ABSTRACT
<b>Introduction</b>: Patient-centric treatment is important in primary care, and one of the characteristics of this type of care is shared decision making (SDM) on treatment options between the patient and the doctor. However, no study has examined the circumstances of SDM practice in primary care in Japan. In this study, we investigated the proportion of doctors who practice SDM and examined their characteristics.<br><b>Methods</b>: In 2014, we sent a postal survey to one doctor in each of the internal medicine clinics in 10 wards and 2 cities within the Tokyo Metropolitan Area. We evaluated the decision-making methods for treatment using a five-point scale (paternalism, close to paternalism, informed consent, SDM, informed decision making), and evaluated the doctors'background and patient interviews.<br><b>Results</b>: Informed consent was the most frequently used decision-making method for treatment (40.8 %), and 14.6% of the doctors opted for SDM. Most of these doctors were in their 50s, and had spent the longest period of their working life in clinics. These doctors also had a tendency to select items that encouraged spontaneous remarks of the patients.<br><b>Conclusion</b>: The findings of the present study suggest that the practice of SDM, which is an important factor in patient-centric medicine in primary care, is not very prevalent at present.
ABSTRACT
<b>Introduction</b>: The rising poverty rate has spurred concerns regarding income-related disparities in medical-care utilization. This study attempted to investigate physicians'recognition of patients'refraining from medical care for financial reasons and the characteristics of physicians who made efforts to improve such situations.<br><b>Methods</b>: A mail survey was conducted between July 1 and September 30, 2014. All internal medicine clinics (n=1989) in 12 municipalities in Tokyo were included. One physician from each clinic was requested to answer the 60-item questionnaire.<br><b>Results</b>: Of the 617 questionnaires returned (response rate 31 %), 550 (454 male physicians) complete responses were analyzed. About 90% of physicians recognized that patients refrained from seeking medical care for financial reasons, and used various methods to encourage receipt of treatment (e.g., prescribing inexpensive medicines). Physicians who were 40-59 years old, specialized in general practice, implementing informed consent or shared decision making, and frequently recognizing that patients refrained from seeking medical care were more likely to engage in efforts to encourage treatment seeking.<br><b>Conclusion</b>: Our results suggest that physicians in primary care roles such as general practice and utilizing shared decision making are more likely to engage in efforts to encourage medical care utilization in patients who refrain due to financial reasons.