Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan
Abstract Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, “polydoctoring,” where patients see mult...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Journal of General and Family Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jgf2.651 |
| _version_ | 1797627774265982976 |
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| author | Takayuki Ando Takashi Sasaki Yukiko Abe Yoshinori Nishimoto Takumi Hirata Junji Haruta Yasumichi Arai |
| author_facet | Takayuki Ando Takashi Sasaki Yukiko Abe Yoshinori Nishimoto Takumi Hirata Junji Haruta Yasumichi Arai |
| author_sort | Takayuki Ando |
| collection | DOAJ |
| description | Abstract Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, “polydoctoring,” where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community‐dwelling older adults aged 85–89 were utilized in this cross‐sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity. |
| first_indexed | 2024-03-11T10:29:14Z |
| format | Article |
| id | doaj.art-f0f5b1b41c4f49bbb3607cbfeecf4a99 |
| institution | Directory Open Access Journal |
| issn | 2189-7948 |
| language | English |
| last_indexed | 2024-03-11T10:29:14Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of General and Family Medicine |
| spelling | doaj.art-f0f5b1b41c4f49bbb3607cbfeecf4a992023-11-15T05:53:10ZengWileyJournal of General and Family Medicine2189-79482023-11-0124634334910.1002/jgf2.651Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in JapanTakayuki Ando0Takashi Sasaki1Yukiko Abe2Yoshinori Nishimoto3Takumi Hirata4Junji Haruta5Yasumichi Arai6Center for General Medicine Education Keio University School of Medicine Tokyo JapanCenter for Supercentenarian Medical Research Keio University School of Medicine Tokyo JapanCenter for Supercentenarian Medical Research Keio University School of Medicine Tokyo JapanCenter for Supercentenarian Medical Research Keio University School of Medicine Tokyo JapanCenter for Supercentenarian Medical Research Keio University School of Medicine Tokyo JapanCenter for General Medicine Education Keio University School of Medicine Tokyo JapanCenter for Supercentenarian Medical Research Keio University School of Medicine Tokyo JapanAbstract Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, “polydoctoring,” where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community‐dwelling older adults aged 85–89 were utilized in this cross‐sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.https://doi.org/10.1002/jgf2.651care fragmentationcontinuitymultimorbiditypolydoctoringpolypharmacy |
| spellingShingle | Takayuki Ando Takashi Sasaki Yukiko Abe Yoshinori Nishimoto Takumi Hirata Junji Haruta Yasumichi Arai Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan Journal of General and Family Medicine care fragmentation continuity multimorbidity polydoctoring polypharmacy |
| title | Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan |
| title_full | Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan |
| title_fullStr | Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan |
| title_full_unstemmed | Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan |
| title_short | Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross‐sectional study in Japan |
| title_sort | measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity cross sectional study in japan |
| topic | care fragmentation continuity multimorbidity polydoctoring polypharmacy |
| url | https://doi.org/10.1002/jgf2.651 |
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