• Tsunetaka Kijima, Akira Matsushita, Kenju Akai, Tsuyoshi Hamano, Satoshi Takahashi, Kazushige Fujiwara, Yuko Fujiwara, Makoto Sato, Toru Nabika, Kristina Sundquist, Jan Sundquist, Yutaka Ishibashi, and Shunichi Kumakura.
• Department of General Medicine, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan. tunekijima@gmail.com.
• Bmc Health Serv Res. 2021 Mar 25; 21 (1): 274.

BackgroundThis study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty.MethodsThis cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman's correlation and structural equation modelling.ResultsOf 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness.ConclusionsWhile a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients' contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.

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