The Significance of Self-medication Support at Pharmacies and Drugstores -Consideration of Visit Encouragement Related to Cold-like Symptoms by Pharmacists and Drugstore Salespersons- / 日本プライマリ・ケア連合学会誌

Objective: We investigated cases of visit encouragement by pharmacists and drugstore salespersons, and confirmed the significance of self-medication support.Methods: We conducted a web survey for pharmacists working at community pharmacies and drugstores, and registered salespersons working at drugstores. The main survey items were the attributes of the respondents, whether they had experience in encouraging visits to the doctor during consultations for cold-like symptoms, and the type of encouragement (patient background, main complaints, and prognosis).Results: We obtained responses from 300 pharmacists working at community pharmacies, 57 pharmacists working at drugstores, and 56 registered salespersons. Of the respondents, 88% of the pharmacists at community pharmacies, and 100% of the pharmacists and registered salespersons at drugstores had experience in encouraging doctor visits. Of the 84 visit encouragement cases reviewed, the diseases that were often suspected were influenza, sinusitis, and gastroesophageal reflux disease. Cases of early symptoms of tuberculosis, mycoplasma pneumonia, and cerebral infarction, which were identified as a result of the doctor visits, were also included.Conclusion: Our study suggested that when customers with cold-like symptoms received accurate support from pharmacists and registered salespersons, they not only selected the correct OTC drugs for their symptoms, but they also received support that led to the early detection of serious diseases.

<b>Adverse Drug Reactions Associated to Medications for Homebound Patients: Observations Based on a Nationwide Survey in Japan</b> / 薬剤疫学

<p><b>Objective: </b>The government has been promoting further contribution to home care by pharmacists since almost all homebound patients are prescribed more than one medicine. However, little information is available on the adverse drug reactions (ADRs) in home care setting. This study was conducted to describe the ADRs reported by pharmacists in home care and examine factors related to their reports.</p><p><b>Design: </b>Questionnaire survey</p><p><b>Methods: </b>We requested patient-visiting pharmacists at community pharmacies throughout Japan to answer questions about their patients. Main questions included patient characteristics, number of drugs taken, presence of ADRs and details, and pharmacists' workload related to home-visiting.</p><p><b>Results: </b>Data on 5,447 patients were collected from 1,890 pharmacies. The percentage of patients in whom the visiting pharmacists found ADRs was 14.4%. ADRs reported in 10 or more cases covered 12 categories, accounting for 85.2% of all ADRs. The top five categories were: dizziness, grogginess, or lightheadedness; gastrointestinal disturbances; clinical test value abnormality; altered mentation; and cutaneous symptoms. In seven of the 12 ADR categories, central nervous system drugs such as sleeping pills, antianxiety drugs, and psychoneurosis drugs were in the top three suspected drugs. Additionally, patients' gender, residential situation, and the number of drugs taken were implied as factors related to ADRs.</p><p><b>Conclusion</b>：Our study indicated that, while the percentage of ADR occurrences in home-visiting service in Japan was at the same level as outpatients in other countries, drugs for the central nervous system accounted for a higher percentage of suspected drugs. Further, occurrence of ADRs was associated with the use of more than 6 concomitant drugs. These results suggest that physicians and pharmacists need to collaborate in decreasing the number and dose of central nervous system drugs.</p>

The Factors that Influence the Intention of Consumers with Cold-like Symptoms Who Visited Drugstores to Purchase OTC Drugs to Consult Pharmacists or Sellers / 医薬品情報学

<b>Objective: </b>The subjects of this study were consumers with cold-like symptoms who visited drugstores to purchase OTC drugs.  The purpose was to elucidate the factors that influence the intention of these consumers to consult pharmacists or sellers.<br><b>Design: </b>Analytic observational study<br><b>Method: </b>We conducted a survey of consumers who visited pharmacies or drugstores for cold-like symptoms.  Pharmacists and registered sellers (hereafter “pharmacists or sellers”) utilized tools to serve them, entering details in customer records.  We handed postcards to these consumers asking them to respond to questions about the prognosis and the degree of satisfaction about the service they had received.  We then used the customer records and follow-up results to perform linear regression analysis with “I would like to consult the pharmacist or seller again” (hereafter “desire for consultation”) as the dependent variable, and the usefulness of the advice and degree of satisfaction about the explanation and service as the independent variables.<br><b>Results</b>: We analyzed the data of 81 consumers for whom we were able to match the customer records and postcards.  The linear regression analysis indicated that “the usefulness of the advice (coefficient of standardization: 0.73)” affected the desire for consultation most, followed by “the degree of satisfaction about the service (coefficient of standardization: 0.24).<br><b>Conclusion: </b>We verified that, in self-medication assistance, advice that lets consumers feel the consultation was actually “helpful” by focusing on individual needs, and good customer service were necessary to increase the desire for consultation with pharmacists or sellers, and to encourage actual consultation.

Consumer Opinions on the Online Sales of Over-The-Counter Drugs / 医薬品情報学

<b>Objective: </b>To identify consumer opinions on the online sales of over-the-counter drugs (“OTCs”) and related factors.<br><b>Methods: </b>A Web survey of consumers was conducted.  The main questions were: (1) Respondent attributes; (2) Frequency of purchasing OTCs; (3) Behaviors while in poor physical condition or while ill; (4) Experience of side effects; (5) Experience of purchasing health foods and OTCs online; (6) Opinion on online sales, and (7) The reasons for their opinion.  Respondents were grouped into two categories based on whether they were for or against online sales in (6).  The distributions of the answers to (1) through (5) from these groups were verified using the χ² test.  Text mining was used to closely examine the answers to (7).<br><b>Results: </b>68.5% of the 2,609 respondents were in favor of online sales, with 31.5% against.  Females and elderly respondents had higher rates of opposition.  Consumers who frequently purchased OTCs, used drugs while in poor physical condition or while ill, and had experience purchasing health foods and OTCs online had higher rates of favoring it.  The top reason for favoring online sales was “convenience,” while the main reasons for opposing it were “safety,” “difficulty in selection,” and “liability.”<br><b>Conclusion: </b>Pharmacists will need to respond to consumer concerns when selling OTCs by developing the “ability to observe consumers’ condition and understand their concerns,” thereby improving their communication ability in face-to-face sales.

Examining the Effect of Pharmacists’ Visits to Homebound Patients on the Elimination of Unused Drugs / 医薬品情報学

<b>Objective: </b>To examine the effect of pharmacists’ visits to homebound patients on the elimination of unused drugs.<br><b>Method: </b>We conducted a survey with pharmacies throughout Japan that provided home-visit service, asking them questions regarding their work with up to five patients (the survey period was from January 15 through the end of February, 2013).  Main survey questions were: (1) whether they managed unused drugs since the start of their home-visit, and (2) how they managed the unused drugs.  For (2), we conducted case studies by asking the pharmacists to choose the case that impressed them most and describe the unused drugs involved, actions taken, and the results.<br><b>Results: </b>Data on 5,447 patients were collected from 1,890 pharmacies throughout Japan (collection rate: 56.9%).  Pharmacists managed unused drugs from 2,484 patients (45.6%). 1,746 patients (3,590 cases) were qualified for analysis.  In 2,332 cases (65.0%), pharmacist intervention eliminated the incidences of unused drugs.  In 782 cases (21.8%), unused drugs were discarded, while the number of drug administration days was adjusted in 2,623 cases (73.1%).  In 21 cases (0.6%), drugs were both discarded and had the number of days adjusted.  There were others for 164 cases (4.5%).  The total price of the eliminated unused drugs was approximately 6,920,000 yen (4,000 yen/person).  Illnesses that benefited most from the elimination of unused drugs were chronic respiratory failure (16,306 yen/person), and Parkinson’s disease (4,803 yen/person).<br><b>Conclusion: </b>We confirmed the economic effect of eliminating unused drugs by pharmacists’ home visits.

An Attempt at Objective Evaluation of the Current Situation of Concomitant Drug Use for Dementia Outpatients at Community Pharmacies / 医薬品情報学

<b>Objectives: </b>The objectives of this study are to evaluate the current situation of concomitant drug use by community-dwelling elderly dementia patients, and to extract factors influencing the presence of potentially inappropriate medications (PIMs).<br><b>Method: </b>The research subjects were patients 65 years of age or older for whom concomitant drugs were prescribed on the same prescription form as donepezil hydrochloride.  One hundred and twenty community pharmacies randomly selected from 28 of the 47 prefectures throughout Japan.  Main research topics were sex, age, the clinical department to which the prescribing physician belonged, daily dosage of donepezil, and concomitant drugs.  Concomitant drugs were evaluated using the Beers Criteria: the Japanese Version. Furthermore, to search factors influencing the presence of PIMs, logistic regression analysis was used.<br><b>Results: </b>Data for 335 patients were extracted.  The average number of concomitant drug cases per patient were 4.2 (SD 2.6), and 109 patients (32.5%) were prescribed PIMs.  A logistic regression analysis confirmed that significant factors influencing the presence of PIMs were “the clinical department to which the prescribing physician belonged” (OR 4.80, 95%CI 1.01-22.72), “concomitant drug cases” (OR 1.26, 95%CI 1.13-1.41) and “the presence of concomitant use of central nervous system agents” (OR 5.82, 95%CI 3.35-10.11).<br><b>Conclusion: </b>This study revealed that more than a few cases of community-dwelling elderly patients of dementia were using concomitant drugs with potential risks.  It suggested that influencing factors were “the specialty of the prescribing physician” and “the presence of concomitant use of central nervous system agents.”

A Study about “YARIGAI” : What Makes Work Worth Doing for the Community Pharmacists Who Participated in a Workshop of the COMPASS Project / 社会薬学

Objective : By extracting and modeling the component factors that community pharmacists have for “YARIGAI”—a Japanese colloquial expression commonly defined as “something worthwhile doing”—and by re-defining “YARIGAI,” we sought to help improve the quality of work lives of community pharmacists. Methods : All of 139 employee pharmacists participated in a workshop of the COMPASS Project (May 2011) were surveyed using a self-administered questionnaire. Responses were collected on the scene. The seventeen, 6-point-scale questions focused on the “patient-pharmacist relationship,” which may be related to “YARIGAI.” Then “YARIGAI” factors were extracted using factor analysis, and modeled using covariance structure analysis. IBM SPSS (ver. 20) and Amos 5.0J were used for the analyses. Results : To the item “I feel ‘YARIGAI’ with pharmacy work,” 12.2% of the 139 respondents said, “Strongly agree”, followed by “Agree” (41.0%) and “Somewhat agree” (33.8%). A factor analysis extracted three factors related to “YARIGAI” (knowledge, patient counseling management, and sense of personal growth). After modeling (AGFI : 0.903, RMSEA : 0.048) with these factors as latent variables and items in them as observable variables, a positive correlation was indicated for all the following factor pairs : “knowledge” and “patient counseling management”, “knowledge” and “sense of personal growth”, and “sense of personal growth” and “patient counseling management” (standardized points of estimate : 0.71, 0.55, and 0.42, respectively). Standardized coefficients for all latent and observable variables were 0.7 or higher, showing a good fit. Conclusion : “YARIGAI” of pharmacists employed by community pharmacies can consist of “knowledge,” “patient counseling management,” and “sense of personal growth”. Our results suggest that the improvement of communication skills and knowledge can lead to improvement of “YARIGAI” of pharmacists working for community pharmacies.

A Quantitative Analysis of Factors Affecting Dispensing Errors in Community Pharmacies / 医薬品情報学

<b>Objective: </b>This study quantitatively analyzes the factors causing dispensing errors in community pharmacies and explores the characteristics of these factors and their order of importance.<br><b>Design and Methods: </b>We collected data records on the contents and causes of dispensing errors as reported between April and July 2009 by a total of 320 pharmacists at 56 stores of two pharmacy chains (15 stores in Hokkaido and 41 stores in the Kansai area).  We focused on the following three types of dispensing error: 1) “measurement error”, 2) “wrong drug dispensing error” and 3) “wrong dosage form specification error”.  We conducted multiple regression analyses and discriminant analyses with occurrence frequency of each type of error as dependent variables and count frequency of each causal factor as independent variables.<br><b>Results: </b>The result of the multiple regression analyses indicated that the primary causes of the three types of errors in order of strength of the regression coefficients were as follows.  For “measurement error”: 1) pharmacist’s wrong assumption and 2) calculation error; for “wrong dosage form specification error”: 1) insufficient confirmation of prescription and 2) pharmacist’s wrong assumption; for “wrong drug dispensing error”: 1) pharmacist’s wrong assumption and 2) insufficient confirmation of prescription.  The results of the discriminant analysis indicated that only for the discriminant coefficient between “wrong dosage form specification error” and “wrong drug dispensing error” no significant difference in the mean was found (<i>p</i>=0.539).<br><b>Conclusions: </b>Results show that partly different factors cause “measurement error” as compared with the two other types of dispensing errors.  In addition, while basically the same factors were found to cause “wrong drug dispensing error” and “wrong dosage form specification error,” there was a difference in the order of importance of these factors.  This study uncovered differences in terms of causal factors affecting each dispensing error type.

A Preliminary Study about the Relationship between Workload and the Outcomes of Community Pharmacists’ Home Visiting Service / 社会薬学

Aim:To examine any relations of workload and outcomes of pharmacists’ home visiting service for medication management and guidance. Survey Target:Managing pharmacists and home-visiting pharmacists from community pharmacies of the Osaka Pharmaceutical Association’s Yao and Toyonaka branches as of March, 2012. Methods:Survey forms regarding drug management and guidance at patients’ homes were mailed, requesting mail or online response. Workload indexes were visit frequency and work time on site. The relation of workload and its outcomes was examined using univariate analysis regarding three items:change in unused medication amount;detection of side effects during visits;change in prescription. SPSS ver. 20 for Windows was used for statistical analysis. Results:90 of 201 pharmacies responded (collection rate 44.8%), and 110 home patients’ data were analyzed. 5-to-15-minute actual work time scored highest (57.4%), followed by less than 5 minutes and 15 to 30 minutes, both at 21.3%. Visit frequency of twice a month scored highest (70.4%), followed by once a week (19.4%), once a month (7.4%), and once in more than one month (2.8%). 5-minute or longer patient visits had a tendency of higher percentage of patients whose unused medication decreased after visits started than less-than-5-minute visits (<i>P</i>=0.072). “Once a week” visits had a tendency of higher percentage of pharmacists detecting side effects than less frequent visits (<i>P</i>=0.061) and changing in prescription (<i>P</i>=0.085). Conclusion:The results above implied the relationship between workload and outcomes incurred by pharmacists’ home visits for medication safety management and guidance.

Factors Affecting the Effect of Treatment of VCM Based on the Quantity of MRSA for Hospital-Acquired Pneumonia / 医薬品情報学

<b>Objective: </b>To determine the factors affecting the antimicrobial effect of VCM on MRSA.<br><b>Study Design: </b>Case series study.<br><b>Methods: </b>This study was conducted on pneumonia patients admitted to a university-affiliated hospital between January 2000 and December 2008 and had MRSA in their sputum culture.  From seven days prior to the starting VCM administration through the end of the administration, detailed information such as underlying diseases, VCM serum concentration and quantity of MRSA were recorded.  Logistic regression analysis was carried out on current diseases, trough concentration, surgery experience, and the detection of Gram-negative bacteria to verify the antimicrobial effect of VCM.<br><b>Results: </b>The number of subjects investigated this study was 55 subjects.  Multiple logistic regression analysis did not yield any significant factors when carried out using the factors affecting the antimicrobial effect of VCM on MRSA as independent variables.<br><b>Conclusions: </b>Multivariable analysis yielded no factors as being significant in affecting the antimicrobial effect of VCM, but did indicate in that patients aged 70 and older, the antimicrobial effect of VCM was poor for MRSA.  This suggests that when pharmacists intervene in antimicrobial treatment for improved effects, it is important to consider not only the serum concentration of VCM, but also the background of the patient.

The Relationship between the Awareness of Pharmacists Regarding Instructions on the Use of Inhaled Corticosteroids and the Instructions Conveyed / 医薬品情報学

<b>Objective: </b>To clarify the relationship between the awareness of pharmacists regarding instructions on the use of inhaled corticosteroids and the instructions conveyed.<br><b>Design: </b>Fact-finding-survey using self-administered questionnaires.<br><b>Methods: </b>The survey items consisted of age, years of clinical experience, number of prescriptions from asthmatics per month (“number of prescriptions”), items to concern when giving instructions (“items to concern”) time required to give instructions on inhaler usage (“time required”), and the pharmacists’ awareness regarding instructions on the inhaler usage (“awareness items”).  There were six awareness items for which responses were solicited on a four-grade scale.  Respondents were divided into two groups: a “high awareness” group giving responses of “completely agree” (or “completely disagree” for diametrically opposed items) and a “low awareness” group giving other responses.  T test was used to compare the average of age, years of clinical experience, number of prescriptions, concern degree, and time required between 2 groups.<br><b>Results: </b>This showed the higher consciousness that “instructions on inhaler usage are important issue relating to the patient’s asthma therapy” was significantly-high degree of concern and time required.  Also, the consciousness that “instructions on inhaler usage are a specialized activity performed by pharmacists” was related to age, years of clinical experience and level of concern degree.  Additionally, this suggested the pharmacists giving negative responses with respect to the notions that “the effect of instructions on inhaler usage is not worth the trouble” and “patients have insufficient desire to master of inhaler usage” had a higher degree of concern.<br><b>Conclusions: </b>For significance and importance of instructions on inhaler usage, there was confirmed to be relationship between pharmacists’ awareness and the information conveyed and time spent on the instructions.  This suggested that it was important to improve awareness of instructions on inhaler usage in both the clinical and educational setting.

Challenges in Instructing Adult Asthma Patients in the Use of Inhalers / 薬剤疫学

<B>Objective</B>: The objective of this study was to clarify issues in providing more effective guidance in the drug treatment, especially the usage instructions of inhaled steroids, of adult bronchial asthma patients by verifying which points of explanation are especially important in controlling attacks, and whether or not issues exist stemming from a evaluation gap between patients and pharmacists regarding the degree of explanation and understanding on the usage instructions of inhaled steroids.<br><B>Method</B>: Our survey targeted pharmacists working at community pharmacies in eight different areas of Japan, along with adult bronchial asthma patients using these pharmacies. Patients were questioned regarding the content and the degree of explanation in inhalation methods, the degree of understanding, and the degree of improvement in symptoms. For each point of explanation, the ratio of the score gap between (1) the patients’ evaluation (‘perception’) of the degree of the pharmacists’ explanation and pharmacists’ own evaluation of the degree of his/her own explanation, and (2) the patients’ evaluation of the degree of their own understanding and the pharmacists’ evaluation of the degree of patient understanding was calculated. We also verified the relationship between the patients’ evaluation and the degree of control of asthma attacks using a χ² test. We then reviewed the points of explanation which indicated significant difference, in an attempt to elucidate the characteristics of the patient-pharmacist “evaluation gap.”<Br><B>Results</B>: The results indicated that the degree of explanation of the “objectives of using inhaled steroids,” and “how to cope with asthma attacks,” as well as the degree of understanding of the “objectives of using inhaled steroids,” “directions for use and dosage,” and “drug interactions” provided an important clue to controlling asthma attacks. Of special note was the existence of “a gap in evaluation (perception)” regarding the degree of explanation and understanding between the patients and the pharmacists for the “objectives of using inhaled steroids” and “how to cope with asthma attacks.”<br><B>Conclusions</B>: It is crucial to pay special attention to the objectives of using inhaled steroids and how to cope with asthma attacks when guiding patients.