Associations of types of primary care facilities with adult vaccination and cancer screening in Japan

Abstract

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.