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ObjectiveThe aim of this study was to explore factors associated with healthcare professionals’ subjective perceptions of complex issues in primary care settings in Japan.DesignCross-sectional survey conducted through a self-administered web-based questionnaire.SettingJapan, from June to October 2020.ParticipantsHealthcare professionals recruited via an email list from the Japan Primary Care Association.MeasuresThe questionnaire assessed subjective perception of satisfaction, confidence and burden regarding complex issues using a 100 mm Visual Analogue Scale (VAS). Explanatory variables included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), basic demographic information, administrative experience and an organisational climate scale. This scale comprised the ‘Plan, Do, See’ (PDS) factor for management and the ‘Do’ factor in a leader-centred direction for those working under compulsion. Factors associated with subjective perceptions were analysed using binomial logistic regression analysis and Bonferroni analysis (p<0.017).ResultsData from 593 participants (average age of 41.2 years, including 133 nurses, 128 physicians and 120 social workers) were analysed. Median (quartile) VAS scores for satisfaction, confidence and burden were 50 (36–70), 52 (40–70) and 50 (30–66), respectively. Higher satisfaction group was significantly associated with PDS factor, Do factor and JASSIC Score. Greater confidence group associated with older age, male, Do factor, administrative experience and JASSIC Score. No factors were significantly associated with the higher perceived burden.ConclusionThese findings reveal that interprofessional competency self-assessment influence perceptions of complex issues among healthcare professionals. Moreover, satisfaction with complex issues might be enhanced by a manageable organisational climate, while confidence might be influenced by personal attributes.

Interprofessional education (IPE) for medical students is becoming increasingly important, as reflected in the increasing number of medical schools adopting IPE. However, the current status of and barriers to pre-registration IPE implementation in Japanese medical schools remain unknown. The purpose of this study was to clarify the status and barriers of IPE implementation in medical schools in Japan. We conducted a curriculum survey from September to December 2016 of all 81 medical schools in Japan. We mailed the questionnaire and asked the schools' undergraduate education staff to respond. The survey items were the IPE implementation status and barriers to program implementation. Sixty-four of the 81 schools responded (response rate 79.0%), of which 46 (71.9%) had implemented IPE, 42 (89.1%) as compulsory programs. Half of IPE programs were implemented in the first 2 years, while less than 10% were implemented in the latter years of medical programs. As part of the IPE programs, medical students collaborated with a wide range of professional student groups. The most common learning strategy was lectures. However, one-third of IPE programs used didactic lectures without interaction between multi-professional students. The most common perceived major barrier to implementing IPE was adjustment of the academic calendar and schedule (82.8%), followed by insufficient staff numbers (73.4%). Our findings indicate that IPE is being promoted in undergraduate education at medical schools in Japan. IPE programs differed according to the circumstances of each school. Barriers to IPE may be resolved by improving learning methods, introducing group discussions between multi-professional students in lectures or introducing IPE programs using team-based learning. In summary, we demonstrated the current status and barriers of IPE implementation in Japanese medical schools. Our findings will likely lead to the promotion of IPE programs in Japan.

BackgroundOlder adults’ uptake of influenza and pneumococcus vaccines is insufficient worldwide. Although patient experience of primary care is associated with vaccine uptake in children, this relationship remains unclear for older adults.ObjectiveThis study examined the association between patient experience of primary care and influenza/pneumococcal vaccine uptake in older adults.Design and MethodsWe conducted a multicentered cross-sectional survey involving 25 primary care institutions in urban and rural areas in Japan. Participants were outpatients aged ≥ 65 years who visited one of the participating institutions within the 1-week study period. We assessed patient experience of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which includes six domains: first contact (accessibility), longitudinality (continuity of care), coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a generalized linear mixed-effects model to adjust for clustering within institutions and individual covariates.Key ResultsOne thousand participants were included in the analysis. After adjusting for clustering within institutions and other possible confounders, influenza and pneumococcal vaccine uptake was positively associated with JPCAT total scores (odds ratio per 1 standard deviation increase: 1.19, 95% confidence interval: 1.01–1.40 and odds ratio: 1.26, 95% confidence interval: 1.08–1.46, respectively). Of the JPCAT domains, coordination and community orientation were associated with influenza vaccine uptake and longitudinality, coordination, and comprehensiveness were associated with pneumococcal vaccine uptake.ConclusionsInfluenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake.

Background Self‐assessment of professionals' interprofessional competency is meaningful for benchmarking oneself and helping to identify training needs. We aimed to clarify differences in self‐assessment of interprofessional competency in Japan by profession and type of facility. Methods We conducted a cross‐sectional study using a web survey among primary healthcare providers in Japan, especially members of the Japan Primary Care Association, between June and October 2020. After sampling using the e‐mail list, we used an exponential nondiscriminative snowball method as purposive sampling through key professional informants between November 2020 and February 2021. The questionnaire covered items including participant demographics (age, gender, years of experience as professionals, years of experience working at the current institution, attendance type (regular or part‐time work), administrative experience, profession, and facility type) and included the Japanese version of the Self‐assessment Scale of Interprofessional Competency (JASSIC). Differences between healthcare professions (physician, nurse, pharmacist, rehabilitation therapist, and social worker) and between types of facility (university hospital, medium‐sized hospital, small hospital, and clinics) were compared using the Kruskal–Wallis test. Results A total of 593 people responded to the survey. Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. JASSIC scores of physicians and social workers were significantly higher than those of rehabilitation therapists (p < 0.01). Concerning facilities, professionals working in clinics rated themselves higher than those in medium‐sized hospitals (p < 0.01). Conclusions We revealed that self‐assessment of interprofessional competency in Japan varied by profession and type of facility. We clarified differences in self‐assessed interprofessional competency among health and welfare professionals in Japan in relation to profession and type of facility, using an anonymous, self‐administered questionnaire (web survey). We used the Japanese version of Self‐assessment Scale of Interprofessional Competency (JASSIC). A total of 593 people responded to this survey, which revealed higher JASSIC scores for physicians and social workers than for rehabilitation therapists.

Background The aim of this study was to explore what experiences certified primary care physicians (PCPs) in Japan found meaningful in their work. Method Between October 2021 and February 2022, semi-structured interviews were conducted with Japan Primary Care Association (JPCA)-certified family physicians or JPCA Diplomates in primary care who were working at clinics or small hospitals in Japan regarding “work experiences that they felt were meaningful as physician’s work”. The interviews were conducted face-to-face or via video call. The data obtained were transcribed verbatim and data analysis was conducted using inductive thematic analysis. Results Fourteen physicians participated in the interview survey. Six themes were identified regarding work experiences that PCPs found meaningful: 1) management of diverse health problems, 2) comprehensive approach to patients, their families, and their issues, 3) trust relationships with patients built by continuity, 4) experience supporting patients with complex problems through interprofessional collaboration, 5) contribution to healthcare provider and medical student education, and 6) contribution to the community and society. Conclusion PCPs appear to find meaning in their work through two main pathways. First, they improve their own clinical abilities through practice. Second, they experience fulfillment by contributing to patients and the broader community. This clarification of the specific experiences of PCPs that are related to the meaning of work could potentially encourage PCPs working in various settings.

Abstract PurposeThe purpose of the present study was to quantitatively determine the expression of transporters, receptors and tight junction molecules at the blood-arachnoid barrier (BAB) and blood-spinal cord barrier (BSCB) in cervical, thoracic and lumbar spines from dogs.MethodsThe expression levels of 31 transporters, 3 receptors, 1 tight junction protein, and 3 marker proteins in leptomeninges and capillaries isolated from spines (3 male and 2 female dogs) were determined by quantitative Targeted Absolute Proteomics (qTAP). The units were converted from fmol/μg protein to pmol/cm (absolute abundance at the BAB and the BSCB in a 1 cm section of spine).ResultsThe expression of MDR1 and BCRP were greater at the BSCB compared to the BAB (especially in the cervical cord), and the expressions at the lumbar BSCB were lower than that for the cervical BSCB. Among the organic anionic and cationic drug transporters, OAT1, OAT3, MRP1, OCT2 and MATE1/2 were detected only in the BAB, and not at the BSCB). The expression of these transporters was higher in the order: lumbar > thoracic > cervical BAB. The expressions of GLUT1, 4F2hc, EAAT1, 2, PEPT2, CTL1, and MCT1 at the BSCB of the cervical cord were higher than the corresponding values for the cervical BAB, and these values decreased in going down the spinal cord.ConclusionThese results provide a better understanding of the molecular mechanisms underlying the concentration gradients of drugs and endogenous substances in the cerebrospinal fluid and parenchyma of the spinal cord.

Background Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work. Methods This was a cross‐sectional study that used self‐administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J‐WAMI) were also assessed. Participants were divided into high‐ and low‐scoring groups according to the median J‐WAMI score, and logistic regression analysis was performed to identify factors related to the high J‐WAMI‐scoring group. Results A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years. The median overall J‐WAMI score was 38. Factors associated with the high J‐WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95% CI: 1.02–1.06) and engagement in research (OR: 2.74, 95% CI 1.33–5.66). Conclusions Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among PCPs. Supporting these types of work may enhance PCPs' value of their work. Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among primary care physicians in Japan.

Background This study investigated social participation trajectories following the Coronavirus Disease 19 (COVID‐19) pandemic and its relationship with frailty among community‐dwelling older adults. Methods We selected 5000 older residents (65–84 years) from Kitaibaraki City, Japan, excluding those certified for long‐term care. After the first survey in April 2022, the second survey was conducted with 1931 respondents from the first survey in May 2023. Respondents of the second survey who had participated in social participation activities in January 2020 were eligible for this study. The questionnaire included social participation status in January 2020, April 2022, and May 2023, along with the Kihon Checklist in April 2022 and May 2023. Participants were categorized into four groups according to the participation status: Continued, Resumed, Discontinued in 2023, and Discontinued in 2022. Binary logistic regression analysis assessed the relationship between these groups and frailty risk assessed by Kihon Checklist, adjusting for age, gender, living status, economic conditions, working status, self‐rated health, and 2022 frailty status. Results Of 1289 respondents (66.8%), 648 were analyzed. Social participation groups were: Continued (284, 43.8%), Resumed (119, 18.4%), Discontinued in 2023 (92, 14.2%), and Discontinued in 2022 (153, 23.6%). The Discontinued in 2022 group had a significantly higher risk of frailty (OR = 2.26, 95% CI: 1.16–4.42, p = 0.017) compared to the Continued group. Conclusions Social participation trajectories are associated with frailty risk in older adults. Sustained discontinuation of social activities, particularly since 2022, is related to increased frailty risk, highlighting the importance of maintaining social engagement.

Introduction/objectives: A primary care patient’s decision to undergo seasonal influenza vaccination may have been different during the global COVID-19 pandemic in the 2020 to 2021 season. The purpose of this study is to investigate what affected primary care patients’ decisions to undergo seasonal influenza vaccination in the 2020 to 2021 season. Methods: Semi-structured interviews were conducted in a primary care clinic in Ibaraki, Japan. We used a purposive sampling strategy to reach individuals aged 20 years or older who underwent influenza vaccination. The transcripts were analyzed using thematic analysis. Results: Twenty-one patients completed the interview. Two main themes emerged: the desire to avoid risks to one’s health and being a part a community in coexistence with others. The first theme included desire to avoid influenza and expectations that vaccination will prevent severe disease. The second theme included concerns about the consequences of one’s own influenza infection on others in the community and necessity of vaccination based on the surroundings and others. Conclusions: Raising awareness of risk factors such as older age and comorbidities, and the expectations of community members might be effective in promoting influenza vaccination.

Introduction/Objectives: This study aimed to clarify what primary care physicians (PCPs) in Japan understand of the role of physical therapists (PTs) through the experience of working with PTs in hospitals, and what roles PCPs expect for PTs in future primary care. Methods: Semi-structured interviews were conducted individually with 9 purposively sampled PCPs with sufficient experience of collaboration with PTs. Interview data were analyzed by theme analysis focusing on “What does the PCP understand about the role of PTs through the experience of working with PTs in hospitals?” and “What roles and purposes does the PCP wish for PTs in primary care settings?” Results: PCPs viewed PTs as providers of rehabilitation in the traditional medical model, and understood their role as an occupation having a mono-causal viewpoint, namely a specific and well-defined outcome for individual patients, and intervening with patients within a short clinical course with the aim of improvement or maintenance of the patient’s condition. With regard to future primary care, PCPs expected that PTs would interpret various factors related to patient lives from the viewpoint of causal interactions; become important stakeholders in the community; and respond flexibly to patients and the environmental factors around them with continued support to the individual. Conclusions: PCPs understood the role of PTs in hospitals as “Rehabilitation in the traditional medical model,” and expected the future role of PTs in primary care as “Rehabilitation in integrated community care.”