Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
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DOI：
10.1370/afm.2894
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发表时间：
2023-01-01
影响因子：
4.4
通讯作者：
Matsushima, Masato
中科院分区：
文献类型：
--
作者：
Aoki, Takuya;Sugiyama, Yoshifumi;Matsushima, Masato
在大流行期间，当初级保健提供者在提供预防保健、慢性病管理和对急性常见病的早期反应方面存在许多障碍时，目前尚不清楚初级保健属性是否有助于减少住院。我们的目的是检查核心初级保健属性和总住院率之间的关联在COVID-19 pandemic.METHODS我们进行了一项全国性的前瞻性队列研究，在流行期间使用的代表性样本的日本成年人口年龄在40至75岁。初级保健属性（第一次接触，忠诚，协调，全面性和社区方向）进行了评估，使用日本版的初级保健评估工具（JPCAT）。主要结局指标是2021年5月至2022年4月12个月期间的住院率。结果分析了1，161名参与者的数据（随访率为92%）。调整可能的混杂因素后，总体初级保健属性（通过JPCAT总评分评估）以剂量依赖性方式与住院率降低相关（与无常规护理来源相比，最高评分四分位数的比值比[OR] = 0.37，95%CI，0.16-0.83）。JPCAT和住院治疗的每个领域的得分之间的所有关联在统计学上显着比较时，最高的四分位数没有通常的来源care.CONCLUSIONS我们的研究表明，提供初级保健，特别是高质量的初级保健，是与减少总住院治疗，即使在大流行时，有许多障碍，提供通常的医疗保健。这些发现支持了在COVID-19大流行期间和之后寻求加强初级保健系统的政策。Ann Fam Med 2023;21：27-32。https://doi.org/10.1370/afm.2894
PURPOSE During a pandemic, when there are many barriers to providing preventive care, chronic disease management, and early response to acute common diseases for primary care providers, it is unclear whether primary care attributes contribute to reducing hospi-talization. We aimed to examine the association between core primary care attributes and total hospitalizations during the COVID-19 pandemic.METHODS We conducted a nationwide prospective cohort study during the pandemic using a representative sample of the Japanese adult population aged 40 to 75 years. Pri-mary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) were assessed using the Japanese version of Primary Care Assess-ment Tool (JPCAT). The primary outcome measure was any incidence of hospitalization dur-ing a 12-month period from May 2021 through April 2022.RESULTS Data from 1,161 participants were analyzed (92% follow-up rate). After adjustment for possible confounders, overall primary care attributes (assessed by the JPCAT total score) were associated in a dose-dependent manner with a decrease in hospitalizations (odds ratio [OR] = 0.37, 95% CI, 0.16-0.83 for the highest score quartile, compared with no usual source of care). All associations between each domain score of the JPCAT and hospitalization were statistically significant when comparing the highest quartile with no usual source of care.CONCLUSIONS Our study revealed that the provision of primary care, particularly high -quality primary care, was associated with decreased total hospitalization, even during a pandemic when there are many barriers to providing usual medical care. These findings support policies that seek to strengthen primary care systems during and after the COVID-19 pandemic.Ann Fam Med 2023;21:27-32. https://doi.org/10.1370/afm.2894