Aoki Takuya, Miyashita Jun, Yamamoto Yosuke, Ikenoue Tatsuyoshi, Kise Morito, Fujinuma Yasuki, Fukuma Shingo, Kimachi Miho, Shimizu Sayaka, Fukuhara Shunichi
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
Fam Pract. 2017 Apr 1;34(2):206-212. doi: 10.1093/fampra/cmw126.
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.
由于预先照护计划（ACP）对临终关怀有积极影响，其在初级保健环境中变得越来越重要。
我们旨在调查初级保健患者体验与ACP之间的关系。
这项横断面研究在日本的28家初级保健诊所进行。我们使用初级保健评估工具日语版（JPCAT）评估初级保健的患者体验，该工具包括六个领域：首次接触、连续性、协调性、全面性（可用服务）、全面性（提供的服务）和社区导向。主要结局指标是患者与初级保健提供者之间的ACP讨论以及预先指示（AD）的完成情况。我们使用广义线性混合模型来调整诊所内的聚类和个体协变量。
对535名初级保健患者的数据进行了分析。在对患者的社会人口统计学和健康特征进行调整后，发现JPCAT总分与ACP讨论显著相关[每增加1个标准差的优势比（OR）= 4.33；95%置信区间（CI），2.53 - 7.47]，但与AD的完成情况无关（每增加1个标准差的OR = 1.42；95% CI，0.94 - 2.12）。代表初级保健属性的JPCAT的所有领域与ACP讨论均呈正相关。首次接触和全面性（提供的服务）领域得分与AD的完成情况显著相关。
我们发现更好的初级保健患者体验与ACP讨论密切相关。我们的研究结果强化了患者体验在初级保健中作为优质临终关怀一部分的重要性。
