ABSTRACT
We conducted a cross-sectional survey of pharmacists in clinical settings to assess the status and extent of challenges experienced by pharmacists in providing drug information to pregnant and breastfeeding women. The survey was completed anonymously via the internet using a structured questionnaire. The survey items included basic respondent characteristics, their experiences, attitude toward providing information to pregnant and breastfeeding women, and efforts toward obtaining relevant knowledge. Out of the 1,000 participating pharmacists, 96.8% received inquiries about pregnancy and breastfeeding. However, 92.5% of them recognized that the consultations they provided to pregnant and breastfeeding patients were not sufficient. The reasons for the sentiment were as follows: a lack of basic knowledge regarding pregnancy and breastfeeding and the effects of medications on pregnancy and breastfeeding (37.9% and 37.7%, respectively), a feeling that it is difficult to select appropriate information to share with patients (32.1%), lack of detailed information in the drug package insert (26.0%), lack of opportunities to learn about drug treatment during pregnancy and breastfeeding (20.9%), and the notion that pregnancy and breastfeeding are delicate and difficult topics to discuss (19.8%). While most pharmacists provided consultations regarding pregnancy and breastfeeding, only 7.5% felt that they provided sufficient consultations on this topic. Some pharmacists were concerned about their limited knowledge of pregnancy and breastfeeding. They also had difficulty addressing pregnancy and breastfeeding-related subjects, and communicating with pregnant and breastfeeding women. Pharmacists should advance their education by including elements regarding informed choice and make use of appropriate sources of information.
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Objective: The study aimed to identify potential components of the collaboration between hospital and community pharmacists from the perspective of pharmacists in municipal hospitals. Methods: Following a preliminary study, an online survey was conducted among pharmacy directors and those on an equivalent managerial level in municipal hospital pharmacies. The survey used a 5-point Likert scale with 32 items about the components of collaboration between hospital and community pharmacists. We performed an exploratory analysis and structural equation modeling of the data. Results: The analysis proposed a five-factor model (“Organizational climate,” “Information sharing system,” “Community support system,” “Interest in healthcare policy,” and “Understanding of healthcare policy”), which consisted of 17 items. Subsequent confirmation with structural equation modeling created a model with good fit (in terms of partial evaluation and overall goodness of fit) with a chi-square of 86.218, P-value of 0.564, goodness of fit index of 0.907, adjusted goodness of fit index of 0.857, and other good model fit indices (comparative fit index of 1.000 and root mean square error of approximation of 0.000). Discussion: This study identified two core universal concepts and three concepts adhering to the current medical context, that seem to guide the behavior of municipal hospital pharmacists─who are major players in community healthcare─in their collaboration with community pharmacists.
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The purpose of this study was to clarify the factor structure of the diversifying interpersonal work of pharmacists and its influential factors. A questionnaire-based survey was conducted for pharmacists registered with an internet research company. We collected data on respondents’ basic characteristics (gender and age), years of experience as a pharmacist, whether the respondents were certified as pharmacists, home-care experience, participation in study sessions and workshops, and experiences related to medication support. Factor analysis revealed three main factors from 26 items regarding pharmacists’ interpersonal work: Factor 1, “basic abilities of patient medication record management and medication counseling,” Factor 2, “clinical knowledge and assessment ability,” and Factor 3, “cooperation and support system.” Multiple regression analysis revealed a significant association between age and Factor 1 (β=−0.131, P<0.001). Home-care experience was associated with Factor 2 (β=0.076, P=0.013) and Factor 3 (β=0.115, P<0.001). Participation in study sessions and workshops were significantly associated with all the factors (Factor 1: β=0.103, P=0.001, Factor 2: β=0.247, P<0.001, Factor 3: β=0.238, P<0.001). This study clarified the factor structure of interpersonal work performed by community pharmacists. It is suggested that providing educational programs based on pharmacists’ ages and strengthening regional cooperation such as home medical care are necessary to standardize the quality of pharmacists’ interpersonal work.
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ObjectThe COVID-19 outbreak emerged in late 2019 in China, expanding rapidly thereafter. Even in Japan, epidemiological linkage of transmission was probably lost already by February 18, 2020. From that time, it has been necessary to detect clusters using syndromic surveillance. MethodWe identified common symptoms of COVID-19 as fever and respiratory symptoms. Therefore, we constructed a model to predict the number of patients with antipyretic analgesics (AP) and multi-ingredient cold medications (MIC) controlling well-known pediatric infectious diseases including influenza or RS virus infection. To do so, we used the National Official Sentinel Surveillance for Infectious Diseases (NOSSID), even though NOSSID data are weekly data with 10 day delays, on average. The probability of a cluster with unknown febrile disease with respiratory symptoms is a product of the probabilities of aberrations in AP and MIC, which is defined as one minus the probability of the number of patients prescribed a certain type of drug in PS compared to the number predicted using a model. This analysis was conducted prospectively in 2020 using data from October 1, 2010 through 2019 by prefecture and by age-class. ResultsThe probability of unknown febrile disease with respiratory symptom cluster was estimated as less than 60% in 2020. DiscussionThe most severe limitation of the present study is that the proposed model cannot be validated. A large outbreak of an unknown febrile disease with respiratory symptoms must be experienced, at which time, practitioners will have to "wing it". We expect that no actual cluster of unknown febrile disease with respiratory symptoms will occur, but if it should occur, we hope to detect it.
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<b>Objective</b>:Many epidemiological studies revealed that the varicella and herpes zoster have inverse correlation. This paper examines to confirm these associations by using Prescription Surveillance. <b>Design</b>: Multiple regression analysis about association between the incidence rate of herpes zoster and varicella adjusting for prefecture, fiscal year and week. <b>Methods</b>: We used the general public data from Prescription Surveillance. Prescription Surveillance estimates the number of patients who were prescribed anti-varicella zoster virus drug with age class. We assumed the patients under 15 years old were varicella patients, and over 65 years old were herpes zoster patients. Each the number of patient was aggregated by week and prefecture from April 5, 2010 to March 31, 2013. We regressed the incidence rate of herpes zoster on the incidence rate of varicella adjusting for prefecture, fiscal year and week. Moreover, we regressed it on the several lag of the incidence rate of varicella. <b>Results</b>: The incidence rate of varicella was significantly positive, however the estimated coefficient was 0.030. The lag of incidence rate of varicella were also significantly positive, however these estimated coefficient were less than 0.030. <b>Conclusion</b>: We found that the incidence rate of herpes zoster and varicella have positive correlation, however its magnitude was not so important. It needs attention that our finding means positive correlation when we remove seasonality and regionality of both incidences.
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[Purposes] Evidence-based medicine (EBM) is now the established standard for selecting appropriate treatment, the basic ideas of which cannot be ignored even in the field of Kampo medicines. With this in mind, we conducted a meta-analysis (MA) for those Kampo medicines which had been administered in randomized clinical trials, as a method of establishing the evidence for Kampo medicines, and then examined the resulting data obtained for the present study. Here, we focused on the assessing the usefulness in postpartum control, using Kyukichoketsuin (KCI), with methylergometrine maleate (MME) as control.<br>[Methods] We searched and collected articles published before September 2004 in Igaku Chuo Zasshi (Japana Centra Revuno Medicina) and Medline using keywords such as “Kyukichoketsuin”, etc. First we selected target articles for analysis in accordance with our inclusion criteria and examined the quality of those articles using a score system adopted by Chalmers, in 1981. Then we extracted target data from the articles in accordance with meta-analytic methods, integrated the resulting data using the DerSimonian-Laird method, and implemented sensitivity analysis to them.<br>[Results and Discussion] We selected four articles for our target analysis. All four were of similar quality. When we set post-labor pains as an assessment item, and integrated three of the four articles, KCI showed that it more significantly decreased those pains compared to MME, with an integrated odds ratio of 0.32 (95%CI, 0.17-0.60). The one remaining independent article, however, in which KCI exerted statistically significant effect in height of day-five uterine fundus, indicated no higher significance through integration with the first three articles. Also, even integrating the height of the uterine fundus shown in the articles, on day four as well as the height before integration, had no significance. These results indicate that the effect of KCI for the involution of the uterus may be the same as that of MME. Regarding the volume of breast-milk lactation on day four in comparison between two test drugs, some articles showed more volume in both the KCI and MME. groups, despite reaching no significant decreases in volume, with an integrated odds ratio of -8.20 (95%CI, -16.17--0.23). However, contrary to this, results for the integration of day-five breast-milk lactation volume showed an increase in the KCI group, although without reaching significant difference. Therefore, the effectiveness of KCI for breast-milk lactation could not be generally categorized as less than that of MME.<br>[Conclusion] MA demonstrated that KCI was more effective in decreasing post-labor pains than was MME. We could not implement the comparable study in safety at this time. Therefore, further analysis on KCI including safety may be required to argue total effectiveness on postpartum control.
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[<b>Purpose</b>]<br>The purpose of this study was to demonstrate the effectiveness of Kampo medicines, from the aspect of cost effectiveness. We obtained judgment criteria by analyzing past published papers and implemented our study according to criteria about the kinds of formulations and diseases that were suitable for pharmacoeconomic analysis.<br>[<b>Method</b>]<br>First, we extracted the original, clinical, and NHI price listed formulations (EA) from each published paper, by searching for Japanese key words such as “_??__??_ (Kampo)” or “_??__??_ (economic)” in the databases of “Igaku Chuo Zasshi” and “Institute for Health Economics and Policy.” Considering the importance establishing a controlled treatment method in pharmacoeconomic analysis, we defined papers with a comparative control (Comp) as one judgment criterion (1), then extracted these data; and analyzed how target (diseases and formulations), controlled formulation, measurement outcomes, and “Sho” (patterns or syndromes) were handled in each paper. Secondly, we defined those formulations which had been referred to many times in the EA as our second judgment criterion (2), because we thought they had abundant and clear outcomes, and then implemented an outcome analysis of them.<br>[<b>Results and Discussion</b>]<br>Judgment criterion (1): The number of formulations, and the total number of papers referring to a Comp (38 articles) were 25 and 41 (Shoseiryuto [4], Shosaikoto [4], Kyukichoketsuin [3] in descending order) respectively. Approximately two-thirds of target illnesses covered in these papers were gastrointestinal diseases, infectious diseases, ear nose and throat diseases; and in women, pregnancy or delivery-related diseases. Concerning outcomes, only 10.5% of the papers measured human outcomes such as quality of life (QOL), which might suggest that the implementation of cost effectiveness analysis was difficult. The results of analyzing how to handle “Sho” suggested that Kyo-sho or Vacuity-sho patient formulations tended to exert their treatment effects relatively, even without consideration for “Sho”.<br>Judgment criterion (2): Using EA prices, we expedientially defined frequently referred formulations as those referred to in 15 or more of the total research paper number, and then extracted them. As the result of this extraction, 6 formulations (Hochuekkito, Keishibukuryogan, Shishihakuhito, and etc.) were obtained. Among these formulations, Shishihakuhito had high rates (88.2%) for achieving treatment goals, including the improvement of skin symptoms such as erythema and pruritus.<br>[<b>In Conclusion</b>]<br>A comparison between Kampo and Western medicines was not simply applicable, due to large differences between their mechanisms of action, and the ways they exert their effect, even if their ultimate effects are the same. We would need to create a study plan which would cover human outcomes when making a further pharmacoeconomic study, because Kampo medicines do have a good chance of improving QOL. We would even say that Vacuity-sho formulations given to patients could easily work, without consideration for “Sho”.
