Objective The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies.However,whether patterns of chronic physical conditions have comparatively different associa...Objective The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies.However,whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear.This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.Design This study was designed as a nationwide cross-sectional survey in Japan.setting General sample of the Japanese population.Participants Adult Japanese residents were selected by a quota sampling method.Data were analysed from 1788 residents who reported one or more chronic health conditions.results Among four physical multimorbidity patterns:cardiovascular-renal metabolic(CRM),skeletal-articular digestive(SAD),respiratory-dermal(RDE)and malignant-digestive urologic(MDU),multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms(aOR=1.68,95%CI:1.21 to 2.31 for the pattern score highest quartile,compared with the lowest quartile),followed by SAD and MDU patterns(aOR=1.41,95%CI:1.01 to 1.98 for the SAD pattern score highest quartile;1.41,95%CI:1.01 to 1.96 for the MDU pattern score highest quartile,compared with the lowest quartile).In contrast,the CRM pattern score was not significantly associated with depressive symptoms(aOR=1.31,95%CI:0.90 to 1.89 for the pattern score highest quartile,compared with the lowest quartile).Conclusions Physical multimorbidity patterns have different associations with depressive symptoms.Among these patterns,patients with the RDE pattern may be at a higher risk for developing depressive symptoms.This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status,which is one of the crucial outcomes for multimorbid patients.展开更多
Objectives To evaluate primary care access for COVID-19 consultation among residents who have a usual source of care(USC)and to examine their associations with patient experience during the pandemic in Japan.Design Na...Objectives To evaluate primary care access for COVID-19 consultation among residents who have a usual source of care(USC)and to examine their associations with patient experience during the pandemic in Japan.Design Nationwide cross-sectional study.Setting Japanese general adult population.Participants 1004 adult residents who have a USC.Main outcome measures Patient experience assessed by the Japanese version of Primary Care Assessment Tool Short Form(JPCAT-SF).Results A total of 198(19.7%)reported restricted primary care access for COVID-19 consultation despite having a USC.After adjustment for possible confounders,restricted primary care access for COVID-19 consultation was negatively associated with the JPCAT-SF total score(adjusted mean difference=−8.61,95%CI−11.11 to−6.10).In addition,restricted primary care access was significantly associated with a decrease in all JPCAT-SF domain scores.Conclusions Approximately one-fifth of adult residents who had a USC reported restricted primary care access for COVID-19 consultation during the pandemic in Japan.Our study also found that restricted primary care access for COVID-19 consultation was negatively associated with a wide range of patient experience including first contact.Material,financial and educational support to primary care facilities,the spread of telemedicine and the application of a patient registration system might be necessary to improve access to primary care during a pandemic.展开更多
基金the Institute for Health Outcomes and Process Evaluation Research(iHope International)provided the ethical approval for this study(approval no 201611).
文摘Objective The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies.However,whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear.This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.Design This study was designed as a nationwide cross-sectional survey in Japan.setting General sample of the Japanese population.Participants Adult Japanese residents were selected by a quota sampling method.Data were analysed from 1788 residents who reported one or more chronic health conditions.results Among four physical multimorbidity patterns:cardiovascular-renal metabolic(CRM),skeletal-articular digestive(SAD),respiratory-dermal(RDE)and malignant-digestive urologic(MDU),multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms(aOR=1.68,95%CI:1.21 to 2.31 for the pattern score highest quartile,compared with the lowest quartile),followed by SAD and MDU patterns(aOR=1.41,95%CI:1.01 to 1.98 for the SAD pattern score highest quartile;1.41,95%CI:1.01 to 1.96 for the MDU pattern score highest quartile,compared with the lowest quartile).In contrast,the CRM pattern score was not significantly associated with depressive symptoms(aOR=1.31,95%CI:0.90 to 1.89 for the pattern score highest quartile,compared with the lowest quartile).Conclusions Physical multimorbidity patterns have different associations with depressive symptoms.Among these patterns,patients with the RDE pattern may be at a higher risk for developing depressive symptoms.This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status,which is one of the crucial outcomes for multimorbid patients.
基金This work was supported by JSPS KAKENHI Grant Number JP20K18849.
文摘Objectives To evaluate primary care access for COVID-19 consultation among residents who have a usual source of care(USC)and to examine their associations with patient experience during the pandemic in Japan.Design Nationwide cross-sectional study.Setting Japanese general adult population.Participants 1004 adult residents who have a USC.Main outcome measures Patient experience assessed by the Japanese version of Primary Care Assessment Tool Short Form(JPCAT-SF).Results A total of 198(19.7%)reported restricted primary care access for COVID-19 consultation despite having a USC.After adjustment for possible confounders,restricted primary care access for COVID-19 consultation was negatively associated with the JPCAT-SF total score(adjusted mean difference=−8.61,95%CI−11.11 to−6.10).In addition,restricted primary care access was significantly associated with a decrease in all JPCAT-SF domain scores.Conclusions Approximately one-fifth of adult residents who had a USC reported restricted primary care access for COVID-19 consultation during the pandemic in Japan.Our study also found that restricted primary care access for COVID-19 consultation was negatively associated with a wide range of patient experience including first contact.Material,financial and educational support to primary care facilities,the spread of telemedicine and the application of a patient registration system might be necessary to improve access to primary care during a pandemic.
