Practices, Recommendations, Knowledge, and Sources of Information for Primary Care Physicians regarding Vaccinations: A Nationwide Survey in Japan, 2019 / 日本プライマリ・ケア連合学会誌

Introduction: Vaccine policies have changed in recent years in Japan. In the present study, we assessed practices, recommendations, knowledge, and sources of information among primary care physicians (PCPs) regarding vaccinations in Japan. Methods: We conducted a nationwide cross-sectional study targeting PCPs in Japan. We used a web-based self-administered questionnaire targeting physicians that were members of the Japan Primary Care Association in 2019. We analyzed respondent administrations, recommendations, knowledge, and sources of information regarding vaccinations. Results: We received responses from 1,084 PCPs (20.1%) and invited 981 participants for the analysis. The rates at which physicians gave routine and voluntary vaccines in their own practices were 23.3-95.5% and 13.2-94.4%, respectively. The active recommendation rates for routine and voluntary vaccines were 41.6-92.0% and 13.6-75.5%, respectively. Furthermore, among routine vaccines, human papillomavirus vaccine was the least administered and recommended. PCPs working at clinics had the most accurate knowledge about vaccinations, and PCPs utilized academic organizations most readily as an information resource. Conclusion: We clarified practices, recommendations, knowledge, and sources of information regarding vaccinations among PCPs in Japan.

Mental Health Competencies in Family Medicine Residency Training / 日本プライマリ・ケア連合学会誌

In recent years, the integration of mental health into primary care has become a global trend, as it is recognized to be effective for providing appropriate treatment, improving outcomes, and using resources appropriately. Therefore, in many countries, mental health education in primary care has been developed and delivered. However, systematic training on mental health for family physicians has not been sufficiently provided in Japan. We performed a scoping review in order to clarify the mental health competencies of primary care physicians by analyzing the educational curricula in other countries using thematic analysis. The competencies extracted were comprehensive and classified into three domains: "general competencies in primary care," "general competencies in mental health in primary care," and "specific competencies in mental health in primary care". In the future, it will be necessary to create a competency list based on the reported data and formulate a model curriculum based on the current situation in Japan.

The Learning of Bereavement Care by Family Physicians: A Qualitative Study / 日本プライマリ・ケア連合学会誌

Introduction: The learning and practice of bereavement care by Japanese family practitioners has largely been unexplored. The purpose of this study was to clarify what family doctors thought they learned by providing care for bereaved families and how they changed because of it.Methods: Semi-structured interviews were conducted with seven family practitioners working in bereaved family outpatient care at the researcher's hospital. A modified grounded theory approach was used for the analysis.Results: The analysis identified five thematic categories: 1) the doctor's feelings and thoughts before learning about bereavement care, 2) things they learned from providing bereavement care, 3) things they learned by interacting with the families and things they learned upon reflections afterward, 4) changes in themselves, and 5) changes in their feelings after learning about bereavement care.Conclusion: The doctors learned to provide bereavement care by directly interacting with families and by reflecting on those experiences; for example, they learned to listen and be empathetic, and to understand individuals' personal responses to grief. As a result, they may have gained the ability to have a more rounded view of life and death and of their role in helping families adjust to the death of a family member.

HANDS-FDF (Home and Away Nine DayS - Faculty Development Fellowship) is an Innovative Faculty Development Program / 医学教育

HANDS-FDF (Home and Away Nine DayS-Faculty Development Fellowship) is probably the first home and away format, continuous faculty development program for primary care physicians deliberately developed by officially FD trained director based on the existing successful programs and pilot testing by officially FD trained director. This fellowship has many unique features with 146 stellar graduates and 15 year history. Other prospective course developer may benefit from studying this course in detail.

Multimorbidity in Primary Care: Current Situation and Research Gap / 日本プライマリ・ケア連合学会誌

In the 1980s, some researchers started using the word "multimorbidity", which is defined as "the co-existence of two or more long-term conditions in an individual". Multimorbidity has become one of the most important topics in recent primary care because of its clinical significance. Multimorbidity is more common among the elderly, and was suggested to be associated with female sex, lower socio-economic status and mental disease. Multimorbidity is associated with a higher mortality, lower quality of life and reduced functional status. It is also associated with the treatment burden such as consultation frequency, fragmented healthcare provision and inadequate polypharmacy. Multimorbidity has negative impact on health care resource use such as hospital visits, unexpected admission and total health care costs. However, the total picture and health care effects of multimorbidity have only been reported in observational studies, and there is little evidence of which interventions are effective for multimorbidity patients. In this review paper, we carried out a literature review of high-quality reports from Japan and overseas. We provide an overview of the current situation of multimorbidity research and highlight the research gaps. Based on these results, we would like to propose approaches for multimorbidity patients in clinical settings.

Point-of-care Ultrasound in Primary Care in Japan: Current Situation and Future Perspectives / 日本プライマリ・ケア連合学会誌

Point-of-care ultrasound (POCUS) has become increasingly employed in recent years. POCUS is the concept of quickly assessing for conditions using ultrasound based on the patient history and physical examinations to make a clinical decision in a timely manner. This concept has been developed and widely used in emergency medicine and other specialties, and has spread to primary care over the past several years. In Japan, POCUS is not well-known in primary care, but the importance of primary care physicians using ultrasound has been reported since the 1990s. However, many physicians depend on higher imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), instead of ultrasound. Although the benefits of integrating POCUS into primary care have been documented, the barriers of POCUS being employed by primary care physicians include a shortage of educational resources and time during busy practice. As primary care settings in Japan vary, such as clinics, hospitals and patient homes, the indications and required skills for POCUS differ. A standardized training curriculum for POCUS needs to be developed according to the primary care setting.

Quality audit of maintenance dialysis at a family medicine residency program facility / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : In Japan, there are over 300,000 hemodialysis (HD) patients and 6,000 new patients are introduced yearly, a figure which is increasing. It is estimated that 12,000 specialists are needed to provide care for these patients, but there are currently only 4,000 to 7,000 such specialists. There is very little literature regarding the role of generalists in the care of HD patients. In our facility, family physicians provide care for HD patients including managing end stage renal disease (ESRD) with backup support from nephrologists.<br><b>Aims</b> : To explore the possibility of expanding the generalist's role in the care of HD patients by critically reviewing our care using several quality indicators and demographics compared with available literature data.<br><b>Methods</b> : Retrospective chart review.<br><b>Outcome measures</b> : patient demographics, quality indicators including Kt/Vdp, hemoglobin, serum albumin, serum calculated calcium, serum phosphorus, intact-PTH, rates of hospitalization, transfer of care, and death.<br><b>Results</b> : Fifty-two patients were cared for in 2011. The average target achievement rate was 80.0% for Kt/Vdp, 69.9% for hemoglobin, 63.7% for serum albumin, 85.4% for corrected serum calcium, 78.3% for serum phosphorus, and 56.8% for intact-PTH.<br><b>Conclusion</b> : Generalists can contribute to the care of HD/ESRD patients by utilizing appropriate quality assurance training and support, and in turn reduce the work burden of specialists without compromising quality of care.

The transition from student to resident: A survey about abilities expected fo first-year residents / 医学教育

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.<BR>1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.<BR>2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.<BR>3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.<BR>4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.<BR>5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.<BR>6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.