title: Population-level preferences for primary care physicians' characteristics in Japan: a structural equation modeling.
abstract: OBJECTIVE
  Primary care has potential to play a role for improving the patient care in Japanese health care system; however, little information is available about how patients perceive the roles of primary care physicians (PCPs) within the Japanese health care system. We aimed to assess population-level preferences for PCPs and investigated the extent to which preferences vary in relation to different population groups in Japan.
  
  
  METHODS
  Data were extracted from a cross-sectional questionnaire survey in October 2003. An 18-item questionnaire was used to measure the preferences for PCPs. Exploratory factor analysis was performed to identify latent factors, while confirmatory factor analysis was used to evaluate the fit of the structure using structural equation modeling (SEM).
  
  
  METHODS
  Nationally representative sample of the adult Japanese general population was chosen by controlling for age, sex, and the size of cities.
  
  
  RESULTS
  A total of 2,453 adults>or=18-years-old were analyzed. SEM provided a 4-factor structural model of the population-level preference for PCPs, such as clinical competence (path coefficient (pc)=0.72), gate-keeping (pc=0.64), communication with patients or specialists (pc=0.49) and high education (pc=0.25) and demonstrated the best goodness-of-fit. Those who were middle aged, have a high family income, and a high level of education, placed more importance on gate-keeping characteristics, and the rural residents emphasized communication rather than clinical competence.
  
  
  CONCLUSIONS
  Our results indicate that the preferences for PCPs are divided into four main factors and underscore the variation among preferences according to different population groups, such as age, socioeconomic and educational status, and places of living. These variations should be considered to improve the primary care system in Japan.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, St. Luke's Graduate School of Nursing, Tokyo. otakahas@luke.or.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.forename: Sachiko
authors.initials: S
authors.lastname: Ohde
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Jacobs
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Haruo
authors.initials: H
authors.lastname: Yanai
authors.forename: Tomoya
authors.initials: T
authors.lastname: Okubo
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Hinohara
authors.forename: Tsuguya
authors.initials: T
authors.lastname: Fukui
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D057240:Patient Preference / Q000523:psychology*; D010821:Physicians, Family / Q000191:economics / Q000458:organization & administration / Q000523:psychology*; D044382:Population Groups / Q000208:ethnology / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D012959:Socioeconomic Factors; D055815:Young Adult