Article Text
PDF
Abstract
Objectives Evidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals.
Design Multicentre cross-sectional study.
Setting A total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals).
Participants Adult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person.
Primary outcome measure Polypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH).
Results Data were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant.
Conclusions Clinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.
- quality in health care
- primary care
- general medicine (see internal medicine)
Data availability statement
No data are available. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Data availability statement
No data are available. Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.
Footnotes
Contributors All authors (TA, YF and MM) of the paper contributed the conception or design of the work. TA performed the statistical analyses. TA, YF and MM interpreted the analyses. TA drafted the manuscript. All authors reviewed and edited the manuscript, contributed to the discussion of the data and performed critical review of the manuscript. All authors gave the final approval of the manuscript before submission. TA is the guarantor of the work and accepts full responsibility for the presented content.
Funding This work was supported by Institute for Health Economics and Policy, Japan (grant number N/A).
Competing interests TA and MM received lecture fees and lecture travel fees from the Centre for Family Medicine Development of Japanese Health and Welfare Co-operative Federation. TA and MM are advisers of the Centre for Family Medicine Development practice-based research network. MM’s son-in-law worked at IQVIA Services Japan K.K. which is a contract research organisation and a contract sales organisation. MM’s son-in-law works at SYNEOS HEALTH CLINICAL K.K. which is a contract research organisation and a contract sales organisation.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.