Comparison of Primary Care Experience in Hospital-Based Practices and Community-Based Office Practices in Japan
Comparison of Primary Care Experience in Hospital-Based Practices and Community-Based Office Practices in Japan
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DOI：
10.1370/afm.2463
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发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Fukuhara, Shunichi
中科院分区：
文献类型：
--
作者：
Aoki, Takuya;Yamamoto, Yosuke;Fukuhara, Shunichi
目的 医疗保健（包括初级保健）的质量受到提供医疗保健的环境的影响。我们调查了初级保健实践地点与患者体验之间的关联，重点关注基于医院的实践和基于社区的办公室实践之间的差异。方法我们在日本基于初级保健实践的研究网络中对 25 家参与机构进行了横断面研究：6 家中小型医院和 19 家社区办公室。我们使用日本版初级保健评估工具 (JPCAT) 评估患者的初级保健体验，该工具包括 6 个领域：首次接触、纵向、协调、可用服务的全面性、所提供服务的全面性和社区导向。 结果 分析基于 1,725 名初级保健患者。在对设施内可能的混杂因素和聚集进行调整后，与基于社区的办公室实践相比，基于医院的实践与社区导向的患者体验较差相关（调整后的平均差 = -5.76；95% CI，-10.35 至 -1.17）。相比之下，以医院为基础的实践与相对较好的患者首次接触体验相关（调整后平均差 = 15.43；95% CI，5.13 至 25.72）。 结论 我们的研究阐明了以医院为基础的实践和以社区为基础的办公室实践在初级保健方面的优势和挑战之间的差异，重点是以患者为中心。改善以医院为基础的实践中的社区导向，并改善以社区为基础的办公室实践中的可及性，包括非工作时间护理，可以提高初级护理的质量并促进跨环境护理的标准化。
PURPOSE The quality of health care, including primary care, is influenced by the context in which care is delivered. We investigated the association between primary care practice location and patient experience with a focus on differences between hospital-based practices and community-based office practices.METHODS We conducted a cross-sectional study in a primary care practice-based research network in Japan among 25 participating facilities: 6 small and medium-sized hospitals and 19 community-based offices. We assessed patient experience of primary care using a Japanese version of Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness with respect to services available, comprehensiveness with respect to services provided, and community orientation.RESULTS Analyses were based on 1,725 primary care patients. After adjustment for possible confounders and clustering within facilities, compared with community-based office practices, hospital-based practices were associated with poorer patient experience of community orientation (adjusted mean difference = -5.76; 95% CI, -10.35 to -1.17). In contrast, hospital-based practices were associated with comparatively better patient experience of first contact (adjusted mean difference = 15.43; 95% CI, 5.13 to 25.72).CONCLUSIONS Our study elucidates differences in the strengths and challenges of primary care between hospital-based practices and community-based office practices, with a focus on patient centeredness. Improving community orientation in hospital-based practices and improving accessibility, including out-of-hours care, in community-based office practices may enhance the quality of primary care and promote standardization of care across settings.