Associations of types of primary care facilities with adult vaccination and cancer screening in Japan.
OBJECTIVE
To examine the association between primary care facility types and the quality of preventive care, especially adult vaccination and cancer screening, with a focus on the differences between community clinics and hospitals.


DESIGN
Multicenter cross-sectional study.


SETTING
A primary care practice-based research network in Japan (25 primary care facilities).


PARTICIPANTS
Adult outpatients for whom the participating facility serves as their usual source of care.


INTERVENTION
None.


MAIN OUTCOME MEASURES
Influenza and pneumococcal vaccination delivery and performance of colorectal, breast and cervical cancer screening.


RESULTS
Data collected from 1725 primary care outpatients were analyzed. After adjustment of possible confounders and clustering within facilities, hospital-based practices were significantly associated with poorer uptake of influenza [adjusted odds ratio (aOR) = 0.64, 95% confidence interval (CI) 0.42-0.96] and pneumococcal vaccines (aOR = 0.55, 95% CI 0.40-0.75) and colorectal cancer screening (aOR = 0.59, 95% CI 0.39-0.88) compared with clinic-based practices. In contrast, the associations of types of primary care facilities with uptake of breast and cervical cancer screening were not statistically significant.


CONCLUSIONS
Differences in the performance of adult vaccination and cancer screening raised concerns about the provision of preventive care at hospital-based compared with clinic-based primary care practices. Efforts to improve preventive care at hospital-based primary care practices should help to promote equalization of the quality of primary care. Further study is needed on the comparisons of other quality indicators among different structures of primary care facilities.
['Aoki|Takuya|T|', 'Fukuhara|Shunichi|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000554:Ambulatory Care Facilities D001943:Breast Neoplasms D015179:Colorectal Neoplasms D003430:Cross-Sectional Studies D055088:Early Detection of Cancer D005260:Female D006801:Humans D007252:Influenza Vaccines D007564:Japan D008875:Middle Aged D010044:Outpatient Clinics, Hospital D022242:Pneumococcal Vaccines D011320:Primary Health Care D011795:Surveys and Questionnaires D002583:Uterine Cervical Neoplasms D014611:Vaccination
vaccination ambulatory care early detection of cancer preventive medicine primary health care quality of health care