ArticleBMC health services research2017
The ecology of medical care on an isolated island in Okinawa, Japan: a retrospective open cohort study.
Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Healthcare-Seeking Behaviors in a Depopulated Rural Area of Shiga Prefecture, Japan in 2025: A Descriptive Study Using the Ecology of Medical Care Model.Journal of general and family medicine · 2026Article
- Practice-Based Research Network Activities and Future Nationwide Plans in Japan.Journal of general and family medicine · 2026Article
- The Ecology of Medical Care in Shanghai: Temporal Trends and International Comparisons.Risk management and healthcare policy · 2025Article
- Reasons for encounters, diagnoses, and admission rate among emergency referrals at an urban primary care clinic in Japan: A retrospective cohort study.Journal of general and family medicine · 2024Article
- Improvement in Quality of Life through Self-Management of Mild Symptoms during the COVID-19 Pandemic: A Prospective Cohort Study.International journal of environmental research and public health · 2022Article
- Association between Self-Medication for Mild Symptoms and Quality of Life among Older Adults in Rural Japan: A Cross-Sectional Study.Medicina (Kaunas, Lithuania) · 2022Article
- The Association between the Self-Management of Mild Symptoms and Quality of Life of Elderly Populations in Rural Communities: A Cross-Sectional Study.International journal of environmental research and public health · 2021Article
- Demand and supply of invasive and noninvasive ventilators at the peak of the COVID-19 outbreak in Okinawa.Journal of general and family medicine · 2020Article
- The ecology of medical care: access points to the health care system in Austria and other developed countries.Scandinavian journal of primary health care · 2019Article
- Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2019Article
- Gatekeeping function of primary care physicians under Japan's free-access system: a prospective open cohort study involving 14 isolated islands.Family practice · 2019Article
- The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study.PloS one · 2018Observational
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Authors and funding
3 authors.
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Abstract
backgroundWe aimed to describe the ecology of medical care on an isolated island with limited access to secondary care, and to evaluate the gatekeeping function of the island's primary care clinic through comparison with a previous nationwide survey.
methodsWe conducted this retrospective, open cohort study on Iheya, an isolated island in Okinawa Prefecture that has one primary care clinic. We considered Iheya as unique location in which to examine the role of primary care in Japan. Participants were patients who visited the island's clinic between February 1, 2013 and January 31, 2014. We calculated the number of visits to the clinic and referrals to off-island medical facilities using electronic medical records. We also compared data for Iheya with a nationwide survey conducted in 2003.
resultsIheya had 1314 inhabitants in 2013. Of the 5682 visits to the clinic in the 1-year study period, 290 people were referred to off-island medical institutions. There were 64 referrals to emergency departments; of these, 57 people were admitted to hospital. The rate of visits to the clinic per month per 1000 inhabitants was 360.4 visits (95% confidence interval: 351.0-369.7). Of these, 18.4 (16.3-20.5) were referred off-island, with 4.1 (3.1-5.1) referrals to emergency departments and 3.6 (2.6-4.6) hospitalizations. Despite the high incidence of visits to the primary care clinic, the rates of hospital-based outpatient clinic visits, emergency department visits, and hospitalizations were lower than rates reported in a previous Japanese study.
conclusionsThis suggests that several dimensions of primary care, its gatekeeping function in particular, are likely to play important roles in this geographical setting.
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