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Research ArticleOriginal Research

Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan

Takuya Aoki, Yoshifumi Sugiyama, Rieko Mutai and Masato Matsushima
The Annals of Family Medicine January 2023, 21 (1) 27-32; DOI: https://doi.org/10.1370/afm.2894
Takuya Aoki
1Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
2Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
MD, PhD, MMA
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  • For correspondence: taoki@jikei.ac.jp
Yoshifumi Sugiyama
1Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
3Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Tokyo, Japan
MD, PhD
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Rieko Mutai
4Department of Adult Nursing, The Jikei University School of Nursing, Tokyo, Japan
RN, MSN, PhD
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Masato Matsushima
1Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
MD, PhD, MPH
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    Figure 1.

    Participant flowchart.

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    Figure 2.

    Association between the overall measure of primary care attributes and hospitalization.

    EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool; Q = quartile.

    Notes: Association assessed by the JPCAT total score. Adjusted for age, sex, educational level, number of chronic conditions, and EQ-5D-5L. Error bars indicate 95% CIs. JPCAT total score quartiles: Q1, 0.0-35.4; Q2, 35.4-47.9; Q3, 47.9-60.4; Q4, 60.4-100.0.

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    Table 1.

    Participant Characteristics at Baseline

    CharacteristicTotal
    (N = 1,161)
    Non-Hospitalized
    (n = 1,074)
    Hospitalized
    (n = 87)
    Lost to Follow-Up
    (n = 101)
    Age, mean (SD), y
    Sex, No. (%)
         57.8 (10.3)     57.5 (10.2)62.4 (9.9)     53.6 (10.2)
       Male566 (48.8)514 (47.9)52 (59.8)49 (48.5)
    Educational level, No. (%)
       Bachelor’s degree or higher528 (45.5)492 (45.8)36 (41.4)38 (37.6)
       Data missing24 (2.1)23 (2.1)1 (1.1)5 (5.0)
    Number of chronic conditions, mean (SD)    1.2 (1.3)    1.2 (1.3)    1.9 (1.6)    1.0 (1.1)
       Data missing, No. (%)36 (3.1)33 (3.1)3 (3.4)10 (9.9)
    EQ-5D-5L, mean (SD)         0.89 (0.08)         0.89 (0.08)         0.83 (0.14)         0.88 (0.10)
       Data missing, No. (%)    5 (0.4)    4 (0.4)    1 (1.1)    0 (0.0)
    Usual source of care, No. (%)
       Yes723 (62.3)671 (62.5)52 (59.8)57 (56.4)
    JPCAT scores, mean (SD)a
    Total score
    Domain scores
    47.5 (17.0)47.6 (16.9)45.5 (17.8)45.2 (19.5)
       First contact34.3 (26.3)34.3 (26.4)33.4 (25.9)29.6 (27.2)
       Longitudinality57.0 (25.2)57.2 (25.1)54.6 (26.5)52.9 (29.9)
       Coordination56.1 (30.6)56.2 (30.3)54.9 (34.3)52.0 (34.6)
       Comprehensiveness (services available)51.1 (26.3)51.1 (26.3)50.5 (26.0)51.8 (30.7)
       Comprehensiveness (services provided)36.3 (32.0)36.6 (32.3)31.6 (26.4)32.0 (30.9)
       Community orientation50.1 (19.7)50.2 (19.8)48.8 (18.9)52.9 (20.0)
    • EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool.

    • ↵a Participants who have usual source of care.

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    Table 2.

    Hospitalization by JPCAT Domain Scoresa (N = 1,161)

    JPCAT scoresJPCAT Domains, aOR (95% CI)
    First ContactLongitudinalityCoordinationComprehensiveness (Services Available)Comprehensiveness (Services Provided)Community Orientation
    No usual source of carerefrefrefrefrefref
    Q10.64 (0.30-1.36)0.97 (0.46-2.02)0.62 (0.30-1.28)0.68 (0.34-1.35)0.40 (0.19-0.84)b0.45 (0.21-0.99)b
    Q20.44 (0.09-2.23)0.34 (0.16-0.73)b0.49 (0.25-0.94)b0.17 (0.03-0.89)b0.80 (0.26-2.49)0.39 (0.11-1.40)
    Q30.47 (0.24-0.90)b0.60 (0.26-1.38)0.36 (0.14-0.95)b0.55 (0.30-1.03)0.70 (0.39-1.26)0.65 (0.36-1.18)
    Q40.49 (0.26-0.93)b0.42 (0.22-0.82)b0.45 (0.22-0.92)b0.47 (0.23-0.97)b0.24 (0.10-0.56)b0.32 (0.15-0.68)b
    • aOR = adjusted odds ratio; EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool; Q = quartile.

    • Notes: First contact score quartiles: Q1, 0.0-12.5; Q2, 12.5-25.0; Q3, 25.0-50.0; Q4, 50.0-100.0.

    • Longitudinality score quartiles: Q1, 0.0-37.5; Q2, 37.5-62.5; Q3, 62.5-75.0; Q4, 75.0-100.0.

    • Coordination score quartiles: Q1, 0.0-50.0; Q2, 50.0; Q3, 50.0-87.5; Q4, 87.5-100.0.

    • Comprehensiveness (services available) score quartiles: Q1, 0.0-37.5; Q2, 37.5-50.0; Q3, 50.0-75.0; Q4, 75.0-100.0.

    • Comprehensiveness (services provided) score quartiles: Q1, 0.0; Q2, 0.0-25.0; Q3, 25.0-62.5; Q4, 62.5-100.0.

    • Community orientation score quartiles: Q1, 0.0-37.5; Q2, 37.5-50.0; Q3, 50.0-62.5; Q4, 62.5-100.0.

    • ↵a Adjusted for age, sex, educational level, number of chronic conditions, and EQ-5D-5L.

    • ↵b Significant difference, P <.05

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Annals of Family Medicine: 21 (1)
Annals of Family Medicine: 21 (1)
Vol. 21, Issue 1
January/February 2023
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Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
Takuya Aoki, Yoshifumi Sugiyama, Rieko Mutai, Masato Matsushima
The Annals of Family Medicine Jan 2023, 21 (1) 27-32; DOI: 10.1370/afm.2894

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Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan
Takuya Aoki, Yoshifumi Sugiyama, Rieko Mutai, Masato Matsushima
The Annals of Family Medicine Jan 2023, 21 (1) 27-32; DOI: 10.1370/afm.2894
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Subjects

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