In the present study, we aimed to identify multimorbidity patterns in a Japanese population and investigate whether these patterns have differing effects on polypharmacy and dosage frequency. Data was collected on 17 chronic health conditions via nationwide cross-sectional survey of 3,256 adult Japanese residents. Factor analysis was performed to identify multimorbidity patterns, and associations were determined with excessive polypharmacy [concurrent use of ≥ 10 prescription or over-the-counter (OTC) medications] and higher dosage frequency ( ≥ 3 doses per day). Secondary outcomes were the number of concurrent prescription medications and the number of concurrent OTC medications. We used a generalized linear model to adjust for individual sociodemographic characteristics. Five multimorbidity patterns were identified: cardiovascular/renal/metabolic, neuropsychiatric, skeletal/articular/digestive, respiratory/dermal, and malignant/digestive/urologic. Among these patterns, malignant/digestive/urologic and cardiovascular/renal/metabolic patterns showed the strongest associations with excessive polypharmacy and the number of concurrent OTC medications. Malignant/digestive/urologic, respiratory/dermal, and skeletal/articular/digestive patterns were also associated with higher dosage frequency. Multimorbidity patterns have differing effects on excessive polypharmacy and dosage frequency. Malignant/digestive/urologic pattern may be at higher risk of impaired medication safety and increased treatment burden, than other patterns. Continued study is warranted to determine how to incorporate multimorbidity patterns into risk assessments of polypharmacy and overall treatment burden.

Background. Tools for assessing quality of primary care from patient experience have never previously existed in Japan. Objective. The aim of this study was to develop the Japanese version of Primary Care Assessment Tool (JPCAT) and to examine the validity of this tool in the assessment of the quality of primary care from patient experience in Japan. Methods. We used a cross-sectional mail survey to test the validity and reliability of JPCAT. The questionnaire was sent to 1100 residents, 40–75 years of age, who were randomly selected from a basic resident register in Kita City, Tokyo, Japan. We examined internal consistency included Cronbach’s alpha, exploratory factor analysis, multi-trait analysis and correlation between overall user satisfaction scores and JPCAT total scores. Results. The tool was developed using responses from 204 residents, out of a total of 402 participants in the survey (50.7%), who had the usual sources of care. A 29-item JPCAT was constructed to include six multi-item subscales, representing each of the five primary care principles (first contact, longitudinality, comprehensiveness, coordination and community orientation). All of the multi-item scales achieved good internal consistency, item-total correlations and construct validity. The overall Cronbach’s alpha coefficient was 0.90. The Spearman correlation coefficient between the JPCAT total score and the overall user satisfaction was 0.58. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales except the longitudinality domain. Conclusions. We developed JPCAT and examined its validity and reliability in assessing the core principles of primary care in Japan. This tool could be used for health service research in primary care.

Advance care planning (ACP) is becoming increasingly important in the primary care setting because of its positive impact on the end-of-life care. We aimed to investigate the relationship between patient experience of primary care and ACP. This cross-sectional study was conducted in 28 primary care clinics in Japan. We assessed patient experience of primary care using a Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided) and community orientation. The primary outcome measures were ACP discussion between patients and primary care providers and completion of advance directives (AD). We used a generalized linear mixed model to adjust clustering within clinics and individual covariates. Data were analysed for 535 primary care patients. After adjustment for patients’ sociodemographic and health characteristics, the JPCAT total score was found to be significantly associated with ACP discussion [odds ratio (OR) per 1 SD increase = 4.33; 95% confidence interval (CI), 2.53–7.47] but not with completion of AD (OR per 1 SD increase = 1.42; 95% CI, 0.94–2.12). All domains of JPCAT, which represent attributes of primary care, had positive associations with ACP discussion. First contact and comprehensiveness (services provided) domain scores were significantly associated with completion of AD. We found that better patient experience of primary care was strongly associated with ACP discussion. Our findings reinforce the significance of patient experience in primary care as part of quality end-of-life care.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Primary care is regarded as a setting that potentially mitigate patient health literacy (HL) related inequalities. However, there is a lack of evidence about influence of patient HL on the patients’ perception of quality of primary care. We aimed to examine the association between HL and patient experience of primary care attributes. We conducted a cross-sectional survey, and sent questionnaires to adult residents who were randomly selected from a basic resident register in Yugawara Town, Kanagawa, Japan. We assessed HL using a 14-item Health Literacy Scale (HLS-14) and patient experience of primary care attributes using a Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a multivariable linear regression analyses to adjust individual covariates. Data were analyzed for 381 residents who had a usual source of care. After adjustment for patients’ sociodemographic and health characteristics, patient HL was positively associated with the JPCAT total score (B = 4.49, 95% confidence interval: 0.27 to 8.65 for HLS-14 total score highest quartile, compared with the lowest quartile). Among primary care attributes, HL had significant associations with longitudinality and comprehensiveness (service provided). We found that HL was positively associated with patient experience of primary care attributes in Japanese people. Our findings indicated that greater efforts might be needed to improve patient-centered and tailored primary care to those with low HL.

Background: This study explored whether psychosocial intervention applications (apps) are effective in preventing postpartum depression. Methods: We conducted an initial article search on 26 March 2020, and the updated search on 17 March 2023 on the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Scopus, PsycINFO, CINAHL, and ProQuest Dissertations & Theses A&I. Furthermore, we searched the International Clinical Trials Platform Search Portal (ICTRP), and Clinical Trials. Results: We identified 2515 references, and sixteen studies were ultimately included in this review. We conducted a meta-analysis of two studies on the onset of postpartum depression. There were no significant differences between the intervention and control groups (RR 0.80; 95% CI 0.62 to 1.04; P = 0.570). We performed a meta-analysis of the Edinburgh Postnatal Depression Scale (EPDS). The intervention group had significantly lower EPDS scores than the control group (mean difference -0.96; 95% CI -1.44 to -0.48; P < 0.001, I2 = 82%, Chi² = 62.75, P < 0.001; high heterogeneity). Conclusion: This study presents the results of current RCTs on interventions with apps, including an app with an automated psychosocial component for preventing postpartum depression that has been conducted. These apps improved the EPDS score; furthermore, they may prevent postpartum depression.