Schuster Richard J, Zhu Ye, Ogunmoroti Oluseye, Terwoord Nancy, Ellison Sylvia, Fujiyoshi Akira, Ueshima Hirotsugu, Muira Katsuyuki
University of North Carolina, Chapel Hill, USA.
Qual Prim Care. 2013;21(1):51-60.
There is a 42% lower cardiovascular disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in practice management of CVD risk factors in the two countries that might contribute to this difference?
CVD risk factor management reported by Japanese versus US primary care physicians was studied.
We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey.
The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use practice guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001).
Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing CVD risk factors deserves study. This descriptive report poses questions that require a more definitive study either with a more representative sample or direct observation of physician practices. US physicians responding to the survey reported greater administrative efforts, frustration and disparities in their practice, yet they followed practice guidelines more carefully. Japanese physicians responding reported focusing on quick, frequent visits that may have been more medication oriented, expecting more patient responsibility in self-care, which may have resulted in better chronic disease management. There may be differences in CVD risk factor management by primary care physicians in Japan versus the USA.
与美国相比，日本的心血管疾病（CVD）死亡率低42%。两国医生在CVD危险因素的实际管理方面是否存在差异，这些差异是否可能导致了这种死亡率的不同？
研究日本与美国基层医疗医生报告的CVD危险因素管理情况。
我们进行了一项描述性研究。对来自每个国家的医生开展了一项基于互联网的调查。从日本滋贺县和美国俄亥俄州抽取的便利样本中，分别有48名日本医生和53名美国医生完成了调查。
调查样本可能不具有更大样本的代表性。调查显示，98%的受访日本医生看诊患者的时间少于10分钟，而76%的美国医生看诊时间为10至20分钟（P<0.0001）用于管理CVD危险因素。87%的日本医生（相比之下美国医生为32%）在三个月内对患者进行随访（P<0.0001）。61%的日本医生将少于30%的看诊时间用于患者教育，而60%的美国医生将超过30%的看诊时间用于患者教育（P<0.0001）。与75%每1至6个月更新一次药物的美国医生相比，日本医生更频繁地更新处方（83%更新时间间隔少于每月）（P<0.0001）。只有20%的日本医生常规使用实践指南，而美国医生这一比例为50%（P=0.0413）。美国医生更频繁地报告医疗差异（P<0.0001）。43%的日本医生（相比之下美国医生为10%）认为他们在行医时有相对的自由（P<0.0001）。
毫无疑问，许多因素在不同国家影响着心血管疾病。主要因素包括健康的社会决定因素、遗传学、公共卫生和整体文化（这些因素反过来又决定饮食、运动和其他因素）。然而，医疗保健系统是社会的一个昂贵组成部分，其在管理CVD危险因素方面的作用值得研究。这份描述性报告提出了一些问题，这些问题需要通过更具代表性的样本或对医生实践的直接观察进行更明确的研究。参与调查的美国医生报告称在他们的实践中行政工作更多、更沮丧且差异更大，但他们更严格地遵循实践指南。参与调查的日本医生报告称注重快速、频繁的看诊，可能更侧重于药物治疗，期望患者在自我护理方面承担更多责任，这可能导致更好的慢性病管理。日本和美国基层医疗医生在CVD危险因素管理方面可能存在差异。
