Relationship Between Physicians’ Engagement in Home Medical Care,Inpatient Care or Both,and Their Approach to Caring for Older Patients With Multimorbidity in Japan

Abstract

In Japan, little is known about the approaches to medical care for older patients with multimorbidity used by physicians either at patients’ homes or in hospitals. A questionnaire survey was conducted to understand the current approaches to older patients with multimorbidity. The questionnaire was sent to 3300 people, including 1650 geriatric specialists and 1650 primary care specialists, were enrolled. A four-point Likert-type scale was used to score the following items: diseases that cause difficulties in treatment (diseases), patient backgrounds that cause difficulties in treatment (backgrounds), important clinical factors, and important clinical strategies. We used the Tukey–Kramer test to examine the differences between scores across 3 groups: physicians providing only home care (the “home” group), physicians providing only inpatient care (the “hospital” group), and physicians providing both home care and inpatient care (the “home and hospital” group). Out of 836 valid responses, those from 587 physicians were included in the analysis. The overall score for diseases was significantly higher in the “hospital” group than in either the “home” or “home and hospital” groups. The overall score for important clinical strategies was significantly higher in the “home and hospital” group than in the “hospital” group. In conclusion, physicians’ approaches to treating older people with multimorbidity may vary by practice setting, and particularly whether they provide care only to patients at home or in hospital or to both. To improve the quality of transition of care between hospital and home, a support system that considers differences in physician practice should be developed.