Patient experience of primary care and advance care planning: a multicentre cross-sectional study in Japan

Aoki, Takuya; Miyashita, Jun; Yamamoto, Yosuke; Ikenoue, Tatsuyoshi; Kise, Morito; Fujinuma, Yasuki; Fukuma, Shingo; Kimachi, Miho; Shimizu, Sayaka; Fukuhara, Shunichi

doi:10.1093/fampra/cmw126

Cited by 42 publications

(44 citation statements)

References 21 publications

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“…According to previous studies, patient experience affects various behaviors, such as adherence to treatment, cancer prevention activities, emergency department visits, and advance care planning. [27][28][29][30] The results of this study have contributed additional findings on the association between patient experience and healthcare utilization. This is the first confirmatory longitudinal study to reveal the association between patient experience of primary care and bypassing a primary care gatekeeper to seek care at a higher- PCAT is an internationally established measure for the evaluation of patient experience of primary care.…”

Section: Discussionmentioning

confidence: 88%

Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 88%

Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan

et al. 2018

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“…The total score reflects an overall measure of the quality of core primary care principles. Previous studies have shown that the JP-CAT has good reliability and validity, 20 and that it is associated with the adoption of breast cancer screening, 22 advanced care planning discussions, 23 and the bypassing of PCPs. 24…”

Section: Patient Experience Of Primary Carementioning

confidence: 99%

Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study

Kaneko

Aoki

Mori

et al. 2018

The Journal of Rural Health

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Purpose In rural areas, the management of hospitalizations and emergency department (ED) visits is an important issue, and it is compounded by factors such as the long distance to secondary care facilities, funding difficulties in many rural medical institutions, and shortage of medical staff. While better patient experience (PX) has been shown to reduce hospitalizations and ED visits, previous studies have not considered the differences between urban and rural areas. In addressing this gap, this study examines the association between PX and hospitalizations/ED visits on isolated islands. Methods This prospective cohort study was conducted on 5 isolated islands in Okinawa, Japan. We assessed the PX of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was hospitalizations and ED visits in a year. We used a mixed effect model to adjust clustering within islands and individual covariates. Findings Of 1,258 residents, 740 responded to a questionnaire for PX measurement. There were 73 hospitalizations and 62 ED visits. Adjusting for confounding and geographical clustering, hospitalizations had significant positive association with the PX score of each patient. ED visits were not associated with the total score of the JPCAT. Conclusion On the isolated islands, PX in primary care had positive correlation with hospitalizations. The contrast of our findings to those of previous studies may be due to the close patient‐doctor relationship on isolated islands.

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“…In the opinion of patients, families, and health care professionals, the family physician (FP) is the key professional for the discussion of ACP [4,[6][7][8][9]. Previous studies investigated the attitude of FPs toward ACP and the facilitators of or barriers to discussing ACP with FPs [10]; limited information is currently available on frequency of and topics involved in the ACP discussion among patients, their family members, and FPs [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

et al. 2020

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Background: To improve the quality of advance care planning (ACP) in primary care, it is important to understand the frequency of and topics involved in the ACP discussion between patients and their family physicians (FPs). Methods: A secondary analysis of a previous multicenter cross-sectional observational study was performed. The primary outcome of this analysis was the frequency of and topics involved in the ACP discussion between outpatients and FPs. In March 2017, 22 family physicians at 17 clinics scheduled a day to assess outpatients and enrolled patients older than 65 years who were recognized by FPs as having regular visits. We defined three ACP discussion topics: 1) future decline in activities of daily living (ADL), 2) future inability to eat, and 3) surrogate decision makers. FPs assessed whether they had ever discussed any ACP topics with each patient and their family members, and if they had documented the results of these discussions in medical records before patients were enrolled in the present study. We defined patients as being at risk of deteriorating and dying if they had at least 2 positive general indicators or at least 1 positive disease-specific indicator in the Japanese version of the Supportive and Palliative Care Indicators Tool. Results: In total, 382 patients with a mean age of 77.4 ± 7.9 years were enrolled, and 63.1% were female. Seventy-nine patients (20.7%) had discussed at least one ACP topic with their FPs. However, only 23 patients (6.0%) had discussed an ACP topic with family members and their FPs, with the results being documented in their medical records. The topic of future ADL decline was discussed and documented more often than the other two topics. Patients at risk of deteriorating and dying discussed ACP topics significantly more often than those not at risk of deteriorating and dying (39.4% vs. 16.8%, p < 0.001). Conclusion: FPs may discuss ACP with some of their patients, but may not often document the results of this discussion in medical records. FPs need to be encouraged to discuss ACP with patients and family members and describe the decisions reached in medical records.

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Patient experience of primary care and advance care planning: a multicentre cross-sectional study in Japan

Abstract: We found that better patient experience of primary care was strongly associated with ACP discussion. Our findings reinforce the significance of patient experience in primary care as part of quality end-of-life care.

Cited by 42 publications

References 21 publications

Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan

Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan

Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study

Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study

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