First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study

Abstract

Purpose

We sought to profile first-time patients without a referral who sought medical care at the Department of Internal Medicine at a medium-sized acute care hospital in Japan. We anticipated that the analysis would highlight the demand for medical care needs from acute care hospitals and help confirm one of the problems associated with primary care in Japan.

Patients and methods

The study population comprised 765 patients who sought outpatient consultation without a referral at “the Department of General Internal Medicine” at the Ikeda City Hospital on Fridays over 4 years. Data on the following variables were collected: age, sex, examination date, reason for encounter (RFE), diagnosis, as well as history of consultation with or without antibiotic treatment at another medical institution for the same RFE. We used the International Classicication of Primary Care, Revised Second edition (ICPC-2-R) codes for RFEs and diagnoses.

Results

The main RFE fields were digestive (ICPC-2-R Chapter D), general and unspecified (A), and respiratory (R). The main diagnosis fields were digestive (D), respiratory (R), general and unspecified (A), and musculoskeletal (L). In total, 27.6% of patients had sought consultation at another medical institution for the same RFE. Of these, 64.7% of patients for whom the RFE was cough (ICPC-2-R code, R05), and 72.0% for whom the RFE was fever (A03) were prescribed antibiotics. In total, 62.4% of patients underwent emergency investigations and waited for the results; 4.3% were hospitalized on the same day; and 60.5% were medicated at the initial examination. In 11.5%, the main underlying problem appeared to be psychosomatic.

Conclusion

We used the ICPC-2-R to analyze the state of first-visit patients without a referral visiting the Department of Internal Medicine at a medium-sized acute care hospital in Japan. Common RFEs were abdominal pain, cough, and fever. A tendency toward overprescription of antibiotics was observed among primary care physicians.

Keywords:

• medium-sized hospital
• general internal medicine
• general practice
• reason for encounter
• International Classification of Primary Care
• antibiotic overuse

Acknowledgments

We would like to extend our deepest gratitude toward Dr Masaki Amenomori, who gave the authors guidance regarding general medical treatment, and nurses Mieko Maeyama and Eriko Okiie, who assisted with general outpatient treatment.

We also thank Crimson Interactive Pvt. Ltd. (Ulatus) – www.ulatus.jp – and Forte Science Communications – www.forte-science.co.jp – for their assistance in manuscript translation and editing.

Author contributions

NK treated all patients, accumulated the data, and wrote the draft. KH, MM, SM, and TU participated in discussions regarding treatment, accumulation of data, and the Discussion section. MM accumulated the data. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.