title: Attributes of primary care in relation to polypharmacy: a multicenter cross-sectional study in Japan.
abstract: OBJECTIVE
  To investigate the association between attributes of primary care and polypharmacy.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A primary care practice-based research network in Japan (28 primary care clinics).
  
  
  METHODS
  Adult outpatients filled out a standardized questionnaire.
  
  
  METHODS
  Polypharmacy defined as the use of five or more concurrent prescription or over-the-counter medications.
  
  
  METHODS
  Attributes of primary care were assessed via patient experience using the Japanese version of Primary Care Assessment Tool (JPCAT). Poisson mixed effects model was used to adjust for clustering within clinics and covariates.
  
  
  RESULTS
  Data were analyzed for 544 primary care outpatients. After adjusting for patients' sociodemographic and health characteristics, the JPCAT community orientation score was found to be inversely associated with polypharmacy at the clinic level [risk ratio per 1 standard deviation increase = 0.83; 95% confidence interval (CI), 0.73-0.96; P = 0.008]. Sensitivity analyses using a different definition of polypharmacy showed results similar to those of the primary analyses.
  
  
  CONCLUSIONS
  We found that a higher level of community-oriented primary care is associated with a lower prevalence of polypharmacy in outpatients at the clinic level. These findings may be useful in developing community-based interventions to minimize polypharmacy.
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsuyoshi
authors.initials: T
authors.lastname: Ikenoue
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan.
authors.forename: Morito
authors.initials: M
authors.lastname: Kise
authors.affiliation: Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Fujinuma
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.|Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan.|Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D019338:Polypharmacy; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: drug errors; patient experience; patient-centered care; polypharmacy; primary care/general practice