Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan

Takayuki Ando; Takashi Sasaki; Yukiko Abe; Yoshinori Nishimoto; Takumi Hirata; Junji Haruta; Yasumichi Arai

doi:10.1002/jgf2.651

Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan

J Gen Fam Med. 2023 Sep 22;24(6):343-349. doi: 10.1002/jgf2.651. eCollection 2023 Nov.

Authors

Takayuki Ando¹, Takashi Sasaki², Yukiko Abe², Yoshinori Nishimoto^{2

3}, Takumi Hirata^{2

4}, Junji Haruta^{1

5}, Yasumichi Arai²

Affiliations

¹ Center for General Medicine Education Keio University School of Medicine Tokyo Japan.
² Center for Supercentenarian Medical Research Keio University School of Medicine Tokyo Japan.
³ Department of Neurology Keio University School of Medicine Tokyo Japan.
⁴ Institute for Clinical and Translational Science Nara Medical University Kashihara Japan.
⁵ Medical Education Center Keio University School of Medicine Tokyo Japan.

Abstract

Background: Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity.

Methods: Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation.

Results: The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs.

Conclusions: RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.

Keywords: care fragmentation; continuity; multimorbidity; polydoctoring; polypharmacy.