Addressing healthcare needs in an inaugural family medicine clinic in a core city in Japan: Mixed‐methods research

Abstract

Background

There exists little research elucidating the benefits of family medicine clinics for community with ample specialist healthcare resources.

Methods

We conducted mixed‐methods research. Within the inaugural family medicine clinic, the following data was collected during the initial 2 months: (i) newly identified healthcare needs among scheduled outpatients; (ii) management of outpatients with complex health and social needs; and (iii) provision of home‐visit care. Newly detected health care needs were summarized qualitatively using a summative content analysis. Patients' complexity was quantitatively scored using the Japanese version of the Patient Centred Assessment Method.

Results

Physicians identified 156 new needs and 13 complex cases. The complexity of patients receiving home‐visit care was high.

Conclusions

This study demonstrates that an inaugural family medicine clinic adeptly addressed a diverse spectrum of patients' healthcare needs.

This study aimed to reveal how family medicine can swiftly respond to healthcare needs by examining an inaugural family medicine clinic. These findings underscore the unique significance of family medicine clinics, particularly in areas with abundant specialist medical care resources.

1. INTRODUCTION

With the aging population and increasing health inequalities, many patients present complex social and health needs. ¹ Family physicians can address these intricate needs, ¹ offering effective care through both outpatient and home‐based services. ²

However, Japan contends with a shortage of family physicians. ³ The prevalent practice of consulting multiple sub‐specialists, known as polydoctoring, is widespread in Japan, and healthcare becomes fragmented. ⁴ Nonetheless, there is little research illustrating the advantages of family medicine clinics for community with ample subspecialist healthcare resources.

This study aims to reveal healthcare needs encountered in a newly established family medicine clinic in a city, where no family medicine clinic existed previously.

2. METHODS

This research was performed at an inaugural family medicine clinic in a regional city with a population of around 300,000 in Japan. The city is equipped with approximately 4700 general beds, 2300 convalescent beds, and 1600 psychiatric beds. The number of beds per city population was highest among the cities in Japan. The number of clinics (except dental clinics) was about 250.

The clinic was about 1 km away from the city's main train station. Within 1 km of the clinic, there are 8 hospitals, 2 of which are tertiary care hospitals, and 11 clinics: 5 internal medicine clinics, 2 dental clinics, 1 internal medicine and pediatric clinic, 1 psychiatry clinic, 1 ophthalmology clinic, 1 otolaryngology clinic. Until the opening of our clinic, primary care had been predominantly delivered by hospitals and clinics managed by sub‐specialists. Ours is the first clinic in the city to explicitly offer family practices. The clinic was established through the inheritance of an original internal medicine clinic, with the second author assuming the role of clinic director and providing daily care. During the data collection mentioned below, the first author practiced on Mondays and Tuesdays, the third author on Wednesdays, Thursdays, and Fridays, and the fourth author on Saturdays. All four authors were family physicians and delivered outpatient as well as home‐visit care.

This study employed the Japanese version of the Patient Centred Assessment Method (PCAM) ⁵ as an indicator of patients' complexity. A higher score means higher complexity. The maximum score is 48 points. The mean score in outpatients at a Japanese family medicine clinic was reported to be 16.5. ⁵

We collected the following data during the first 2 months of opening. We decided on this period because we want to reflect on the acute changes brought to the clinic, and patients were seen every 1–2 months at regular intervals at the former clinic.

As mentioned below, we collected both qualitative and quantitative data complementarily to gain thorough understanding and prioritize answering the research questions, followed a concurrent triangulation mixed‐methods design. ⁶

Firstly, physicians recorded information on newly identified healthcare needs about outpatients who had chronic conditions and regular schedule for visiting our clinic. Such information was considered necessary to share with other physicians. This data was documented in a shared notebook. The first author conducted a thorough reading of shared information and coded and categorized it through summative content analysis, which aims to identify and quantify targeted content in the text. ⁷ The results of the analyses were reviewed and approved by the second, third, and fourth authors. These four authors made a conscious effort to reflect their practice as a family physician in the coding.

Secondly, when encountering patients with intricate health and social needs, physicians shared patient information with medical assistants (the fifth to seventh authors). These medical assistants conducted thorough interviews with the patients or relevant individuals to comprehensively understand their existing needs and took appropriate actions to address their issues.

Thirdly, the clinic initiated home‐visit care because there were no medical institutions in the vicinity providing such care. Physicians and medical assistants collected detailed patient information in initiating home‐visit care. The PCAM was collaboratively scored by the first and the second or fifth authors.

Patient consent was obtained on an opt‐out basis. The study received approval from the ethical committee in Ehime Seikyo Hospital (No. 51‐2‐2024‐005). This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. ⁸

3. RESULTS

Throughout the 2 month duration, a total of 1327 outpatients were attended to, comprising 888 routine visits, 307 patients presenting with acute fever, and 132 newly presenting patients unrelated to fever. Home‐visit care was instigated for 23 patients. There was no missing data.

3.1. Newly identified healthcare needs

The family physicians identified a total of 156 healthcare needs in 125 regularly scheduled outpatients. Their ages ranged from 3 to 94 years, with a median age of 73. Through content analysis, these needs were classified into the following categories.

3.1.1. Physical disease or condition (51 cases)

This category encompassed physical problems or conditions that might have been present but were overlooked or not received appropriate management. Undifferentiated problems (e.g., chest pain, loss of weight, leg edema) and endocrine, gastrointestinal, musculoskeletal, and psychological conditions were often detected. The details are shown in Appendix S1.

3.1.2. Optimal prescription (23 cases)

Two cases of adverse drug events, thirteen of potentially inappropriate prescriptions, and eight of inappropriate polypharmacy were newly discovered.

3.1.3. Social condition (19 cases)

This category encompassed social problems such as isolation and loneliness, nonapplication for social security systems, and stress.

3.1.4. Narrative of illness (17 cases)

This category encompassed cases where hearing patients' narratives of their experiences was necessary (e.g., “The COVID‐19 pandemic prevented me from attending a rehabilitation, and it weakened my physical health.”).

3.1.5. Health maintenance (16 cases)

There were seven cases involving discussions about cancer screening, three about vaccines, three about smoking cessation, and three about osteoporosis.

3.1.6. Optimal management of chronic condition (15 cases)

This category encompassed patients requiring optimization of chronic condition management. It included 10 cases of diabetes and/or dyslipidemia, 2 cases of thyroid diseases, and one case each of chronic heart failure, hypertension, and hyperuricemia.

3.1.7. Consultation about family members (Nine cases)

There were seven consultations regarding older parents experiencing cognitive and physical decline, one consultation regarding children, and one consultation regarding grandchildren.

3.1.8. Care integration (Six cases)

There were six cases in which care integration was needed.

3.2. Outpatients with intricate health and social needs

A total of 13 patients were identified as possessing intricate health and social needs necessitating the intervention of an interdisciplinary team. Their ages ranged from 33 to 94 years, with a median age of 86. The mean total score of PCAM was 27.15, with scores spanning from 17 to 39 (Table 1).

TABLE 1.

PCAM scores of outpatients with intricate health and social needs.

Categories and items	Mean score (SD) [max: 4 points; min: 1 point]
Health and well being	2.27
1. Physical health needs	2.38 (0.51)
2. Physical health impacting mental well being	2.31 (0.75)
3. Lifestyle impacting mental well being	1.77 (0.93)
4. Other mental well‐being concerns	2.62 (0.65)
Social environment	1.81
1. Home environment	1.23 (0.60)
2. Daily activities	2.23 (0.83)
3. Social network	2.62 (0.77)
4. Financial resources	1.15 (0.38)
Health literacy and communication	2.19
1. Health literacy	2.23 (0.93)
2. Engagement in discussion	2.15 (0.80)
Service coordination	3.23
1. Other services	3.30 (1.18)
2. Service coordination	3.15 (0.99)
Total	27.15 (5.63)

Management of these cases encompassed sharing information with the community comprehensive support centers (five cases), attentively listening to patients' narratives with close follow‐up (three), sharing information with other stakeholders such as family members or care managers (two), recommending hospitalization (one), instituting home‐visit care (one), and furnishing information to the patient (one).

3.3. Patients receiving home‐visit care

A total of 23 patients were introduced to home‐visit care. Their ages ranged from 60 to 100 years, with a median age of 85. Ten patients were directed by hospitals to initiate home‐visit care. Other initiators included family members (five cases), care managers or rehabilitation care staff (three cases), community comprehensive support centers (two cases), transition from the previous clinic (two cases), and direct request from the patient (one case). The mean total score of PCAM was 29.35, with scores spanning from 17 to 44. (Table 2).

TABLE 2.

PCAM scores of patients receiving home‐visit care.

Categories and items	Mean score (SD) [max: 4 points; min: 1 point]
Health and well being	2.38
1. Physical health needs	2.56 (0.95)
2. Physical health impacting mental well being	2.52 (0.95)
3. Lifestyle impacting mental well being	2.04 (0.87)
4. Other mental well‐being concerns	2.39 (0.99)
Social environment	2.29
1. Home environment	2.17 (1.11)
2. Daily activities	2.35 (0.83)
3. Social network	2.74 (0.81)
4. Financial resources	1.91 (1.16)
Health literacy and communication	2.57
1. Health literacy	2.70 (1.15)
2. Engagement in discussion	2.43 (1.04)
Service coordination	2.76
1. Other services	2.83 (0.89)
2. Service coordination	2.70 (1.02)
Total	29.35 (7.47)

4. DISCUSSION

The spectrum of newly identified diseases or conditions was broad, highlighting the comprehensive nature of care inherent to family medicine. ⁹ It highlights the importance for family physicians to uphold a broad proficiency encompassing a wide array of illnesses. ¹⁰ The management of chronic diseases, prevention, polypharmacy, and multiple long‐term conditions epitomize the comprehensive and integrated care paradigm of family medicine.

Outpatients with complex health and social needs exhibited high scores in the “service coordination” domain of the PCAM, suggesting that comprehensive care across healthcare resources outside the clinic is needed. High levels of complexity were seen among the home‐visit care patients. Given the absence of prior home‐visit care provision in this area, the clinic was able to fill the gap through provision of home‐visit care.

This study has several limitations. The study is small in scale and conducted within a single center. There remains uncertainty regarding the needs that may have been overlooked or omitted. Research on delineating the long‐term impact of a family medicine clinic on a larger scale is warranted.

AUTHOR CONTRIBUTIONS

Conceptualization, JM, MN; methodology, JM; software, JM; validation, JM, MN, NI, KH, ES; formal analysis, JM; investigation, JM, MN, NI, KH, ES, SY, ST; resources, JM; data curation, JM, MN, NI, KH, ES; writing—original draft preparation, JM; writing—review and editing, MN, NI, KH, ES, SY, ST; visualization, JM.; supervision, MN; project administration, JM; funding acquisition, JM. All authors have read and agreed to the published version of the manuscript.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

The study received approval from the ethical committee in Ehime Seikyo Hospital (No. 51‐2‐2024‐005).

Supporting information

Appendix S1.

Mizumoto J, Nishimura M, Ishikawa N, Hisatake K, Satake E, Yamamoto S, et al. Addressing healthcare needs in an inaugural family medicine clinic in a core city in Japan: Mixed‐methods research. J Gen Fam Med. 2025;26:269–272. 10.1002/jgf2.777