Musashikoganei Clinic, Japanese Health and Welfare Co-operative Federation, 1-15-9, Honcho, Koganei-shi, Tokyo, 184-0004, Japan.
Division of Clinical Epidemiology, Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
BMC Fam Pract. 2017 Sep 13;18(1):87. doi: 10.1186/s12875-017-0658-5.
The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system.
We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density.
We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems.
This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan need to be able to deal with "non-internal-medicine-related" RFEs and health problems, and that curriculum including practical non-internal medicine-related training is likely to be important.
日本的医疗体系尚未为基层医疗医生建立结构化的培训体系；因此，接受过内科为基础的培训项目的医生继续在基层医疗环境中发挥主要作用。为了促进更高效的初级卫生保健系统的发展，评估其当前在患者就诊原因（RFE）和健康问题范围内的状况是重要的一步。认识到内科医生通常不涵盖的患者 RFE 和健康问题的比例，可以提供有价值的信息，以促进以基层医疗医生为中心的系统的发展。
我们进行了一项系统评价，在这项研究中，我们在 2015 年 3 月之前，通过国际初级保健疾病分类（ICHPPC）和初级保健分类（ICPC）对日本的观察性研究进行了系统检索，这些研究被编码为六个数据库（PubMed、Cochrane 图书馆、Google Scholar、Ichushi-Web、JDreamIII 和 CiNii）。我们使用人口密度作为可达性指标。考虑到人口密度，我们计算了斯皮尔曼等级相关系数，以检验每个研究区域中“非内科相关”RFE 和健康问题的比例之间的相关性。
我们发现了 17 项具有不同设计和背景的研究。在这些研究中，认为内科医生不涵盖的“非内科相关”RFE 比例从 4%到 40%不等。此外，“非内科相关”健康问题的比例从 10%到 40%不等。然而，人口密度与“非内科相关”RFE 和健康问题的比例之间没有发现显著的相关性。
这是首次对采用 ICHPPC 和 ICPC 编码的 RFE 和健康问题进行的系统评价，旨在揭示日本基层医疗保健中健康问题的多样性。这些结果表明，日本一些农村地区的基层医疗医生需要能够处理“非内科相关”的 RFE 和健康问题，并且可能需要包括实用的非内科相关培训的课程。
