对多个医疗服务提供者不协调参与的定义和评估;"多医生 "是多病症患者护理分散的一个组成部分

IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL
Yuki Ohnishi MD, Satoshi Watanuki MD
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引用次数: 0

摘要

我们饶有兴趣地阅读了 T Ando 等人的文章,并对作者努力评估多个医疗服务提供者不协调参与的影响表示赞赏:"多医生 "的影响。1 不过,我们想指出两点值得关注的问题。首先,这项研究中的一个重要问题是,使用 "多医生 "的定义(仅指有两个或两个以上定期就诊的医疗机构)并不能恰当地评估日本的现状。当今日本的老年人可能不可避免地要去两家以上的多家医疗机构就诊。历史上,器官专科医生在日本的初级医疗机构中发挥了重要作用,目前我们仍有约 10 万家由器官专科医生管理的初级诊所。日本初级保健协会(JPCA)从 2017 年开始启动了一项培训计划,旨在培养医生成为全科医师/家庭医生专家。2 虽然日本初级保健协会希望这些医生能够解决更广泛的常见问题,如眼部问题和骨质疏松症,以及常见的内科疾病,3 但不可避免地会面临暂时缺乏完成正规课程的真正初级保健医生的问题。因此,在日本,如果老年人同时患有慢性病,而这些慢性病又超出了初级保健医生的诊治范围,那么他们就必须去多家诊所就诊。虽然日本的初级保健系统仍在发展之中,但由于国民健康保险制度的普及,老年人可以到多家医疗机构就诊,享受健康公平。毫无疑问,1961 年建立的全民健康保险制度支持了日本医疗设施和服务的自由使用。4 在重新定义多科医生时,考虑就诊的医疗专科可能会更有效。此外,样本的选择也有问题,作者只从独立居住的人群中选取了一些人。从研究结果来看,如果这项调查将患有多种疾病的居家老年患者包括在内,他们接受多药治疗的机会就会减少。一些老人由于体力下降,难以到门诊就医,因此过渡到家庭医疗护理,在家庭医疗护理中,他们的护理应该得到加强。5 不恰当的处方似乎并不总是与护理分散相关。因此,我们认为,由于定义和样本选择的原因,本研究无法准确评估护理分散对患者预后的影响。要想了解多病患者的护理质量和效率,还需要进一步的研究。我们希望,通过解决医疗碎片化问题,日本的初级医疗能得到更大的改善。作者声明本文无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The definition and evaluation of uncoordinated involvement of multiple healthcare providers; “Polydoctoring” as a component of care fragmentation among patients which multimorbidity

We read with great interest the article by T Ando et al, and appreciate the authors' efforts to assess the influence of the uncoordinated involvement of multiple healthcare providers: “polydoctoring.” The analysis highlights that the involvement of multiple healthcare facilities in patient care is correlated with a higher likelihood of polypharmacy and increased outpatient medical costs.1 However, we would like to point out two concerns.

First, a significant issue in this study was that using the definition of “polydoctoring,” which refers only to having two or more regularly visited facilities, cannot appropriately evaluate the current situation in Japan. It might be unavoidable for today's elderly individuals in Japan to visit multiple medical institutions more than two. Historically, organ specialists played an important role in primary care settings in Japan, and we still have approximately 100,000 primary clinics run by organ specialists. The Japan Primary Care Association (JPCA) has started a training program to qualify doctors as General Practitioner/Family Physician specialists since 2017.2 Although JPCA expects these doctors to address a wider variety of common problems such as eye problems and osteoporosis, as well as common medical conditions,3 it is inevitable to face a transient lack of genuine primary care physicians who have completed a proper program. Therefore, in Japan, visiting multiple clinics is necessary for elderly people with coexisting chronic conditions that are beyond the scope of the primary care physicians they see. While the primary care system in Japan is still in development, thanks to universal access under the national health insurance system, elderly individuals can visit multiple medical facilities and enjoy health equity. There is no doubt that the establishment of the universal health insurance scheme in 1961 supports freedom to access medical facilities and services in Japan.4 It might be effective to consider the medical specialties visited when renewing the definition of polydoctoring.

In addition, the sample selection was problematic. The authors enrolled individuals only from an independent-dwelling subset. Given the study result, if this survey were to include homebound elderly patients with multimorbidity, they would have fewer chances of receiving polypharmacy. Some elderly individuals, experiencing a decline in physical strength that makes it difficult to visit outpatient clinics, transition to home medical care, where their care should be consolidated. However, it was reported that the prevalence of inappropriate polypharmacy was 70% among older adults receiving home medical care.5 Inappropriate prescriptions do not always appear to be associated with care fragmentation.

Accordingly, we suggest that this study cannot accurately evaluate the impact of care fragmentation on patient outcomes because of the definition and sample selection. To understand the quality and efficiency of care for patients with multimorbidity, further research is required. We hope that by addressing the fragmentation of care, primary care in Japan will be improved more.

The authors declare no conflict of interests for this article.

The letter has been approved by the authors' institutional review board or equivalent committee.

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来源期刊
Journal of General and Family Medicine
Journal of General and Family Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.10
自引率
6.20%
发文量
79
审稿时长
48 weeks
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