ObjectivesA nationwide large-scale survey was conducted to identify the prevalence and causal medications of adverse drug events (ADEs) that are caused by potentially inappropriate medications (PIMs) given to homebound elderly patients, factors associated with ADEs, and measures taken by pharmacists to manage ADEs and their effects on ADEs.SettingsA questionnaire was mailed to 3321 pharmacies nationwide. It asked about the details of PIMs and ADEs of up to 5 patients for whom home visits were provided by a pharmacist. Questionnaire forms were filled in by pharmacists who visited the patients.Design and participantsBetween 23 January and 13 February 2013, comprehensive assessment forms were sent to 3321 pharmacies. Data collected from 1890 pharmacies including data of 4815 patients were analysed and 28 patients of unknown sex were excluded. Their average age was 82.7 years. PIMs were identified based on the 2003 Beers Criteria Japan.ResultsThere were 600 patients who did not provide valid answers regarding the medications. In the remaining 4243 patients, one or more medications that were considered to be PIMs had been prescribed to 48.4% of patients. PIM-induced ADEs were found in 8% of these patients by pharmacists during home visits. The top ADE-inducing medications were strong anticholinergic antihistamines, benzodiazepines, sulpiride and digoxin. The most common ADEs associated with benzodiazepines were frequent lightheadedness, somnolence and sleepiness, which increase the risk of falls and subsequent fractures in elderly patients. The following factors associated with ADEs were identified: sex, pharmacist awareness of prescription issues, frequency of visits and time spent at patients’ homes, and the frequency of detailed checks for patient adverse reactions by pharmacists.ConclusionsThe PIM prevalence associated with home healthcare in Japan was relatively high, as reported in previous studies. The present study suggests that pharmacists could reduce the incidence of PIMs and consequent ADEs.

Objective: The objective of the study was to identify factors related to donepezil medication adherence ("adherence") of cognitively impaired patients in community pharmacies. Methods: One hundred and twenty community pharmacies in 28 regions in Japan were randomly selected. Questionnaires were mailed to these pharmacies. The pharmacists answered based on the medication profiles ("YAKUREKI") of the patients given donepezil at their pharmacies. The survey items were "adherence", "who is the key person" and ‘the key person’s understanding and awareness of donepazil and its symptoms. The χ² test and decision tree modeling analysis were performed to examine factors affecting adherence. A 5% level of statistical significance was used in the χ² test. Results: Questionnaires with data on 479 patients were returned. The most common level of adherence was “take as instructed” (81.2%), followed by “forget once or twice a week” (10.2%). The χ² test revealed that adherence was good if "key person" was professional caretaker (P = 0.004). Also, adherence was better if key person understood medication about dosage, P < 0.001; effect, P = 0.002; and general side effects,, P < 0.001. According to decision tree analysis, the key person had the strongest relationship with adherence. Conclusions: It was confirmed that the key person’s understanding of the medication and symptoms of cognitive impairment are related to adherence. In particular, it was suggested that there is a strong relationship between the key person and adherence and that factors related to adherence differ according to who the key person is. It is essential in the treatment of cognitive impairment to accurately identify the "key person", in order to provide better pharmaceutical care in community pharmacies

In Japan the prevalence of dementia has increased considerably, and pharmacists are involved in addressing these patients' medication-related problems. Here, we determined whether pharmacists' comprehensive assessment of medication proˆles could reduce the burden of dementia patients' medication-related problems. In this historical cohort study 120 community pharmacies were randomly selected, and participating pharmacists completed questionnaires concerning comprehensive assessment of patient medication proˆles, using a``start'' questionnaire for patients prescribed medication prior to or during the study period and a``follow-up'' questionnaire for patients who subsequently visited pharmacies for prescriptions. Numbers and details of problems and solutions implemented by pharmacists and identiˆed in the start and follow-up questionnaires were compared. Changes in start and follow-up scores were also compared between patients whose problems were identiˆed by pharmacists (identiˆed group) and those whose problems were not (nonidentiˆed group). Data were collected for 349 patients issued medication by 60 pharmacies. The most common medication-related problems identiˆed in the start survey were key person's understanding of donepezil (60 cases) and other dementia treatments (60 cases), and adherence to treatment (53 cases). Solutions implemented by pharmacists included gathering information regarding drug administration and dementia awareness from the key person and providing pharmaceutical counseling and instruction. Subsequently, problems related to understanding of dementia treatment, understanding donepezil, and adherence were resolved by 70.0％, 65.0％, and 58.5％, respectively. Pharmacists' comprehensive assessment of medication proˆles could eŠectively solve dementia patients' medication-related problems.

A nationwide survey was conducted to verify relations between the workload of home-visiting service by community pharmacists and outcomes. Data were collected on 5447 patients from 1890 pharmacies. Most (61.9％) pharmacists visited patients' homes twice monthly, spending there a net average of 20.6 work minutes. At the time of the survey, 29.8 ％ of the patients had improvement of adherence compared with at start of home visits; 65.5％ had no change, and 1.4％ had gotten worse. Similarly, 41.6％ had decreased unused medications, 54.4％ had no change, and 2.3％ had increased. Home-visiting pharmacists found adverse drug events (ADEs) caused by drug administration in 14.4％ of their patients. They dealt with 44.2％ of these cases by discontinuing administration of the responsible drug, 24.5％ by reducing the dosage, and 18.3％ by changing drugs, with a total of 88.1％ having been improved. Prescription changes intended to correct problems occurred in 37.1％ of the patients. In patients whom the pharmacists visited more often, a higher percent had ADEs, had their prescription changed to correct problems, and had improved adherence and unused medications. The average actual work time was longer in patients whose outcomes improved than in those whose outcomes did not. A higher involvement in homecare by pharmacists was found to improve outcomes of drug treatment.

A survey was conducted among pharmacists providing``home-visit guidance on drug management'' to patients taking medication for dementia. Factors related to medication adherence among patients and pharmacists' acquisition of patient information were then veriˆed. The survey items were: (1) patient attributes (degree of care received, bed-ridden, family composition, and living environment); (2) the person controlling medications; (3) drug storage method and location; (4) dispensing method; (5) patient management of visiting nurses; (6) patient management of visiting physician; (7) details of pharmacist's home-visit guidance; (8) medication adherence; (9)ˆve items related to cognitive function (short-term memory, autonomous judgment, ‰uctuations in level of consciousness, excitation and loss of orientation, understanding); and (10) ten items related of ADL (mobility in bed, transferring, mobility within the home or outdoors, dressing upper/lower body, eating, toilet use, individual hygiene, bathing). The t test was used to verify the number of items of patient information concerning cognitive function and physical function that pharmacists could acquire at a visit. It was suggested that pharmacists were able to acquire more patient information (◯ cognitive function and ◯ ADL) when they visited patients cared for at home, compared to facility residents (◯ p＝0.008, ◯  p＝0.006). Thus, it was suggested that there is a latent risk concerning the pharmacist's ability to discover problems with administration of medications among facility residents. Theseˆndings demonstrate that it is essential for pharmacists to be more proactive about providing home-visit guidance.