Polydoctoring and Health Outcomes among the Very Old Population with Multimorbidity in Japan: A Retrospective Cohort Study
Introduction
As the global population ages, understanding healthcare dynamics becomes crucial, especially among the very old individuals living with multiple chronic conditions – a group known as those with multimorbidity. This blog post discusses findings from a retrospective cohort study conducted in Japan, focusing specifically on the phenomenon of polydoctoring—where patients receive care from multiple healthcare providers—and its impact on health outcomes.
Study Design and Setting
The study utilized data from the DeSC database, spanning from April 2014 to December 2022. This comprehensive database includes medical claims information from various insurers across Japan’s North Kanto, Kinki, Tokai, and Shikoku regions. Primarily, the elderly population aged 75 years and above is covered by Japan’s Long-Life Medical Care System (LLMCS), which guarantees access to healthcare services largely free of charge. Participants were selected based on specific eligibility criteria ensuring a focus on individuals aged 75-89 years with at least two chronic conditions.
Study Population
The research aimed to analyze a sample of elderly patients who had demonstrated a wide range of chronic illnesses, defined according to the Fortin list. By excluding individuals aged 90 and above and those hospitalized at the start of the observation period, the study ensured a more homogeneous cohort. Participants were observed for at least six months, beginning from their entry date into the study.
Outcomes Measured
The primary outcome of the study was all-cause mortality, while the secondary outcomes included hospitalizations for all causes and those specifically due to ambulatory care-sensitive conditions (ACSC). The latter category is crucial in understanding the quality and continuity of primary care, providing insights into preventable hospitalizations that could arise from poor care coordination.
Key Variables
The study focused on the number of regularly visited facilities (RVFs) as a proxy for polydoctoring. Patients visiting various healthcare facilities thrice a year formed the operational definition of RVFs. The research also controlled for demographic factors like age and sex, while utilizing the Charlson Comorbidity Index (CCI) to account for the severity of patients’ health conditions.
Statistical Analysis
Employing multivariable Cox proportional hazard models, the study examined associations between RVFs and both primary and secondary outcomes. Kaplan-Meier survival curves illustrated time to all-cause mortality and hospitalizations. Costs associated with outpatient medical care were also analyzed to understand the economic burden stemming from polydoctoring.
Results and Implications
Early findings of the study shed light on the complex relationship between polydoctoring and health outcomes. Those patients with lower RVFs generally exhibited better health outcomes, likely due to more coordinated care. Conversely, individuals with excessive RVFs experienced increased mortality and hospitalization, suggesting a stark warning regarding fragmented care.
Moreover, the study highlighted the financial pressures associated with polydoctoring. Patients engaging with many health providers incurred significantly higher outpatient medical costs—a finding that speaks volumes to the burden on both patients and the healthcare system. This financial strain may exacerbate health disparities, particularly within vulnerable elderly populations.
Challenges and Future Directions
The challenges related to polydoctoring manifest not only in health outcomes but also in the management of medical expenses. Appropriate strategies must be developed to encourage coordinated care while avoiding the pitfalls of fragmented healthcare. Future studies should explore interventions that promote integrated care, which could significantly improve health outcomes while minimizing costs.
Conclusion
This retrospective cohort study underscores the importance of understanding polydoctoring and its implications for health outcomes among Japan’s elderly population with multimorbidity. The findings suggest a need for policies that strengthen care coordination and reduce unnecessary exposure to multiple healthcare providers. As healthcare practices evolve globally, these insights may offer valuable lessons for other countries grappling with similar demographic challenges.
In conclusion, the pathway towards better health outcomes in the very old, multimorbid population is paved with the need for a healthcare framework that prioritizes continuity and quality of care over sheer volume. By addressing the intricacies of polydoctoring, we may be able to enhance the health and well-being of one of the most vulnerable segments of our society.
