Usual Source of Primary Care and Preventive Care Measures in a Pandemic: A Nationwide Study in Japan

Aoki, T.; Fujinuma, Y.; Matsushima, M.

Objectives. In a pandemic when there are many barriers to providing preventive care by health care workers, it is unclear whether primary care contributes to the quality of preventive care and what type of preventive care delivery is a challenge for primary care providers. This study aimed to assess multiple preventive care measures and to examine their associations with having a usual source of primary care and primary care performance during the COVID-19 pandemic in Japan. Design. Nationwide cross-sectional study. Setting. Japanese general adult population. Participants. 1,757 adult residents. Primary outcome measures. Fourteen preventive care measures aggregated the overall, screening, immunization, and counseling composites. Results. Depression screening, zoster vaccination, and tetanus vaccination had low implementation rates even among participants with a usual source of primary care. After adjustment for possible confounders, having a usual source of primary care was positively associated with all preventive care composites. Primary care performance assessed by the Japanese version of Primary Care Assessment Tool Short Form was also dose-dependently associated with an increase in all composites. Results of the sensitivity analyses using a different calculation of preventive care composite were similar to those of the primary analyses. Conclusions. Receipt of primary care, particularly high-quality primary care, contributed to increased preventive care utilization even during the COVID-19 pandemic. However, the rate of mental health screening in primary care was at a very low level. Therefore, addressing mental health issues should be a major challenge for primary care providers during and after the pandemic.