Author reply to the definition and evaluation of uncoordinated involvement of multiple healthcare providers; “Polydoctoring” as a component of care fragmentation among patients with multimorbidity

We appreciate the opportunity to respond to the concerns raised in the letter¹ regarding our article, “Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan.”²

First, we acknowledge the point that in Japan, organ-specific specialists often undertake primary care. This indeed contributes to the prevalence of polydoctoring as patients navigate through multiple healthcare providers. We agree that this unique aspect of Japanese healthcare necessitates a more nuanced understanding of polydoctoring, particularly how it impacts patients with multimorbidity. The propensity for patients to consult multiple healthcare providers is an important aspect of our study, and it is evident that this practice has deep roots in the structural makeup of Japanese healthcare.

Interestingly, our data indicated that approximately one-third of the participants were engaged in regular relationships with a single institution even though they have multimorbidity. This subset of the study population presents an important contrast to the polydoctoring narrative and suggests the presence of integrated care pathways for some patients. This variation in care-seeking behavior offers a unique perspective on patient autonomy and the choices made in managing their health within the existing healthcare framework.

The definition of high-risk polydoctoring is a critical area for further research. The delineation between necessary multidisciplinary care and potentially detrimental polydoctoring remains ambiguous and is subject to individual patient circumstances. Our study's threshold for high-risk polydoctoring may warrant reevaluation in future research to establish more precise criteria that can reliably predict adverse outcomes. Furthermore, it is important to note that fragmentation of care is influenced not only by the number of healthcare providers involved but also by the quality of coordination among them. However, objectively assessing the quality of coordination among various healthcare professionals remains a significant challenge in the current landscape.³ Future research efforts should be directed toward developing methodologies to measure the quality of coordination of care, an aspect crucial for understanding and improving patient care.

Regarding the concerns about selection bias, the letter accurately identifies a significant limitation of our study. Our focus on independently living elderly individuals excluded patients receiving home-based medical care. This omits a crucial subset of patients who may be receiving the most comprehensive care, potentially skewing our understanding of polydoctoring in the broader spectrum of care delivery. The homebound patients, often with diminished physical function, represent a contrasting group to the ambulatory patients who were the focus of our study.

However, this approach also represents the strength of our study. By concentrating on the elderly who are able to visit outpatient clinics, we provide clear insights into polydoctoring in a typical primary care setting relevant to the significant portion of patients seen by family physicians and general practitioners.

In conclusion, we are committed to advancing the understanding of polydoctoring and its implications in Japan. We recognize the need for continued research to explore the nuances of this phenomenon and its impact on healthcare outcomes. Your insightful comments have provided valuable considerations for future studies, and we look forward to contributing further to this important field.

All authors meet the ICMJE authorship criteria. TA wrote the manuscript, and all of the authors reviewed and edited the manuscript.

All authors declare that they have no conflict of interest to disclose.