title: Physician cardiovascular disease risk factor management: practice analysis in Japan versus the USA.
abstract: BACKGROUND
  There is a 42% lower cardiovascular disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in practice management of CVD risk factors in the two countries that might contribute to this difference?
  
  
  OBJECTIVE
  CVD risk factor management reported by Japanese versus US primary care physicians was studied.
  
  
  METHODS
  We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey.
  
  
  RESULTS
  The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use practice guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001).
  
  
  CONCLUSIONS
  Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing CVD risk factors deserves study. This descriptive report poses questions that require a more definitive study either with a more representative sample or direct observation of physician practices. US physicians responding to the survey reported greater administrative efforts, frustration and disparities in their practice, yet they followed practice guidelines more carefully. Japanese physicians responding reported focusing on quick, frequent visits that may have been more medication oriented, expecting more patient responsibility in self-care, which may have resulted in better chronic disease management. There may be differences in CVD risk factor management by primary care physicians in Japan versus the USA.
authors.affiliation: University of North Carolina, Chapel Hill, USA. rschuste@uga.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schuster
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhu
authors.forename: Oluseye
authors.initials: O
authors.lastname: Ogunmoroti
authors.forename: Nancy
authors.initials: N
authors.lastname: Terwoord
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ellison
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiyoshi
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Muira
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012307:Risk Factors; D012308:Risk Management; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology