Given this gap in the literature, the purpose of this study was to examine duration of visits and how these differ by factors such as age and gender in Japan. His office hours, billing procedures, staffing and mix of outpatient care and home visits are typical to private practitioners in rural Japan. The physician introducing himself signaled the start time and extending his salutations to the patient marked the end of the consultation. This research was approved by the University of Michigan Institutional Review Board, ID HUM, and the need for written consent for adults and assent for children was waived because the research presented no more than minimal risk, assent was not practicable, and waiver would not impact the rights and welfare of subjects. Japan also has a Long Term Care Insurance Kaigo Hoken program that covers disability as a consequence of medical conditions[ 6 , 7 ]. Consultations were recorded in seconds, and later converted to minutes.
The mean consultation duration was 6. A two-sample t-test was used to identify any possible differences in mean consulting time between acute and chronic reasons for encounter. Further, a logistic regression analysis was carried out to identify any difference in the likelihood for acute and chronic reasons for encounter by gender and age. The population of Japan has universal coverage either through employee insurance or through the National Health Insurance scheme[ 2 - 5 ]. The majority of cases seen in the clinic were stable, chronic conditions and required shorter consultation times. For example, assuming the standard deviation of the consultation length to be 3. Japanese private practitioners often see patients a day[ 13 ]. Logarithm of consultation time in minutes is used as an outcome since the resultant model provided a better fit to the normality assumption. However, it does not provide moment-by-moment details for a fine-grained understanding of time utilization. This article has been cited by other articles in PMC. Most private practitioners do not provide women's health unless they trained in obstetrics and gynecology. Since they do not have hospital privileges they provide ambulatory-based chronic and acute care, and often home care[ 10 ]. The chronically ill make short clinic visits every days just for medications. Prescribing patterns strongly contribute to the most striking feature of Japanese ambulatory care practice, e. The Okkes study collected data from several countries including Japan regarding reasons of encounters, diagnoses, and interventions[ 18 ]. Japan also has a Long Term Care Insurance Kaigo Hoken program that covers disability as a consequence of medical conditions[ 6 , 7 ]. Although the physician was aware that data about his consultation lengths would be recorded, he did not know the days that time data would be collected. Recent data suggests the longest mean duration of drug dispensing from outpatient offices is 30 days with many chronic medications dispensed for less than 20 days[ 12 ]. Methods Design We conducted a detailed case study of primary care delivery for all patient visits during 8 days at a Japanese family physician's clinic in rural Japan. While the legal limits of the duration of most drug prescriptions officially increased from a maximum of 90 days to more than 90 days in ,[ 11 ] the vast majority of physicians prescribe about a 14 day supply[ 12 ]. To determine time spent according to consultation type - whether acute, chronic or preventive - the reason of the visit and the diagnosis were reviewed and were coded per visit. Other than studies of geriatric clinics and a small linguistics study of ten patient-physician interactions [ 14 , 15 , 17 ] the literature lacks empirical studies on primary care consultation length in Japan. Descriptive statistics were obtained to identify features of the data. This research was approved by the University of Michigan Institutional Review Board, ID HUM, and the need for written consent for adults and assent for children was waived because the research presented no more than minimal risk, assent was not practicable, and waiver would not impact the rights and welfare of subjects. While the Japanese government does not recognize family medicine as a specialty in Japan, there is a national movement to develop family medicine training. The consultation length was recorded using a small digital timer to avoid disrupting the physician-patient interaction. The most informative cross-national comparative research results can be found in studies led by Okkes and Yamada[ 18 , 19 ].
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