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.

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.

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.”