Structural Mapping of Disease-Level Community-Based Care Patterns in Rural Clinics on Remote Islands in Japan: A...

Background/Objectives: Remote islands in Japan constitute a unique medical environment in which physicians often manage a broad spectrum of clinical conditions. However, physicians practicing on remote islands have diverse medical backgrounds, and disease-level community-based care patterns in these settings have not been systematically described. This study aimed to characterize community-based care patterns across diseases in clinics on remote islands in Japan using an exploratory conceptual framework and to examine whether facility- and physician-related attributes were associated with these patterns. Methods: We conducted a questionnaire survey in February 2023 involving rural clinics on remote islands in Japan. For each disease, respondents reported community involvement at three clinical stages-initial consultation, follow-up, and completion of care-yielding eight possible care patterns (000-111). Primary community completeness was defined as the proportion of clinics reporting community-based involvement in initial consultation and completion of care (P111 + P101). Diseases were ranked according to this metric and stratified into three predefined conceptual zones (upper, middle, and lower). Subgroup analyses examined differences in primary community completeness according to facility- and physician-related attributes, including deployment duration, prior rural practice experience, career length, and specialty composition. Results: We analyzed data from 23 clinics covering 167 diseases. Diseases formed a continuous gradient ranging from community-completable to specialist-dependent conditions. Differences in community-based care patterns were most pronounced in the middle zone. Deployment duration was associated with directional differences in community-based care patterns, whereas specialty composition was associated with larger subgroup differences. In contrast, diseases in the lower zone demonstrated relatively stable specialist-dependent patterns regardless of facility- or physician-related attributes. Conclusions: This exploratory study proposed a conceptual framework for characterizing community-based care patterns across diseases in clinics on remote islands in Japan. The findings suggest that community-based care patterns on remote islands may reflect differences in disease-related care structures as well as contextual factors. The proposed framework may support future discussions regarding education, workforce planning, and healthcare systems in remote island settings in Japan.