[Community healthcare activities of physicians in public medical facilities and their evaluation by municipalities].

OBJECTIVES

In order to practice appropriate community healthcare activities, it is essential for healthcare providers to integrate medical, public health, and welfare systems into one comprehensive healthcare body. In Japan, local governments are obliged to provide their entire population with public health and welfare services And physicians who work as government employees at public medical facilities play an important role in combining the three systems. It has been reported that the level of subjective evaluation by the municipality of the degree of involvement by physicians in the region's public health activities and welfare services is associated with the standardized mortality rates for strokes in the area's population. However, little is known about which specific public health and welfare services are more important as factors contributing to the level of evaluation of physicians by the people or municipality. The present study was therefore conducted to determine associations between levels of participation by community physicians in each specific public health or welfare service and the respective levels of evaluation by their municipalities.

METHODS

A cross-sectional study design using a self-reported postal questionnaire survey was conducted with all 3,152 local governments in Japan from July to September, 2000. A total of 3,059 local governments (94%) responded, and 1,315 (42%) that operated a public medical facility were analyzed. The aspects from which local governments evaluated the physicians working for their public medical facilities were: the frequency of involvement in each of 13 services related to public health and welfare; the degree of satisfaction of governments with the physicians' involvement in each of the services; and the relationship between the physicians and the municipal healthcare officials.

RESULTS

The services in which the local governments responded that they 'always' appreciated the physicians involved was significantly associated with the degree of municipal satisfaction. In the multiple logistic regression analysis, the degree of municipal satisfaction was significantly associated with their perception of consistent involvement by the physicians in case conferences on homecare management, health counseling, health education, life style instruction after basic health screening (odds ratio > 2.0 respectively), and school healthcare, vaccination, school health screening, and basic health screening (0 < odds ratio < 1.5 respectively). There was no significant difference in the level of satisfaction between large and small municipalities.

CONCLUSIONS

The findings showed that high levels of municipal appreciation of consistent participation by physicians in certain public health and welfare services is associated with a higher degree of local government satisfaction with the physicians. It is noteworthy that services found to be highly associated with municipal satisfaction were concerned with individual affairs or education, and with activities that do not entail any legal obligation.