Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Tsukamoto, Tomoko; Ohira, Yoshiyuki; Noda, Kazutaka; Takada, Toshihiko; Uehara, Takanori; Ikusaka, Masatomi

doi:10.1186/s12930-014-0009-9

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…The Japanese government has tried to address the issue of undifferentiated functions among different tiers of health care facilities. Since 1996, patients who visit a large hospital without referral have had to pay an additional charge, but the fee (about 3000 to 4000 yen) may not be high enough to deter patients from spontaneously presenting to large hospital [7,20]. Further development of a system to distinguish the function of clinics from those of hospitals by the government may be needed.…”

Section: Discussionmentioning

confidence: 99%

Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Tsukamoto

Ohira

Noda

et al. 2014

Asia Pacific Family Medicine

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Background: There have been some studies of common primary care diseases in Japan, but no reports on which diseases it is difficult for general physicians to diagnose in daily practice. In this study, we identified diseases that provided a diagnostic challenge for Japanese general physicians in daily practice.Methods: The subjects were new undiagnosed patients referred to the General Outpatient Department of Chiba University Hospital during the one-year period from January 2008. We performed a retrospective chart review to identify the referring doctor, patient demographics, the duration of symptoms, the final diagnosis, and the outcome. Final diagnoses were classified according to the International Classification of Primary Care Second Edition (ICPC-2). In addition, the differences between referrals from general physicians and those from other physicians were assessed. Fisher's exact test and the Bonferroni-Holm correction were used for statistical analysis. Results: A total of 169 patients were referred by general physicians and 239 patients were referred by other physicians. The most common ICPC-2 diagnosis was "General & Unspecified" conditions (35 patients, 20.7%), followed by "Psychological" conditions (31 patients, 18.3%) and "Musculoskeletal" conditions (21 patients, 12.4%). No significant differences of the ICPC-2 category for the final diagnosis and each diagnosis were found between patients referred by general physicians and those referred by other physicians. The hospitalization rate was lower for patients referred by general physicians than for patients referred by other physicians (4 patients, 2.4% vs. 24 patients, 10.0%) (P = 0.002).Conclusions: Japanese general physicians found difficulty in diagnosing "Psychological" conditions, "Musculoskeletal" conditions, variations within the normal range, and viral infections that required diagnosis by exclusion. Because most of the patients referred by general physicians had mild conditions, further education at outpatient departments and clinics is required to improve diagnostic performance. Additionally, it is important to increase the gatekeeper role of general physicians and further development of the medical system by the government to distinguish the functions of clinics and hospitals is expected.

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Section: Discussionmentioning

confidence: 99%

Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Tsukamoto

Ohira

Noda

et al. 2014

Asia Pacific Family Medicine

Self Cite

View full text Add to dashboard Cite

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Correlation between patients’ reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC)

Kaneko

Ohta²,

Nago

et al. 2017

BMC Fam Pract

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BackgroundThe Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients’ reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients’ RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system.MethodsWe conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015.We employed population density as index of accessibility. We calculated Spearman’s rank correlation coefficient to examine the correlation between the proportion of “non-internal medicine-related” RFEs and health problems in each study area in consideration of the population density.ResultsWe found 17 studies with diverse designs and settings. Among these studies, “non-internal medicine-related” RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, “non-internal medicine-related” health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of “non-internal medicine-related” RFEs and health problems.ConclusionsThis is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with “non-internal-medicine-related” RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0658-5) contains supplementary material, which is available to authorized users.

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Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Cited by 2 publications

References 15 publications

Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Investigation of diseases that cause diagnostic difficulty for Japanese general physicians

Correlation between patients’ reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC)

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