good. Our findings suggest that an important reason why home and office BP values are not adequately controlled is that physicians approve relatively higher BP levels under treatment, even among middle-aged patients.