Takuya Aoki1, Yosuke Yamamoto1, Tatsuyoshi Ikenoue1, Makoto Kaneko2,3, Morito Kise2, Yasuki Fujinuma2, Shunichi Fukuhara4,5,6. 1. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2. Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan. 3. Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan. 4. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. fukuhara.shunichi.6m@kyoto-u.ac.jp. 5. Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan. fukuhara.shunichi.6m@kyoto-u.ac.jp. 6. Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan. fukuhara.shunichi.6m@kyoto-u.ac.jp.
Abstract
BACKGROUND: To discuss how best to implement the gatekeeping functionality of primary care; identifying the factors that cause patients to bypass their primary care gatekeepers when seeking care should be beneficial. OBJECTIVE: To examine the association between patient experience with their primary care physicians and bypassing them to directly obtain care from higher-level healthcare facilities. DESIGN AND METHODS: This prospective cohort study was conducted in 13 primary care clinics in Japan. We assessed patient experience of primary care using the Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was the patient bypassing their usual primary care physician to seek care at a hospital, with this occurring at least once in a year. We used a Bayesian hierarchical model to adjust clustering within clinics and individual covariates. KEY RESULTS: Data were analyzed from 205 patients for whom a physician at a clinic served as their usual primary care physician. The patient follow-up rate was 80.1%. After adjustment for patients' sociodemographic and health status characteristics, the JPCAT total score was found to be inversely associated with patient bypass behavior (odds ratio per 1 SD increase, 0.44; 95% credible interval, 0.21-0.88). The results of various sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS: We found that patient experience of primary care in Japan was inversely associated with bypassing a primary care gatekeeper to seek care at higher-level healthcare facilities, such as hospitals. Our findings suggest that primary care providers' efforts to improve patient experience should help to ensure appropriate use of healthcare services under loosely regulated gatekeeping systems; further studies are warranted.
BACKGROUND: To discuss how best to implement the gatekeeping functionality of primary care; identifying the factors that cause patients to bypass their primary care gatekeepers when seeking care should be beneficial. OBJECTIVE: To examine the association between patient experience with their primary care physicians and bypassing them to directly obtain care from higher-level healthcare facilities. DESIGN AND METHODS: This prospective cohort study was conducted in 13 primary care clinics in Japan. We assessed patient experience of primary care using the Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was the patient bypassing their usual primary care physician to seek care at a hospital, with this occurring at least once in a year. We used a Bayesian hierarchical model to adjust clustering within clinics and individual covariates. KEY RESULTS: Data were analyzed from 205 patients for whom a physician at a clinic served as their usual primary care physician. The patient follow-up rate was 80.1%. After adjustment for patients' sociodemographic and health status characteristics, the JPCAT total score was found to be inversely associated with patient bypass behavior (odds ratio per 1 SD increase, 0.44; 95% credible interval, 0.21-0.88). The results of various sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS: We found that patient experience of primary care in Japan was inversely associated with bypassing a primary care gatekeeper to seek care at higher-level healthcare facilities, such as hospitals. Our findings suggest that primary care providers' efforts to improve patient experience should help to ensure appropriate use of healthcare services under loosely regulated gatekeeping systems; further studies are warranted.
Entities:
Keywords:
Japan; bypassing; gatekeeping; patient experience; primary care
Authors: Barbara L Braun; Jinnet Briggs Fowles; Christopher B Forrest; Elizabeth A Kind; Steven S Foldes; Jonathan P Weiner Journal: Med Care Date: 2003-07 Impact factor: 2.983
Authors: A Q Yaffee; L K Whiteside; R A Oteng; P M Carter; P Donkor; S D Rominski; M E Kruk; R M Cunningham Journal: Trop Med Int Health Date: 2012-04-23 Impact factor: 2.622
Authors: G Lyratzopoulos; M Elliott; J M Barbiere; A Henderson; L Staetsky; C Paddison; J Campbell; M Roland Journal: BMJ Qual Saf Date: 2011-09-07 Impact factor: 7.035
Authors: Martin Roland; Marc Elliott; Georgios Lyratzopoulos; Josephine Barbiere; Richard A Parker; Patten Smith; Peter Bower; John Campbell Journal: BMJ Date: 2009-09-29
Authors: Griffith Bell; Erlyn K Macarayan; Hannah Ratcliffe; June-Ho Kim; Easmon Otupiri; Stuart Lipsitz; Lisa Hirschhorn; John Koku Awoonor-Williams; Belinda Afriyie Nimako; Anthony Ofosu; Hannah Leslie; Asaf Bitton; Dan Schwarz Journal: JAMA Netw Open Date: 2020-08-03
Authors: Xiu-Jing Hu; Harry H X Wang; Yu-Ting Li; Xiao-Ya Wu; Yi Wang; Jia-Heng Chen; Jia-Ji Wang; Samuel Y S Wong; Stewart W Mercer Journal: Health Expect Date: 2021-09-28 Impact factor: 3.377