Patient satisfaction and loyalty in Japanese primary care: a cross-sectional study.

BACKGROUND: This study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty. METHODS: This cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman's correlation and structural equation modelling. RESULTS: Of 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness. CONCLUSIONS: While a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients' contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.

Height loss but not body composition is related to low back pain in community-dwelling elderlies: Shimane CoHRE study.

BACKGROUND: Low back pain (LBP) is a common complaint in the elderly Japanese population. Although previous studies showed that height loss was associated with LBP, it remains unclear whether LBP is associated with body composition. The objective of the present study was to investigate whether body composition and physical characteristics, including height loss, were associated with LBP. METHODS: The present study is retrospectively registered, and the participants were 2212 community-dwelling Japanese people aged over 60 years who participated in the Shimane CoHRE study in 2016. We investigated the presence of LBP, body composition parameters (muscle, fat, body weight, and bone mass), physical characteristics (body height and height loss), chronic diseases, history of fall, smoking, and drinking habits. We examined the relationships of body composition parameters and physical characteristics with point prevalence of LBP using multivariate logistic regression. RESULTS: The point prevalence of LBP was 43.2% in women and 39.5% in men. Logistic regression models showed that body height and body composition were not significantly associated with LBP; however, height loss was associated significantly with LBP in women and men (OR: 1.14, 95% CI: 1.08-1.20 and OR: 1.13, 95% CI: 1.06-1.21, respectively). Hypertension (OR: 1.32, 9 5% CI: 1.04-1.69) and chronic heart disease (OR: 1.57, 95% CI: 1.01-2.43) in women and history of fall (OR: 1.70, 95% CI: 1.13-2.56) and cerebrovascular disease (OR: 1.88, 95% CI: 1.05-3.34) in men were significantly associated with LBP. However, body composition was not associated with LBP in either gender. CONCLUSIONS: The present study demonstrated that height loss, but not body composition, was related to LBP in community-dwelling elderly people. To elucidate the cause of LBP, it is important to consider the relationship with height loss.

Development of the Japanese version of the general practice assessment questionnaire: measurement of patient experience and testing of data quality.

BACKGROUND: Physicians' interpersonal performance is critical in medical practice, especially primary care practice. The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of primary care from the viewpoint of patients. This questionnaire highlights the evaluation of interpersonal skills and interactions between physicians and patients. Though several other tools also exist to evaluate primary care quality, the GPAQ has several distinctive evaluation items, covering receptionists, access to primary care, and enablement (patients' understanding of self-care and of their own health after consultation). Our purpose was to develop and validate a Japanese version of the GPAQ. METHODS: This cross-sectional study tested the validity and reliability of the Japanese version of the questionnaire. We translated the original GPAQ into Japanese and assessed its reliability and validity among patients aged ≥20 years at five rural primary care centres located in Shimane and Okayama prefectures, Japan. We also examined its internal reliability using Cronbach's alpha coefficient and construct validity-including item-scale correlations, item-other scale correlations, and inter-scale correlations. Moreover, we examined correlations between each score and overall satisfaction using Spearman's correlation coefficient for criterion-related validity. RESULTS: The translated version of the GPAQ was administered, and we received 252 responses (mean age: 68 ± 12.3 years, male: 42.9%); all data were analysed. The translated questionnaire showed good reliability and validity, with Cronbach's alphas ranging from 0.79-0.92 for all scales, and satisfactory item-scale, item-other scale, and inter-scale correlations. Correlations with overall satisfaction were strong (Spearman's correlation coefficients: 0.31-0.38) for all scales except 'continuity of care'. CONCLUSIONS: The Japanese version of the GPAQ was acceptable, reliable, and valid. This could be a useful instrument to evaluate key areas of primary care performance in Japan, particularly physicians' communication skills. Further work is required to evaluate its utility in urban areas.

Accelerometer-measured physical activity and posture among older adults in assisted-living residences.

Objective: Few studies have detailed the physical activity and postural patterns (e.g. lying or sitting) in older adults with declining activities of daily living (ADL). Therefore, we aimed to address this issue by quantifying physical activity using an accelerometer and measuring time spent in various postures among older adults in assisted-living residences. Methods: We quantified physical activity using an accelerometer (ActivPAL) and measured time spent in various postures in 35 older adults (mean age: 89.1 years) with chronic conditions residing in two assisted-living residences in Japan. ActivPAL was attached to the thigh and trunk of patients to distinguish between sitting and lying postures. Results: Participants had a mean count of 6.2 comorbidities, and they were divided into three groups (fully independent, requiring minimal assistance and requiring care) based on their activities of daily living capacity using the Barthel Index. Residents aged ⩾90 years walked a mean of 1109.1 steps and spent 167.3 min upright per day. Fully independent participants walked a mean of 3587.6 steps daily; those requiring minimal assistance walked 1681.0 steps daily; and those requiring care walked 428.9 steps daily. Conclusions: Our findings indicated that step count, number of sit-to-stand transitions, stepping time, and upright time decreased significantly as activities of daily living capacity decreased. Comorbidity type and number of comorbidities were not related to their lying time except for depression status. Lying time was associated with depression status.

Testing hypothetical bias in a choice experiment: An application to the value of the carbon footprint of mandarin oranges.

This study investigates "hypothetical bias," defined as the difference in the willingness to pay for a product attribute between hypothetical and non-hypothetical conditions in a choice experiment, for the carbon footprint of mandarin oranges in Japan. We conducted the following four treatments: a non-hypothetical lab economic experiment, a hypothetical lab survey, a hypothetical online survey, and a hypothetical online survey with cheap-talk. Each treatment asked participants to choose one of three oranges based on price and carbon emissions level. Next, participants were asked to answer questions on demographics and the following three kinds of environmental factors: environmental consciousness, purchasing behavior for goods with eco-labels, and daily environmental behavior. Using the random parameter logit model, the willingness to pay per 1g of carbon emission reduction were 0.53 JPY, 0.52 JPY, 0.54 JPY, and 0.58 JPY in the non-hypothetical lab economic experiment, hypothetical lab survey, hypothetical online survey and hypothetical online survey with cheap-talk, respectively. The complete combinatorial test of the willingness to pay for carbon emission reductions indicates no hypothetical bias between any treatment combinations. Our findings reveal that environmental attributes for food are less likely to show hypothetical bias than other goods. The results of the main effect with an interaction term show that environmental consciousness reduces the coefficients of carbon emissions in all treatments. Therefore, a psychological scale is useful for showing whether hypothetical bias emerges with treatment or participants' personal backgrounds.

Effect of disclosing the relation between effort and unit reliability on system reliability: An economic experiment.

The purpose is to experimentally examine the effect of disclosing the risk probability of each unit in a production system on human behavior and the resulting system reliability. We used an economic experiment based on the theoretical model of Hausken (2002) to evaluate the effect of disclosing the relation between effort and unit reliability. We conducted first the non-disclosed-risk experiment and then the disclosed-risk experiment within subjects in both series and parallel systems. Our experimental results show that disclosing the relation between effort and unit reliability has two positive effects. First, subjects succeeded in improving the system reliability while cutting back on efforts to reduce the risk of their units when the risk probability was disclosed. In each system, the disclosed-risk condition achieves significantly higher system reliability on average than does the non-disclosed-risk condition, although the average level of effort is significantly lower under the disclosed-risk condition than under the non-disclosed-risk condition. Second, disclosing the risk probability simplified the subjects' decision-making process and reduced its cost because subjects made their decisions on the amount of effort to exert based only on the risk probability information without considering other factors, such as the number of accidents.

An association analysis between hypertension, dementia, and depression and the phases of pre-sarcopenia to sarcopenia: A cross-sectional analysis.

Sarcopenia is intricately related to aging associated diseases, such as neuropsychiatric disorders, oral status, and chronic diseases. Dementia and depression are interconnected and also related to sarcopenia. The preliminary shift from robust to sarcopenia (i.e., pre-sarcopenia) is an important albeit underdiscussed stage and is the focus of this study. Identifying factors associated with pre-sarcopenia may lead to sarcopenia prevention. To separately examine the effects of dementia and depression on pre-sarcopenia/sarcopenia, we conducted multiple analyses. This cross-sectional study used health checkup data from a rural Japanese island. The participants were aged 60 years and above, and the data included muscle mass, gait speed, handgrip strength, oral status (teeth and denture), chronic diseases (e.g., hypertension), dementia (cognitive assessment for dementia, iPad Version), and depression (self-rating depression scale). A total of 753 older adult participants were divided into the sarcopenia (n = 30), pre-sarcopenia (n = 125), and robust (n = 598) groups. An ordered logit regression analysis indicated that age and depression were positively correlated with sarcopenia, while hypertension was negatively associated with it. A multiple logistic regression analysis between the robust and pre-sarcopenia groups showed significant associations between the same three variables. Depression was associated with pre-sarcopenia, but not dementia. There was also a significant association between hypertension and pre-sarcopenia. Further research is needed to reveal whether the management of these factors can prevent sarcopenia.

Effect of geographic accessibility to primary care on treatment status of hypertension.

Although primary care access is known to be an important factor when seeking care, its effect on individual health risk has not been evaluated by an appropriate spatial measure. This study examined whether geographic accessibility to primary care assessed by a sophisticated form of spatial measure is associated with a risk of hypertension and its treatment status among Japanese people in rural areas, where primary care is not yet established as specialization. We used an enhanced two-step floating catchment area method to calculate the neighborhood residential unit-level primary and secondary care accessibility for 52,029 subjects who participated in the 2015 annual health checkup held at 15 cities in Shimane Prefecture. Their hypertension level and treatment status were examined cross-sectionally with their neighborhood primary care and secondary care accessibility (computed with two separate distance-decay weight: slow and quick) by multivariable logistic regression controlling for demographics and neighborhood income level. The findings showed that greater geographic accessibility to primary care was associated with a decreased risk of hypertension in both slow and quick distance-decay weight, odds ratio (OR) = 0.989 (95% Confidence Interval (CI) = 0.984, 0.994), OR = 0.989 (95%CI = 0.984, 0.993), respectively. On the other hand, better secondary care accessibility was associated with an increased risk of hypertension and untreated hypertension; however, the effect of secondary care was mitigated by the effect of primary care accessibility in both slow and quick distance-decay model, hypertension: OR = 0.974 (95% CI = 0.957, 0.991), OR = 0.981 (95%CI = 0.970, 0.991), untreated hypertension: OR = 0.970 (95%CI = 0.944, 0.996), OR = 0.975 (95%CI = 0.959, 0.991), respectively. In addition, the results revealed that young and fit people were at a higher risk of untreated hypertension, which is a unique finding in the context of the Japanese healthcare system. Our findings indicate the importance of primary care even in Japan, where it is not yet established, and also emphasize the need for a culturally specific perspective in health equity.