Ensuring sustainable healthcare delivery in rural Japan is a policy priority. However, the relationship between geographic rurality, as measured objectively, and the financial performance of public hospitals essential to these areas remains underexplored.
Objective
To examine the association between the Rurality Index for Japan (RIJ) and the likelihood of ordinary and medical service deficits in public hospitals, while adjusting for hospital size and bed occupancy rate.
Methods
We conducted a nationwide cross-sectional study using the fiscal year 2022 yearbook from Japan's Ministry of Internal Affairs and Communications. The primary outcomes were ordinary and medical service deficits, defined as a balance ratio of < 100%. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for RIJ quartiles, with hospital size and bed occupancy rate as covariates.
Results
A total of 643 hospitals were analyzed. In unadjusted analyses, the highest rurality quartile (Q4) was associated with significantly higher odds of ordinary deficit (OR 1.79, 95% CI 1.11–2.88). However, in multivariable analyses, no statistically significant independent association was found between RIJ and either deficit. Conversely, larger hospitals (≥ 300 beds; aOR 0.53, 95% CI 0.32–0.89) and those with higher bed occupancy rates (≥ 65.6%) were significantly associated with lower odds of ordinary deficit.
Conclusion
Hospital size and bed occupancy rate, rather than geographic rurality itself, are key structural factors associated with the financial sustainability of public hospitals in Japan.
背景：确保日本农村地区可持续的医疗保健服务是一项政策重点。然而，客观衡量的地理乡村性与对这些地区至关重要的公立医院的财务绩效之间的关系仍未得到充分探讨。目的在调整医院规模和床位占用率的情况下，探讨日本农村指数（RIJ）与公立医院普通服务赤字和医疗服务赤字可能性的关系。我们使用日本内务和交通部的2022财年年鉴进行了一项全国性的横断面研究。主要结局是日常和医疗服务赤字，定义为余额比率为100%。以医院规模和床位入住率为协变量，采用多变量logistic回归估计RIJ四分位数的调整优势比（aORs）和95%置信区间（95% ci）。结果共分析643家医院。在未经调整的分析中，最高的农村四分位数（Q4）与普通缺陷的几率显著较高相关（OR 1.79, 95% CI 1.11-2.88）。然而，在多变量分析中，没有发现RIJ和两种缺陷之间有统计学意义的独立关联。相反，较大的医院（≥300张床位；aOR 0.53, 95% CI 0.32-0.89）和床位占用率较高的医院（≥65.6%）与普通赤字的发生率较低显著相关。结论医院规模和床位占用率是影响日本公立医院财务可持续性的关键结构性因素，而非地理乡村性本身。
{"title":"Association Between Rurality and Financial Performance of Public Hospitals in Japan: A Nationwide Cross-Sectional Study","authors":"Kota Sakaguchi, Takafumi Abe, Ayako Erabi, Tomotoshi Iseki, Kaneko Makoto, Yoshihiko Shiraishi, Takashi Watari","doi":"10.1002/jgf2.70088","DOIUrl":"https://doi.org/10.1002/jgf2.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ensuring sustainable healthcare delivery in rural Japan is a policy priority. However, the relationship between geographic rurality, as measured objectively, and the financial performance of public hospitals essential to these areas remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association between the Rurality Index for Japan (RIJ) and the likelihood of ordinary and medical service deficits in public hospitals, while adjusting for hospital size and bed occupancy rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide cross-sectional study using the fiscal year 2022 yearbook from Japan's Ministry of Internal Affairs and Communications. The primary outcomes were ordinary and medical service deficits, defined as a balance ratio of < 100%. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for RIJ quartiles, with hospital size and bed occupancy rate as covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 643 hospitals were analyzed. In unadjusted analyses, the highest rurality quartile (Q4) was associated with significantly higher odds of ordinary deficit (OR 1.79, 95% CI 1.11–2.88). However, in multivariable analyses, no statistically significant independent association was found between RIJ and either deficit. Conversely, larger hospitals (≥ 300 beds; aOR 0.53, 95% CI 0.32–0.89) and those with higher bed occupancy rates (≥ 65.6%) were significantly associated with lower odds of ordinary deficit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hospital size and bed occupancy rate, rather than geographic rurality itself, are key structural factors associated with the financial sustainability of public hospitals in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Understanding how administrative errors, such as prescription and appointment scheduling omissions, and patient confidentiality breaches impact trust in physicians is crucial for improving patient-physician relationships and healthcare outcomes. To investigate the association between administrative errors, general trust in physicians, and interpersonal trust in a physician, we surveyed adults across Japan.
Methods
Participants were adults aged ≥ 20 years who had received treatment at least twice for non-communicable diseases within the past 6 months. The exposure variables were past experiences with prescription errors, confidentiality breaches, and appointment scheduling omissions by personal physicians treating their non-communicable diseases. General trust and interpersonal trust in a physician were measured using the Japanese version of the Wake Forest Physician Trust Scale.
Results
Among the 661 participants, nearly 14% reported experiencing at least one type of administrative error. Prescription errors were associated with a significant decrease in general trust in physicians (−9.78 points, 95% confidence interval [CI]: −13.74 to −5.81). Confidentiality breaches had the most significant negative impact on interpersonal trust (−14.09 points, 95% CI: −24.35 to −3.83), followed by appointment scheduling omissions (−13.56 points, 95% CI: −22.48 to −4.65). Mediation analysis revealed that the association between prescription errors and reduced general trust was partially mediated by decreased trust in personal physicians.
Conclusions
Administrative errors during care for non-communicable diseases significantly undermine patients' trust in physicians. Physicians should prioritize improving their practices, particularly regarding prescription errors, as these errors have broader implications for the public's perception of physicians.
{"title":"The Effect of Three Key Administrative Errors on Patient Trust in Physicians: Prescription Errors, Confidentiality Breaches, and Appointment Scheduling Omissions","authors":"Tetsuro Aita, Yoshia Miyawaki, Yu Katayama, Kosuke Sakurai, Nao Oguro, Takafumi Wakita, Nobuyuki Yajima, Ashwin B. Gupta, Noriaki Kurita","doi":"10.1002/jgf2.70086","DOIUrl":"https://doi.org/10.1002/jgf2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Understanding how administrative errors, such as prescription and appointment scheduling omissions, and patient confidentiality breaches impact trust in physicians is crucial for improving patient-physician relationships and healthcare outcomes. To investigate the association between administrative errors, general trust in physicians, and interpersonal trust in a physician, we surveyed adults across Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were adults aged ≥ 20 years who had received treatment at least twice for non-communicable diseases within the past 6 months. The exposure variables were past experiences with prescription errors, confidentiality breaches, and appointment scheduling omissions by personal physicians treating their non-communicable diseases. General trust and interpersonal trust in a physician were measured using the Japanese version of the Wake Forest Physician Trust Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 661 participants, nearly 14% reported experiencing at least one type of administrative error. Prescription errors were associated with a significant decrease in general trust in physicians (−9.78 points, 95% confidence interval [CI]: −13.74 to −5.81). Confidentiality breaches had the most significant negative impact on interpersonal trust (−14.09 points, 95% CI: −24.35 to −3.83), followed by appointment scheduling omissions (−13.56 points, 95% CI: −22.48 to −4.65). Mediation analysis revealed that the association between prescription errors and reduced general trust was partially mediated by decreased trust in personal physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Administrative errors during care for non-communicable diseases significantly undermine patients' trust in physicians. Physicians should prioritize improving their practices, particularly regarding prescription errors, as these errors have broader implications for the public's perception of physicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although advance care planning (ACP) has been vigorously promoted by the Japanese government, it remains unfamiliar to the general public. This study explored citizens' perspectives on ACP conversations in clinical settings using a newly developed handbook to support such discussions.
Methods
A qualitative study using four focus group interviews was conducted in March 2024 with 15 citizens aged 53–77, recruited through local networks. Participants included cancer survivors, family caregivers, and individuals with bereavement experiences and/or professional experience in healthcare. The interviews were transcribed verbatim and analyzed thematically.
Results
Four main themes emerged: (1) positive responses to ACP, (2) expectations for the broader promotion of ACP, (3) concerns regarding ACP and the use of the Handbook, and (4) real-life experiences related to ACP. Many participants expressed willingness to engage in ACP, and the Handbook was valued as a concrete tool for structuring conversations. Concerns were raised about whether healthcare professionals would have time and readiness to engage in ACP in busy hospital settings, suggesting a misalignment between citizens' openness to ACP and professionals' assumptions about patients' reluctance.
Conclusions
This study highlights the perspectives of relatively healthy citizens, an area that remains understudied. A proactive segment of the public willing to engage in ACP was identified. To support this, practical tools such as the Handbook should be accompanied by institutional support and professional readiness. Encouraging dialogue among citizens themselves may further help foster broader social momentum for ACP in Japan.
虽然日本政府大力推行提前照护计划（advance care planning， ACP），但对于普通民众来说，它仍然是一个陌生的概念。本研究探讨公民的观点在ACP对话在临床设置使用新开发的手册来支持这样的讨论。方法采用4次焦点小组访谈的定性研究方法，于2024年3月通过当地网络招募了15名年龄在53 ~ 77岁之间的市民。参与者包括癌症幸存者、家庭照顾者以及有丧亲经历和/或医疗保健专业经验的个人。采访被逐字记录下来，并按主题进行分析。结果调查结果显示了四个主要主题：(1)对ACP的积极回应；(2)对ACP更广泛推广的期望；(3)对ACP和手册使用的关注；(4)与ACP相关的现实体验。许多与会者表示愿意参加非加太计划，《手册》被认为是组织对话的具体工具。人们担心，在繁忙的医院环境中，医疗保健专业人员是否有时间和准备参与ACP，这表明公民对ACP的开放程度与专业人员对患者不情愿的假设之间存在不一致。本研究强调了相对健康公民的观点，这一领域仍未得到充分研究。我们发现有一部分积极主动的公众愿意参与ACP。为了支持这一点，诸如《手册》之类的实用工具应伴随着机构支持和专业准备。鼓励公民之间的对话可能进一步有助于促进日本ACP更广泛的社会动力。
{"title":"Perspectives of Japanese Citizens on Advance Care Planning in Clinical Settings: Findings From a Focus Group Study","authors":"Michiko Abe, Chikako Banjo, Machiko Inoue","doi":"10.1002/jgf2.70084","DOIUrl":"https://doi.org/10.1002/jgf2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although advance care planning (ACP) has been vigorously promoted by the Japanese government, it remains unfamiliar to the general public. This study explored citizens' perspectives on ACP conversations in clinical settings using a newly developed handbook to support such discussions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study using four focus group interviews was conducted in March 2024 with 15 citizens aged 53–77, recruited through local networks. Participants included cancer survivors, family caregivers, and individuals with bereavement experiences and/or professional experience in healthcare. The interviews were transcribed verbatim and analyzed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four main themes emerged: (1) positive responses to ACP, (2) expectations for the broader promotion of ACP, (3) concerns regarding ACP and the use of the Handbook, and (4) real-life experiences related to ACP. Many participants expressed willingness to engage in ACP, and the Handbook was valued as a concrete tool for structuring conversations. Concerns were raised about whether healthcare professionals would have time and readiness to engage in ACP in busy hospital settings, suggesting a misalignment between citizens' openness to ACP and professionals' assumptions about patients' reluctance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the perspectives of relatively healthy citizens, an area that remains understudied. A proactive segment of the public willing to engage in ACP was identified. To support this, practical tools such as the Handbook should be accompanied by institutional support and professional readiness. Encouraging dialogue among citizens themselves may further help foster broader social momentum for ACP in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report an 80-year-old man with type 2 diabetes who presented with life-threatening hypoglycemia (36 mg/dL) and coma, requiring high-dose insulin (74 units/day). Exogenous insulin antibody syndrome (EIAS) was suspected due to his glycemic instability and high insulin requirements. Subsequent testing confirmed elevated insulin antibodies (8.7 U/mL). Switching insulin analogues (to 32 units/day) promptly achieved stable glycemic control. This case highlights that EIAS, an under-recognized cause of unpredictable glycemia in insulin-treated diabetes, should be considered in patients with severe hypoglycemia and high insulin requirements. Modifying the insulin regimen is key for diagnosis and treatment.
{"title":"Exogenous Insulin Antibody Syndrome: An Overlooked Cause of Severe Hypoglycemia and Insulin Resistance in a Patient With Type 2 Diabetes Treated With Insulin","authors":"Kazuki Miyaue, Hiroki Isono","doi":"10.1002/jgf2.70085","DOIUrl":"https://doi.org/10.1002/jgf2.70085","url":null,"abstract":"<p>We report an 80-year-old man with type 2 diabetes who presented with life-threatening hypoglycemia (36 mg/dL) and coma, requiring high-dose insulin (74 units/day). Exogenous insulin antibody syndrome (EIAS) was suspected due to his glycemic instability and high insulin requirements. Subsequent testing confirmed elevated insulin antibodies (8.7 U/mL). Switching insulin analogues (to 32 units/day) promptly achieved stable glycemic control. This case highlights that EIAS, an under-recognized cause of unpredictable glycemia in insulin-treated diabetes, should be considered in patients with severe hypoglycemia and high insulin requirements. Modifying the insulin regimen is key for diagnosis and treatment.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Japan is promoting physician-led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician-led home care and to identify associated factors.
Methods
This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician-led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10-point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause-specific Cox regression was conducted to identify factors associated with BI improvement.
Results
A total of 660 patients were analyzed, with a median follow-up of 308 days. The one-year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause-specific Cox regression showed that patients with MMSE-J scores < 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement.
Conclusion
Following the initiation of physician-led home visits, approximately one-quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care.
{"title":"Improvement in Activities of Daily Living Among Older Adults With Physician-Led Home Visits: A Multicenter Retrospective Cohort Study in Japan","authors":"Yuki Hinata, Masato Matsushima, Takuya Aoki, Yoshifumi Sugiyama, Tetsuya Kanno, Yasuki Fujinuma, Takamasa Watanabe","doi":"10.1002/jgf2.70082","DOIUrl":"https://doi.org/10.1002/jgf2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Japan is promoting physician-led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician-led home care and to identify associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician-led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10-point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause-specific Cox regression was conducted to identify factors associated with BI improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 660 patients were analyzed, with a median follow-up of 308 days. The one-year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause-specific Cox regression showed that patients with MMSE-J scores < 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Following the initiation of physician-led home visits, approximately one-quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We are members of the Expert Training Support Committee of the Japan Primary Care Association (JPCA) in the Chugoku region and are involved in generalist education at each program. While the need for generalists is rapidly increasing, we face several challenges in supporting its education. In this context, we were especially encouraged by the recent letter from Matsumura et al. on “Sustainable Generalism Education.” [<span>1</span>] The Chugoku region consists of five prefectures with both mountainous and island areas, and, as shown in Figure 1, supervising doctors and family medicine residents are geographically dispersed. Against this backdrop, their call for interdisciplinary collaboration, community-based educational guidance, and cross-organizational sharing of best practices strongly resonates with us.</p><p>What we want to emphasize is the need for support for residents who train in remote areas and for supervising doctors engaged in their education. Because generalist education in Japan is still in its early stages, the number of skillful supervising doctors is limited and tends to be concentrated at specific training sites. Meanwhile, residents are required to rotate through diverse clinical settings, and some residents are obliged by scholarship programs to work in resource-limited rural areas. In such contexts, residents may be forced to practice independently without nearby supervisors, missing opportunities for proper reflection, while routine supervision may be provided by physicians who are inexperienced in medical education. We consider these to be major challenges in this field.</p><p>One of the greatest challenges is portfolio education. Portfolios are essential to the development of a generalist identity, but they require specialized teaching skills and sufficient time [<span>2, 3</span>]. Ideally, residents should be trained under a skillful supervising doctor and reflect on their practice. However, as noted above, geographical distance makes such interactions difficult. Moreover, supervising doctors at host institutions may not be familiar with portfolio education, and it is challenging to obtain a comprehensive overview of the wide range of topics involved. In particular, just-started-up programs often lack accumulated know-how and tend to depend heavily on the residents' ability to learn autonomously.</p><p>In recent years, online learning opportunities in our specialty have been increasing [<span>4, 5</span>]. We have been discussing how these resources might help overcome current educational challenges. One of our efforts has been to open online sessions, conducted by well-established programs, to residents and their supervising doctors in our region. Through these sessions, participants could attend core lectures and learn methods of reflection. Interestingly, most participants were not residents but supervising doctors, highlighting a strong need for learning among educators themselves. This activity also created opp
{"title":"Building a Remote Network for Sustainable Supervision in Family Medicine Residency","authors":"Junki Shimokawa, Yuki Otsuka, Marina Kawaguchi, Akemi Ando, Kazushige Fujiwara","doi":"10.1002/jgf2.70083","DOIUrl":"https://doi.org/10.1002/jgf2.70083","url":null,"abstract":"<p>We are members of the Expert Training Support Committee of the Japan Primary Care Association (JPCA) in the Chugoku region and are involved in generalist education at each program. While the need for generalists is rapidly increasing, we face several challenges in supporting its education. In this context, we were especially encouraged by the recent letter from Matsumura et al. on “Sustainable Generalism Education.” [<span>1</span>] The Chugoku region consists of five prefectures with both mountainous and island areas, and, as shown in Figure 1, supervising doctors and family medicine residents are geographically dispersed. Against this backdrop, their call for interdisciplinary collaboration, community-based educational guidance, and cross-organizational sharing of best practices strongly resonates with us.</p><p>What we want to emphasize is the need for support for residents who train in remote areas and for supervising doctors engaged in their education. Because generalist education in Japan is still in its early stages, the number of skillful supervising doctors is limited and tends to be concentrated at specific training sites. Meanwhile, residents are required to rotate through diverse clinical settings, and some residents are obliged by scholarship programs to work in resource-limited rural areas. In such contexts, residents may be forced to practice independently without nearby supervisors, missing opportunities for proper reflection, while routine supervision may be provided by physicians who are inexperienced in medical education. We consider these to be major challenges in this field.</p><p>One of the greatest challenges is portfolio education. Portfolios are essential to the development of a generalist identity, but they require specialized teaching skills and sufficient time [<span>2, 3</span>]. Ideally, residents should be trained under a skillful supervising doctor and reflect on their practice. However, as noted above, geographical distance makes such interactions difficult. Moreover, supervising doctors at host institutions may not be familiar with portfolio education, and it is challenging to obtain a comprehensive overview of the wide range of topics involved. In particular, just-started-up programs often lack accumulated know-how and tend to depend heavily on the residents' ability to learn autonomously.</p><p>In recent years, online learning opportunities in our specialty have been increasing [<span>4, 5</span>]. We have been discussing how these resources might help overcome current educational challenges. One of our efforts has been to open online sessions, conducted by well-established programs, to residents and their supervising doctors in our region. Through these sessions, participants could attend core lectures and learn methods of reflection. Interestingly, most participants were not residents but supervising doctors, highlighting a strong need for learning among educators themselves. This activity also created opp","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sequelae of the acute phase of coronavirus disease 2019 (COVID-19), termed long COVID, are characterized by a variety of symptoms, including neurological manifestations. Diagnosing long COVID requires excluding alternative conditions that could explain the symptoms. The role of primary care physicians is considered essential in managing long COVID, particularly during the initial screening phase.
Methods
This observational, retrospective, single-center study was conducted at an outpatient clinic from 1 June 2021 to 31 December 2024. We confirmed final diagnoses for patients suspected of having long COVID and included those ultimately diagnosed with other conditions. Clinical data—including symptoms, demographic characteristics, results of clinical examinations, and final diagnoses—were collected.
Results
In total, 44 patients were diagnosed with alternative conditions. Of these, 30 were classified as having post-acute sequelae of SARS-CoV-2 mimic, and 14 patients (2.2% of those who believed they had long COVID and visited our clinic) were diagnosed with other diseases. The median age at the time of their clinic visit was 48 years (range, 42.5–61.5). Diagnoses included collagen diseases (5 patients, 35.7%) and central nervous system disorders (5 patients, 35.7%), among others. Weakness was the most common symptom. In contrast to long COVID, fatigue was less frequently reported in this group.
Conclusions
We identified a variety of alternative diagnoses among patients suspected of having long COVID. We recommend that primary care physicians exercise caution when diagnosing long COVID, particularly in patients who do not report fatigue.
{"title":"Clinical Characteristics of Patients Initially Suspected of Long COVID: A Case Series From a Specialized Outpatient Clinic","authors":"Masayuki Ohira, Takashi Osada, Hiroaki Kimura, Terunori Sano, Masaki Takao","doi":"10.1002/jgf2.70081","DOIUrl":"https://doi.org/10.1002/jgf2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sequelae of the acute phase of coronavirus disease 2019 (COVID-19), termed long COVID, are characterized by a variety of symptoms, including neurological manifestations. Diagnosing long COVID requires excluding alternative conditions that could explain the symptoms. The role of primary care physicians is considered essential in managing long COVID, particularly during the initial screening phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational, retrospective, single-center study was conducted at an outpatient clinic from 1 June 2021 to 31 December 2024. We confirmed final diagnoses for patients suspected of having long COVID and included those ultimately diagnosed with other conditions. Clinical data—including symptoms, demographic characteristics, results of clinical examinations, and final diagnoses—were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 44 patients were diagnosed with alternative conditions. Of these, 30 were classified as having post-acute sequelae of SARS-CoV-2 mimic, and 14 patients (2.2% of those who believed they had long COVID and visited our clinic) were diagnosed with other diseases. The median age at the time of their clinic visit was 48 years (range, 42.5–61.5). Diagnoses included collagen diseases (5 patients, 35.7%) and central nervous system disorders (5 patients, 35.7%), among others. Weakness was the most common symptom. In contrast to long COVID, fatigue was less frequently reported in this group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified a variety of alternative diagnoses among patients suspected of having long COVID. We recommend that primary care physicians exercise caution when diagnosing long COVID, particularly in patients who do not report fatigue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previous studies have examined short-term changes in health care utilization during the COVID-19 pandemic, but research on long-term post-pandemic effects remains limited. We aimed to evaluate health care utilization after the pandemic based on the ecology of medical care model and to compare it with the results before and during the pandemic in Japan.
Methods
We conducted a nationwide repeated cross-sectional survey of a representative sample of the general Japanese adult population in 2021 and 2024. The main outcomes were health care utilization for new health problems. We estimated the number of each health care utilization per 1000 population per month and compared it with the previous study conducted before the pandemic.
Results
Data from a total of 2992 participants were analyzed. Visits to physicians' offices that primarily provide primary care declined during the pandemic and increased after the pandemic, but have not fully recovered to pre-pandemic levels. The recovery in physician's office visits between during and after the pandemic tended to be smaller among younger adults, females, those with lower education levels, those with higher incomes, and those without chronic conditions. On the other hand, emergency room visits, which declined during the pandemic, increased to higher levels than before the pandemic.
Conclusions
Primary care utilization has not recovered to pre-pandemic levels, while emergency room visits have increased to higher levels than before the pandemic. Understanding long-term changes in health care utilization behaviors after the pandemic can help policymakers strengthen primary care systems.
{"title":"Lingering Effects on the Ecology of Medical Care After the COVID-19 Pandemic: A Nationwide Repeated Cross-Sectional Study in Japan","authors":"Takuya Aoki, Masato Matsushima","doi":"10.1002/jgf2.70080","DOIUrl":"https://doi.org/10.1002/jgf2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies have examined short-term changes in health care utilization during the COVID-19 pandemic, but research on long-term post-pandemic effects remains limited. We aimed to evaluate health care utilization after the pandemic based on the ecology of medical care model and to compare it with the results before and during the pandemic in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide repeated cross-sectional survey of a representative sample of the general Japanese adult population in 2021 and 2024. The main outcomes were health care utilization for new health problems. We estimated the number of each health care utilization per 1000 population per month and compared it with the previous study conducted before the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from a total of 2992 participants were analyzed. Visits to physicians' offices that primarily provide primary care declined during the pandemic and increased after the pandemic, but have not fully recovered to pre-pandemic levels. The recovery in physician's office visits between during and after the pandemic tended to be smaller among younger adults, females, those with lower education levels, those with higher incomes, and those without chronic conditions. On the other hand, emergency room visits, which declined during the pandemic, increased to higher levels than before the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Primary care utilization has not recovered to pre-pandemic levels, while emergency room visits have increased to higher levels than before the pandemic. Understanding long-term changes in health care utilization behaviors after the pandemic can help policymakers strengthen primary care systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"595-602"},"PeriodicalIF":2.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohamed Eshmawey, Sonja M. Kagerer, Federica Ribaldi, Aïda B. Fall, Paul G. Unschuld
Background
Subjective cognitive decline (SCD) is characterized by the perception of cognitive dysfunction, and it could be one of the early signs of dementia. While SCD is a common phenomenon in old persons, little is known about how it affects interpersonal relationships.
Methods
We conducted a cross-sectional study involving 16 patients with SCD and 39 volunteers recruited from the COSCODE study. The Hazan and Shafer questionnaires were used to assess patients' attachment styles. The Experience in Close Relationships Scale was used to assess individual differences in attachment-related anxiety and attachment-related avoidance. A Wilcoxon rank-sum test was performed to test for differences between groups, and p-values were Bonferroni-corrected.
Results
SCD is associated with lower disorganized attachment scores (p = 0.01). SCD was not associated with experience in close relationships.
Conclusion
Coping with progressive cognitive decline is a difficult mission. The results of our study on persons with SCD help us to better understand changes in couple relationships before the onset of dementia.
{"title":"Subjective Cognitive Decline, Inter-Personal Attachment Style and Relationship Quality","authors":"Mohamed Eshmawey, Sonja M. Kagerer, Federica Ribaldi, Aïda B. Fall, Paul G. Unschuld","doi":"10.1002/jgf2.70076","DOIUrl":"https://doi.org/10.1002/jgf2.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Subjective cognitive decline (SCD) is characterized by the perception of cognitive dysfunction, and it could be one of the early signs of dementia. While SCD is a common phenomenon in old persons, little is known about how it affects interpersonal relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study involving 16 patients with SCD and 39 volunteers recruited from the COSCODE study. The Hazan and Shafer questionnaires were used to assess patients' attachment styles. The Experience in Close Relationships Scale was used to assess individual differences in attachment-related anxiety and attachment-related avoidance. A Wilcoxon rank-sum test was performed to test for differences between groups, and <i>p</i>-values were Bonferroni-corrected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SCD is associated with lower disorganized attachment scores (<i>p</i> = 0.01). SCD was not associated with experience in close relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Coping with progressive cognitive decline is a difficult mission. The results of our study on persons with SCD help us to better understand changes in couple relationships before the onset of dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"620-625"},"PeriodicalIF":2.3,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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