Identification of the Discrepancies between Pharmacist and Patient Perception of the Pharmacist's Role as an Advisor on Drug Therapy Based on Social Science Theory.

Article 25-2 of the Japanese Pharmacists' Act was revised in June 2014, establishing the position of pharmacists as "advisors on the use of pharmaceuticals." Prior to the Act's revision, we investigated the perceptions of patients and pharmacists about pharmacists' roles using a social science methodology. We also examined current opinions and necessary factors for the future growth and development of pharmacists. This questionnaire survey was conducted using an internet method. Patients and pharmacists answered 12 questions. Responses from 529 patients and 338 pharmacists were analyzed. For all items, pharmacists' awareness of their roles exceeded patients' awareness of the roles. In this study, the difference between pharmacist and patient awareness was larger than in similar research conducted in the United States. The greatest difference was observed in three items: "Understanding the effects of the drugs the patients are taking" (rate of high ratings: pharmacists 80.2%, patients 37.8%), "Understanding the health changes caused by the drugs dispensed to the patients" (pharmacists 80.2%, patients 28.4%), and "Consciously protecting patients from the adverse effects of drugs" (pharmacists 82.8%, patients 42.2%), indicating role discrepancy. Partition analysis indicated the three factors for a pharmacist to be regarded as a drug therapy or medication specialist: "The patient regards the pharmacist as his/her family or regular pharmacist," "The pharmacist is making it easy for a patient to talk with him/her" and "The pharmacist is aware of a patient's use of products other than prescribed drugs, such as over the counter (OTC) medications or health foods and nutritional supplements." Future efforts are necessary to resolve role discrepancy and implement ongoing monitoring.

Quantitative evaluation of initial symptoms as predictors to detect adverse drug reactions using Bayes' theory: expansion and evaluation of drug-adverse drug reaction-initial symptom combinations using adverse event reporting system database.

In prescription dispensing in Japan, to avoid adverse drug reactions (ADR) pharmacists provide patients with information concerning the initial symptoms (IS) of any ADR that might be caused by the drugs they have been prescribed. However, the usefulness of such information for preventing ADR has not been quantitatively evaluated. We previously performed a trial calculation of the usefulness of rash as a predictor of drug-induced liver disorders by applying Bayes' theorem and showed that the predictive utility of IS can be quantitatively evaluated using likelihood ratios. However, for other drug-ADR-IS combinations it was difficult to obtain the information required for the calculations from Japanese data alone. In this study, using the Adverse Event Reporting System (AERS) database of the U.S. Food and Drug Administration (FDA), we evaluated 132 drug-ADR-IS combinations that were considered to be potentially clinical significant. Regarding bezafibrate-associated rhabdomyolysis and cibenzoline-associated hypoglycemia, these ADR were not detected in cases involving monotherapy. For 58 combinations, no events that were considered to be IS of the target ADR developed. Fever, nausea, and decreased appetite were the IS of many ADR, making them very useful predictors. In contrast, pruritus and rash were not very useful. Fever might be a predictor of thiamazole-induced agranulocytosis or levofloxacin- or terbinafine-induced liver disorder, tremors might be useful for predicting paroxetine-induced serotonin syndrome, and decreased appetite might be a useful indicator of terbinafine-induced liver dysfunction.

[Questionnaire to examine the prevalence of allergy symptoms and consumer measures by prefecture].

To ascertain the prevalence of allergy symptoms and consumer measures for eye, nose, skin, food, and asthma by prefecture. The self-evaluation questionnaire was mailed to 100,000 subjects throughout Japan by the OTC distribution network of Fujiyakuhin Co., Ltd. The prevalence of allergy symptoms for eye, nose, skin, food, and asthma was 17.3, 26.7, 14.5, 4.5, and 5.4%, respectively. These values were comparable with those of previous studies. The ratio of consultation behavior in respondents reporting allergy symptoms was estimated to be 26.4-82.1%. The usage rate of OTC drugs in respondents reporting non-consultation and the rate of combined use of prescription and OTC drugs were 2.9-51.1% and 7.0-44.1%, respectively. The positive likelihood ratio for subjective allergy in persons having an allergy history of "both parent and child" was 13.9, and this ratio for subjective child allergy in persons having an allergy history of "either parents" and "both parents" was 4.39 and 15.7. The relationship between consumer measures and the allergy history of subjects and families was observed in various combinations. In this study, the allergy prevalence of eye and food not reported in a previous study was estimated. Furthermore, it appears that there are points which make one think anew about the allergy information offered to consumers and patients by both OTC manufacturers/distributors and pharmacists.

[Evaluation of the efficacy of a medicine bag printed with a photograph of the medicine for the prevention of drug-dispensing errors].

In this study, a survey was conducted to determine the rate of drug-dispensing errors with the use of medicine bags printed with photographs of prescribed medicines (hereafter "medicine bag") for a 6-week period from June 20 to July 31, 2005. During this period, 393928 prescriptions were filled in 127 medical facilities that use the medicine bag. The efficacy of the medicine bag in the prevention of drug-dispensing errors was investigated. A total of 6550 (1.66%) drug-dispensing errors were identified: 70.6% were identified at the inspecting stage; 27.4% at the providing medicine and information stage; and 2% after the medication was dispensed. The drug-dispensing errors identified in the inspecting and providing stages included a) using the wrong contents, b) dispensing the wrong drugs, c) missing drugs, d) calculation errors, e) weighing/measuring errors, and f) others. No significant difference was observed in the error rates; thus it was assumed that the type of error was not dependent on the stage at which dispensing errors was discovered. However, it was found that approximately 25% of errors at the providing stage were discovered as a result of the medicine bag. Errors of types a), b), and c) were often discovered because the photograph was printed on the medicine bag. Therefore it was assumed that the photographs contributed to the discovery of drug-dispensing errors.

[Practice for promoting proper use of reusing the leftover medicines in the outpatients of the chronic disease].

Cooperating with hospitals and clinics, the current situation of leftover medicines for outpatients was investigated. Pharmacies played a role in receiving and counting leftover medicines. Pharmacists reported the number of leftover medicines to physicians and facilitated a decrease in the dosing days of prescriptions for the purpose of reusing leftover medicines. Our study, conducted from March 2003 to July 2003 in three pharmacies, found that the saved drug cost and pharmacist technical fees was 489830 yen. There was an income decrease of 69080 yen to the pharmacies. If, as we found in our study, an average medication savings of 40000 yen per pharmacy-month represents a conservative estimate, the total national cost due to medication saving would nearly 20 billion yen per year. The rate of forgetting to take medicine rose as the dosing frequency increased. With a dose of three times a day before every meal, the forgetting probability was 100%.