The Potential of a Stroke Registry Using Diagnosis Procedure Combination Data from All Hospitals in a Japanese Prefecture.

OBJECTIVES: In Japan, many hospitals have joined the diagnosis procedure combination/per-diem payment system (DPC/PDPS), which provides unified information about inpatients. DPC data are digitized, and the number of participating hospitals has increased recently. Herein, we evaluated the potential of a stroke registry constructed using these unified DPC data from all hospitals in the Iwate Prefecture, Japan. METHODS: The proportion of cerebrovascular disease (CVD) cases registered by DPC-participating hospitals was calculated and compared with all registered cases in the Iwate Stroke Registry in 2008-2017. The cases were categorized based on sex, age-groups, stroke subtypes, and first-ever onset or recurrence onset. Based on the registered cases in the stroke registry, the accuracy of the CVD cases extracted by the disease name from DPC data of a typical core hospital and a typical noncore hospital was evaluated. RESULTS: Of the 71 hospitals with 9,992 beds in the Iwate Prefecture in 2018, 50 hospitals with 8,316 beds participated in the DPC system. The proportion of registered cases from participating hospitals was 95.2% (44,779/47,018) for all stroke types (95.6% men and 94.9% women), 94.3% for cerebral infarction, 97.0% for intracerebral hemorrhage, and 98.7% for subarachnoid hemorrhage, whereas it was 95.7% for first-ever onset and 94.1% for recurrent onset. The proportion of registered cases decreased with increasing patient age. Attending doctors and researchers registered 486 and 41 CVD cases from the core and noncore hospitals, respectively, whereas 455 and 46 CVD cases were extracted from the DPC data of these hospitals, respectively. This yielded 86.6% sensitivity, 99.3% specificity, 92.5% positive predictive value, and 98.7% negative predictive value for the core hospital; these values were 92.7%, 98.6%, 82.6%, and 99.5%, respectively, for the noncore hospital. DISCUSSION/CONCLUSIONS: The stroke registry constructed using DPC data from all hospitals of Iwate Prefecture appears to be adequately complete and accurate.

Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study.

BACKGROUND: A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital. METHODS: Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ). Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records. RESULTS: Among 312 patients, 27 (8.7%) and 52 (16.7%) were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8%) were recognized by physicians as having a mental disorder, but only three (11.1%) were diagnosed as having a mood disorder.Only two patients with major depressive disorder (7.4%) had been prescribed antidepressants. Even among those (n = 15) whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7%) were prescribed an antidepressant. CONCLUSIONS: Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring patients to mental health specialists.

Prevalence of depression among outpatients visiting a general internal medicine polyclinic in rural Japan.

OBJECTIVE: In Europe and the US, primary care has been anticipated in identifying untreated depression. Findings show a high prevalence of depression in such settings. However, the prevalence of depression in an internal medicine clinic in a rural area of Japan, which has a role in primary care, is unclear. METHOD: The prevalence of depression and comorbid psychiatric disorders among outpatients of an internal medicine clinic in a rural general hospital was measured by a structured interview using the Mini International Neuropsychiatric Interview. Outpatients were recruited consecutively and stratified by Patient Health Questionnaire-9 (PHQ-9) scores. Among 598 outpatients, we interviewed 75 randomly selected patients and 29 whose results of the PHQ-9 were positive. We estimated prevalence of depressive episode using age, sex, physical findings by internal medical doctors and PHQ-9 scores as covariates. RESULTS: The estimated prevalence of major and minor depressive episodes were 7.4% [95% confidence interval (CI): 3.4%-11.4%] and 6.8% (95% CI: 2.6%-10.9%), respectively. Among major depressed patients, 71.4% had current suicidal ideation. CONCLUSION: Given the high rate of depression and suicidality, identification of depression and collaboration between internal medical doctors in a rural area of Japan and mental health professionals are needed.

Validity of the Patient Health Questionnaire (PHQ)-9 and PHQ-2 in general internal medicine primary care at a Japanese rural hospital: a cross-sectional study.

OBJECTIVE: Two depression screening tools, Patient Health Questionnaire (PHQ)-9 and PHQ-2, have not had their validity examined in general internal medicine settings in Japan. We examined the validity of these screening tools. METHODS: A total of 598 outpatients of an internal medicine clinic in a rural general hospital were enrolled consecutively and stratified by PHQ-9 score. Seventy-five patients randomly selected and 29 patients whose results from the PHQ-9 were considered to be positive for depressive disorder were then interviewed with a semistructured interview, the Mini International Neuropsychiatric Interview. We calculated diagnostic accuracy of the PHQ-9 and PHQ-2 to detect major depression and that of the suicidality item of the PHQ-9 to detect suicidality using sampling weights with multiple imputations. RESULTS: Sensitivity and specificity for depression were 0.86 and 0.85, respectively, for the PHQ-9 with cutoff points of 4/5, and 0.77 and 0.95, respectively, for the PHQ-2 with cutoff points of 2/3. Sensitivity and specificity of the suicidality item of the PHQ-9 were 0.70 and 0.97, respectively. CONCLUSION: In internal medicine clinics in Japanese rural hospitals, the PHQ-2 with an optimal cutoff point for each setting plus the suicidality item of the PHQ-9 can be recommended to detect depression without missing suicidality.