First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study

Abstract

PurposeWe sought to profile first-time patients without a referral who sought medical care at the Department of Internal Medicine at a medium-sized acute care hospital in Japan. We anticipated that the analysis would highlight the demand for medical care needs from acute care hospitals and help confirm one of the problems associated with primary care in Japan.Patients and methodsThe study population comprised 765 patients who sought outpatient consultation without a referral at “the Department of General Internal Medicine” at the Ikeda City Hospital on Fridays over 4 years. Data on the following variables were collected: age, sex, examination date, reason for encounter (RFE), diagnosis, as well as history of consultation with or without antibiotic treatment at another medical institution for the same RFE. We used the International Classicication of Primary Care, Revised Second edition (ICPC-2-R) codes for RFEs and diagnoses.ResultsThe main RFE fields were digestive (ICPC-2-R Chapter D), general and unspecified (A), and respiratory (R). The main diagnosis fields were digestive (D), respiratory (R), general and unspecified (A), and musculoskeletal (L). In total, 27.6% of patients had sought consultation at another medical institution for the same RFE. Of these, 64.7% of patients for whom the RFE was cough (ICPC-2-R code, R05), and 72.0% for whom the RFE was fever (A03) were prescribed antibiotics. In total, 62.4% of patients underwent emergency investigations and waited for the results; 4.3% were hospitalized on the same day; and 60.5% were medicated at the initial examination. In 11.5%, the main underlying problem appeared to be psychosomatic.ConclusionWe used the ICPC-2-R to analyze the state of first-visit patients without a referral visiting the Department of Internal Medicine at a medium-sized acute care hospital in Japan. Common RFEs were abdominal pain, cough, and fever. A tendency toward overprescription of antibiotics was observed among primary care physicians.

Impact of a Commercial Artificial Intelligence–Driven Patient Self-Assessment Solution on Waiting Times at General Internal Medicine Outpatient Departments: Retrospective Study

“…According to a previous study [ 18 ], physicians estimated that the use of an automated medical history–taking device has the potential to become time consuming in low-complexity cases, in which the medical history is easily taken. In the setting of the small- to medium-sized hospitals in Japan, case complexity is usually low for patients visiting general internal medicine outpatient departments without an appointment [ 26 , 27 ]. We conducted this study in a single center (small- to medium-sized hospital) in Japan.…”

“…This shift in resources could have enhanced the quality of care. Moreover, because approximately half of first-visit patients revisit the outpatient department [ 27 ], the comprehensive patient history taken by AI Monshin may enhance the quality of care for subsequent visits. Moreover, using an AI-based automated medical history–taking system may improve the quality and quantity of data records, which otherwise vary among physicians [ 19 ], ultimately resulting in enhancement in the quality of medical care.…”

Disease burden and quality of life of patients with chronic cough in Japan: a population-based cross-sectional survey

“…Cough is one of the most commonly reported reasons for visit at outpatient clinics and hospitals in Japan 1 2 and one of the most common reasons for seeking primary healthcare worldwide. 3 Globally the prevalence of chronic cough (CC) has been estimated to be 9.6%, while a lower prevalence has been estimated in Asia, 4.4%, 4 and in Japan, 2.2%.…”

Drug Combinations for Mood Disorders and Physical Comorbidities That Need Attention: A Cross-Sectional National Database Survey

“…This is especially true in Japan, where there is no established system for general practitioners. Instead, although patients usually visit primary care physicians for minor symptoms, they can freely access specialized clinics and academic hospitals in all medical disciplines, including psychiatry, as initial medical contact, even without a referral letter 18 19 . As a result, doctors may not be aware of other prescriptions dispensed unless they are prescribed in the same hospital or clinic.…”