Machiko Inoue

Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials

The effectiveness of prophylactic antibiotics use for acute necrotizing pancreatitis has been explored and a number of systematic reviews have been published with conflicting results. The timing of antibiotics administration can be fundamental to their effectiveness, but thus far no reviews have focused on the timing of administration.

Development and validation of the Japanese version of Primary Care Assessment Tool

BACKGROUNDnTools for assessing quality of primary care from patient experience have never previously existed in Japan.nnnOBJECTIVEnThe aim of this study was to develop the Japanese version of Primary Care Assessment Tool (JPCAT) and to examine the validity of this tool in the assessment of the quality of primary care from patient experience in Japan.nnnMETHODSnWe used a cross-sectional mail survey to test the validity and reliability of JPCAT. The questionnaire was sent to 1100 residents, 40-75 years of age, who were randomly selected from a basic resident register in Kita City, Tokyo, Japan. We examined internal consistency included Cronbachs alpha, exploratory factor analysis, multi-trait analysis and correlation between overall user satisfaction scores and JPCAT total scores.nnnRESULTSnThe tool was developed using responses from 204 residents, out of a total of 402 participants in the survey (50.7%), who had the usual sources of care. A 29-item JPCAT was constructed to include six multi-item subscales, representing each of the five primary care principles (first contact, longitudinality, comprehensiveness, coordination and community orientation). All of the multi-item scales achieved good internal consistency, item-total correlations and construct validity. The overall Cronbachs alpha coefficient was 0.90. The Spearman correlation coefficient between the JPCAT total score and the overall user satisfaction was 0.58. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales except the longitudinality domain.nnnCONCLUSIONSnWe developed JPCAT and examined its validity and reliability in assessing the core principles of primary care in Japan. This tool could be used for health service research in primary care.

Implications for Social Support on Prolonged Sleep Difficulties among a Disaster-Affected Population: Second Report from a Cross-Sectional Survey in Ishinomaki, Japan

Study Objectives This study aimed to investigate the role of social factors, especially social support for sleep, among victims living at home around 1–2 years after the Great East Japan Earthquake and tsunami. Design A cross-sectional household survey was conducted between May and December 2012 (14–21 months after the disaster) in the Ishinomaki area, Japan. Univariate and multivariate logistic regression models were used to examine the association between social factors, including social support, and prolonged sleep difficulties (persisting over 1 month). Social support was divided into three functions: emotional, informational, and instrumental support. Participants Data were obtained on 2,593 individuals who were living at home after the disaster. Results The prevalence of prolonged sleep difficulties was 6.9% (5.8% male, 7.7% female). This study showed that lack of social support has a stronger association with prolonged sleep difficulties than non-modifiable or hardly modifiable consequences caused directly by the disaster, i.e., severity of home damage, change in family structure and income. Among the three dimensions of social support, lack of emotional support showed the strongest association with prolonged sleep difficulties. Conclusions Social support, especially emotional support, may positively affect sleep among victims living at home around 1–2 years after a disaster.

The cultural context of teaching and learning sexual health care examinations in Japan: a mixed methods case study assessing the use of standardized patient instructors among Japanese family physician trainees of the Shizuoka Family Medicine Program.

BackgroundIn contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. A number of services within the bailiwick of family medicine have yet to be fully incorporated into Japanese family medicine training programs, especially those associated with sexual health. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment. In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations.Case descriptionBuilding on an existing partnership between the University of Michigan, USA, and the Shizuoka Family Medicine Program, Japan, Japanese family medicine residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. A mixed methods case study targeting residents, trainers, and staff was employed using post-training feedback, semi-structured interviews, and web-based questionnaire.Discussion and evaluationResidents’ and SPIs’ perceptions of the training were universally positive, with SPIs observing a positive effect on residents’ knowledge, confidence, and skill. SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use. SPIs provided an important opportunity for residents to learn about the patient’s perspective and to practice newly learned skills. Respondents noted a general preference for gender concordance when providing gender-specific health care; also noted were too few opportunities to practice skills after returning to Japan. For cultural reasons, both residents and staff deemed it would be difficult to implement a similar SPI-based program within Japan.ConclusionsWhile the SPI program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained. Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan. The feasibility of implementing a similar training program within Japan remains uncertain. More research is needed to understand challenges and how they can be overcome.

Association between health literacy and patient experience of primary care attributes: A cross-sectional study in Japan

Primary care is regarded as a setting that potentially mitigate patient health literacy (HL) related inequalities. However, there is a lack of evidence about influence of patient HL on the patients’ perception of quality of primary care. We aimed to examine the association between HL and patient experience of primary care attributes. We conducted a cross-sectional survey, and sent questionnaires to adult residents who were randomly selected from a basic resident register in Yugawara Town, Kanagawa, Japan. We assessed HL using a 14-item Health Literacy Scale (HLS-14) and patient experience of primary care attributes using a 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. We used a multivariable linear regression analyses to adjust individual covariates. Data were analyzed for 381 residents who had a usual source of care. After adjustment for patients’ sociodemographic and health characteristics, patient HL was positively associated with the JPCAT total score (B = 4.49, 95% confidence interval: 0.27 to 8.65 for HLS-14 total score highest quartile, compared with the lowest quartile). Among primary care attributes, HL had significant associations with longitudinality and comprehensiveness (service provided). We found that HL was positively associated with patient experience of primary care attributes in Japanese people. Our findings indicated that greater efforts might be needed to improve patient-centered and tailored primary care to those with low HL.

Challenges in providing maternity care in remote areas and islands for primary care physicians in Japan: a qualitative study

BackgroundMaintaining a maternity care system is one of the biggest issues in Japan due to the decreasing number of obstetricians, especially in remote areas and islands. The aim of this qualitative study was to explore the challenges in women’s health and maternity care in remote areas and islands for primary care physicians and obstetricians in order to provide an insight necessary to develop a better health care system.MethodsWe conducted semi-structured interviews with 13 primary care physicians and 4 obstetricians practicing maternity care at clinics/hospitals in remote areas and islands across Japan. Interview data were analyzed, using the modified Grounded Theory Approach, to elucidate the challenges primary care physicians faced in their practice.ResultsPrimary care physicians who engaged in maternity care recognized the following challenges: low awareness of primary care, lack of training opportunities, unclear goal of the training, lack of certification system, lack of consultation system, and lack of obstetricians to offer support. These six challenges along with the specialty’s factors such as sudden changes of patients’ condition were considered to result to the provider’s hesitation and anxiety to engage in the practice.ConclusionsThis study found six environmental/systemic factors and three specialty’s factors as the main challenges for primary care physicians in providing maternity care in remote areas and islands for primary care physicians in Japan. Increasing the awareness of primary care and developing a maternity care training program to certify primary care physicians may enable more primary care physicians to engage in and provide women’s health and maternity care in remote areas and islands.

Correlation between family physician’s direct advice and pneumococcal vaccination intention and behavior among the elderly in Japan: a cross-sectional study

BackgroundVaccination is an important element of health maintenance in family medicine. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is highly recommended for the elderly, but its uptake is low in Japan. Primary care system remains under development and preventive services tend to be neglected in the Japanese medical practice. The study aims to investigate the association between family physician’s recommendations for PPSV23 during outpatient care and PPSV23 vaccination intention and behavior in the elderly.MethodWe conducted a cross-sectional study with a questionnaire at a family medicine clinic in a rural area in Japan. The participants were over the age of 65 without dementia who had maintained a continuity with the clinic. The questionnaire inquired PPSV23 vaccination status, family physician’s advice for PPSV23, socio-demographics, and the constructs in the Health Belief Model. We defined those who had had vaccination intention and behavior as “PPSV23 vaccinated group” and those who had no vaccination and uncertainty about being or no intention to be vaccinated in the future as “PPSV23 unvaccinated group.” We used chi-square test for correlation between physician’s advice and PPSV23 vaccination/intention, univariate and multivariate logistic regression analysis for factors related to the vaccination/intention, and descriptive analysis for reasons for reluctance to the vaccination.ResultsWe analyzed 209 valid responses. There were 142 participants in the PPSV23 vaccinated group and 67 in the PPSV23 unvaccinated group. The PPSV23 vaccination group was more likely to have had their physician’s advice (80.2% vs 21.3%, pxa0<u20090.001). Multivariate logistic regression analysis showed a significant association between PPSV23 vaccination and their physician’s recommendation (OR 8.50, 95%CI 2.8–26.0), awareness of PPSV23 (OR 8.52, 95%CI 2.1–35.0), and the perceived effectiveness of PPSV23 (OR 4.10, 95%CI 1.2–13.9). The reasons for reluctance to get vaccinated included lack of understanding of PPSV23, lack of physician’s recommendations, and concerns about side effects of PPSV23.ConclusionFamily physician’s recommendation was positively correlated with PPSV23 vaccination intention and behavior in the elderly. This reinforces the importance of providing preventive services during time-constrained outpatient care, even in medical systems where it is undervalued.

Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan

BackgroundFamily medicine education-emerging countries face challenges in demonstrating a new program’s ability to train residents in womb-to-tomb care and resident ability to provide such care competently. We illustrate the experience of a new Japanese family medicine program with resident self-competency assessments.MethodsIn this longitudinal cross-sectional study, residents completed self-competency assessment surveys online during 2011–2015. Each year of training, residents self-ranked their competence using a 100-point visual analog scale for 142 conditions: acute (30 conditions), chronic (28 conditions) women’s health (eight conditions), and geriatrics/home (12 conditions) care; procedures (38 types); health promotion (21 conditions).ResultsTwenty residents (11 women, 9 men) participated. Scores improved annually by training year from baseline to graduation; the mean composite score advanced from 31 to 65%. All subcategories showed improvement. Scores for care involving acute conditions rose from 49 to 75% (26% increase); emergency procedures, 46–65% (19% increase); chronic care, 33–73% (40% increase); women’s health, 16–59% (43% increase); procedural care, 26–56% (30% increase); geriatrics care-procedures, 8–65% (57% increase); health promotion, 21–63% (42% increase). Acute care, chronic care, and health promotion achieved the highest levels. Women’s health care, screenings, and geriatrics experienced the greatest increase. Health promotion gains occurred most dramatically in the final residency year.ConclusionsA resident self-competency assessment provides a simple and practical way to conduct an assessment of skills, to monitor skills over time, to use the data to inform residency program improvement, and to demonstrate the breadth of family medicine training to policymakers, and other stakeholders.

An Empirical Assessment of Cases Experienced during Inpatient Family Medicine Resident Training in a Rural Community Hospital of the Shizuoka Family Medicine Training Program in Japan

Background: Despite emerging national interest in training family physicians to improve access to medical services in health care shortage areas, empirical data on inpatient resident learning experiences in rural community settings has been lacking. This research sought to understand the breadth of diagnoses, patient demographics, and comorbidities experienced by family medicine residents while training in a newly launched family medicine training program in a rural area in Shizuoka prefecture.