Japan is trying to reform the social system because of aged population and changes in constitution of diseases. According to recent amendment of the law of community health, municipal offices got much more competence to manage health care activities. Primary care physicians need to have knowledge and technique for community health care.
The devision of general practice must take the responsibility not only in compensating for the lack of highly specialized medical education and medical care system, but also in producing physician capable for coping with changes of social systems. Especially, trainees in this division should learn clinical preventive medicine, and join some activities of community health and social services in community during their postgraducate clinical training periods.

Primary care education is extremely important for undergraduate medical students. We evaluated a primary care program with fifth-or sixth-year medical students at the Hokkaido University School of Medicine from October 2002 through July 2003. The aim of this study was to examine differences in the medical situation between a university hospital and primary care clinics and to determine the importance of primary care. We assessed students' opinions about primary care on the basis of student reports. After completing this program, medical students (30.7%) believed primary care medicine was necessary, recognized the importance of the medical techniques, and were motivated to study primary care medicine (93.6%). The problems of this program were the short schedule and the cost of public transportation. We conclude that this primary care program is extremely effective for teaching undergraduate medical students about primary care medicine.

Introduction : The purpose of this study was to review studies on consultation length in Japan.
Methods : We used Ichushi-Web, CiNii, JMEDPlus, Google Scholar, and MEDLINE, and selected and reviewed papers in which researchers have measured consultation length.
Results : We identified 26 studies, 6 of which focused on consultation length in terms of associated factors such as the differences between specialty departments. Seven studies performed in outpatient clinics focused on waiting time as the main topic of investigation and secondarily measured consultation length. In addition, consultation length was used as an indicator for introducing interventions. Three studies discussed appropriate consultation length. Two studies investigated patient satisfaction. The definition of consultation length varied among studies.
Conclusion : Few studies investigated patient outcomes. Further studies are required to monitor consultation length and patient outcomes as well as to clarify the definition of consultation length.

Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital. Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified. Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization. Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.

There is systematic evidence that community-based education is effective in the recruitment of rural physicians to remote communities. However, various obstacles may exist that prevent rural physicians from sustaining their mentoring activities. The aim of this study was to explore ways for rural physicians to overcome such adversities and continue their mentoring activities. We interviewed four nominated physicians (all male, mean age 48 years) based in Hokkaido, Japan, who practiced in an area with less than 10,000 inhabitants. Semi-structured interviews of approximately 60 minutes were performed and focused on topics rural physicians’ found necessary for their teaching activities. All interviews were tape-recorded and transcribed, the verbatim transcripts were analyzed and repeated themes were identified. Three themes that emerged as needs were 1. sustained significant human relationship, including the formation of a network between students and university faculty, as well as developing partnerships with many community relationships, or other medical professions; 2. intrinsic motivations and satisfaction, including pleasure in mentoring the younger generations; and 3. rewards, including financial compensation. Rural physicians as preceptors require nonremunerative, intrinsic motivational factors, such as a sense of satisfaction regarding the education of medical students and being able to relate to residents and others health-care professions, when pursuing their educational activities. To support them, focusing only on monetary facets may be unsuccessful in encouraging them to continue their educational work.

Background: This study aimed to evaluate the relationship between disease type and healthcare-seeking behavior in patients in order to assess the role of primary care in rural areas of Japan.
Methods: National Health Insurance receipt data were collected for outpatients from four towns in Hokkaido, Japan. Disease names were encoded using the International Classification of Primary Care-2 (ICPC-2) coding system. Patient data were divided into two categories: those visiting medical facilities in their own towns and those visiting medical facilities in other towns.
Results: The percentage of patients who visited medical facilities outside their own town ranged from 42.9% to 72.7%; the mean value for all four towns was 54.6%. The three most frequent ICPC-2 codes according to the reimbursement receipts were K86 (hypertension, uncomplicated), T93 (lipid disorder), and T90 (diabetes, noninsulin dependent), and patients with T90 visited facilities in other towns more than those with K86 and T93. Patients with diseases of the eye, such as F91 (refractive error), F92 (cataract), and F71 (allergic conjunctivitis), and those with psychological disorders, such as P76 (depressive disorder), tended to visit facilities outside their towns rather than in their own towns.
Conclusions: Data regarding patients who visit medical facilities in their own towns may provide information on the role of primary care in that particular town. The analysis of medical reimbursement receipts from a particular area provides useful information about disease distribution in addition to an overview of the healthcare needs of the entire community in that area.