Background
Primary care in urban and rural areas
Japanese setting
Methods
Research design
Participants
Data collection
Data analysis
Results
ID | Gender | PGY/ Age | Medical specialty | Present work place | Urban area of workplace (population number/density) Prefecture name, workplace and years | Rural area of workplace (population number/density) Prefecture name, workplace and years |
---|---|---|---|---|---|---|
1 | Male | 15/ 40 | FP | rural CL | Central City (> 200,000/ > 5000) Hokkaido, Sapporo City, MC, 5 y | Municipal Village (~ 3000/ ~ 20) Hokkaido, CL, 11y |
2 | Female | 7/ 31 | FP | urban CL | Central City (> 900,000/ > 15,000) Tokyo, Setagaya Ward, CL, 6y | Municipal City (~ 60,000/ ~ 2000) Saitama, LH, 1y |
3 | Female | 10/ 34 | FP | rural CL | Central City (> 2,500,000/ > 10,000) Osaka, Osaka, CL, 2y | Municipal City (~ 40,000/ ~ 400) Chiba, CL, 6y |
4 | Female | 7/ 34 | FP | urban CL | Central City (> 1000,000/ > 15,000) Tokyo, Taito Ward, CL, 1y | Island (~ 1000/ ~ 100) Okinawa, CL, 6y |
5 | Male | 8/ 32 | FP | urban CL | Surrounding area (> 100,000/ > 10,000) Tokyo, Koganei City, 2y | Island (~ 1000/ ~ 50) Okinawa, CL, 6y |
6 | Female | 10/ 34 | FP | urban CL | Central City (> 1000,000/ > 10,000) Tokyo, Adachi Ward, CL, 4y | Municipal Town (~ 5000/ ~ 6000) Saitama, CL, 6y |
7 | Male | 9/ 33 | DPC | rural CL | Surrounding area (> 700,000/ > 7000) Osaka, Sakai City, MC, 5y | Island (~ 9000/ ~ 30) Kagoshima, CL, 4y |
8 | Male | 10/ 34 | FP | urban LH | Central City (> 500,000/ > 15,000) Tokyo, Suginami Ward, LH, 7y | Municipal City (~ 40,000/ ~ 400) Chiba, CL, 3y |
9 | Female | 9/ 33 | FP | urban LH | Central City (> 300,000/ > 15,000) Tokyo, Kita Ward, LH, 3y | Municipal City (~ 20,000/ ~ 70) Kochi, LH, 6y |
10 | Female | 8/ 32 | FP | urban LH | Central City (> 300,000/ > 15,000) Tokyo, Kita Ward, LH, 3y | Municipal City (~ 40,000/ ~ 500) Shizuoka, CL, 5y |
Category | Concepts |
---|---|
Competency of general practitioners in urban areas | • Demonstration of comprehensive care ability depending on conditions • Integration of fragmented care in urban areas • Active involvement in patients who received fragmented care • Comprehensive care for minority group, a characteristic of each region of urban areas • Understanding various occupations/lifestyles in urban areas • Formation of agreements with patients with various values in urban areas • Judgment for appropriate hospital introduction according to the patient situation • Efforts for regional collaboration on emergency medicine issues in urban areas • Collaboration with various medical care and welfare personnel • Communication with nonresident family members |
Context of general practitioners in urban areas | • Relatively narrow scope of biomedical care • Patients’ selective care-receiving behavior in urban areas • Segmented healthcare services in urban areas • Unclear responsibility regarding care • Confusion about what being a general practitioner in urban areas means • Diversity of socioeconomic regional characteristics in an urban area • Various occupations/lifestyles in urban areas • Relatively high healthcare needs in urban areas • Sense of difficulties in understanding different medical resources • Quality differences in medical care among physicians/hospitals in urban areas • Emergency medicine issues in urban areas • Difficulties in comprehensive local community care • Diversity of local medical care and welfare professionals • Lack of face-to-face relationships in medical care and welfare collaboration in urban areas • Lack of mutual help function around patients in urban areas • Long physical/psychological distance between workplaces and homes • Lack of visibility of families and affiliated communities |
Competency of general practitioners in non-urban areas | • Broad biomedical care scope • Responsibility of doctors as limited medical resources • Judgment to make effective use of limited medical resources • Care collaborating with local communities • Ability to build appropriate human relationships with residents |
Context of general practitioners in non-urban areas | • Clarity of responsibility of care • Ease of maintaining interpersonal continuity • Ease of acquiring identity as a family physician in non-urban areas • Regional differences in medical care-receiving behaviors in non-urban areas • Limited medical resources • A sense of understanding medical care skills of surrounding medical institutions and individual physicians • Face-to-face relationships in healthcare collaboration • Ease of grasping local communities • Face-to-face relationships in medical care and welfare cooperation • Physical/psychological proximity between workplaces and homes • High visibility of patient/family background |
Common competency of general practitioners in urban/non-urban areas | • Biomedical care ability • Comprehensiveness of medical care according to place and situation of medicine • Medical care for patients with multiple diseases • Healthcare workers as support roles in each patient’s life • Necessity of decision-making based on patient background • Connection role in community healthcare • Division of labor/collaboration with subspecialists in hospitals • Creation of social resource networks for community care • Familiar advisors |
Demonstration of comprehensive care ability depending on conditions
“Patient goes to a lot of hospitals, for example, to an orthopedics for osteoporosis, to this clinic for hypertension, and go to a otolaryngology for colds.” (ID5, male, 8PGY)
“I can do joint injections, but I am not an orthopedic specialist and some patients do not want to receive joint injections here…. I think it might be good to divide labor whenever possible.” (ID5, male, 8PGY)
“There are many patients I cannot refer (to another physician)… so whoever comes, you need to have some degree of curiosity toward patients. It would not be possible for me to say that this is not my expertize…” (ID6, female, 10PGY)
Active involvement in patients who received fragmented care
“I guess there are a lot of people visiting multiple hospitals. If something wrong with them, they may call an ambulance. At that time, there is no one who takes final responsibility for the health of that person. In other words, I feel that responsibility is quite unclear.” (ID5, male, 8PGY)
“Primary care doctors responsible for the overall picture are certainly necessary. Especially for the elderly…if they are treated for a health problem outside the specialty of the current attending physician or for a health problem that has no medical name, no one is responsible and care managers often have difficulties.” (ID 8, male, 10 PGY)
Integration of divided care in urban areas
“There are various hospitals, and a patient may visit, for example, five hospitals per week for different treatments, but he is tired and does not want to go anymore to a hospital. For such patients, I kindly suggest ‘if you are visiting too many hospitals, you can cut about two of them and receive the treatments here.’” (ID5, male, 8PGY)
Comprehensive care for minority group, a characteristic of each region of urban areas
“… I think that it is certainly necessary to have the ability to respond flexibly to what people are seeking.” (ID2, female, PGY7)
“There are quite a few people who raise children in an isolated manner because the father, mother, and grandparents are far away or because they are foreigners and are not fluent in Japanese. Many moms cannot make “Mama-tomo (mother friends),” so it may become necessary to spend some time talking with such people during an infant health checkup or the like.” (ID6, female, 10PGY)
Judgment for appropriate hospital introduction according to the patient situation
“There are too many hospitals, and I do not know where (hospital) is the best (for some disease). Then, I feel that I cannot build a face-to-face relationship.” (ID8, male, PGY10)
“There are plenty of hospitals in the area, so I can refer a patient anywhere, but I may have more trouble if I introduce a patient to the wrong hospital. Honestly, if I had more face-to-face relationships with other medical personnel, I would not question as much whether more specialized physicians, or actually a certain physician, or hospital would be better.” (ID6, female, 10PGY)
Collaboration with various medical care and welfare personnel
“I think it may be even harder to demonstrate leadership in community collaboration if I go to an urban area… I think cooperation is unmanageable or hard to achieve… I think it is more difficult in urban areas. Even with the same effort, a higher level (of management) might be required.” (ID1, male, 15PGY)