In addition to the notion of promoting generic drugs to lower pharmaceutical costs, another approach that has gained attention as vital to policy reform is that of utilizing health insurance pharmacies to decrease over-prescription and surplus of drugs. Such a move would perforce require separating medical and dispensary practices. There is increased need for more efficient provision of pharmaceuticals, including proper inventory control, outpatient clinics that function as family pharmacies, and support of home-bound patients’ medication regimens. However, chronic ailments in particular tend to lack subjective symptoms, and decreased intake of medication and surplus medication compound to make these larger policy issues difficult to solve. This has led to the Revised Dispensing Service Fee changes in 2012 and 2014 putting stricter controls on medication regimens and checks of surplus medication. This research examines in parallel the issues of patient satisfaction and loyalty alongside adherence to medication regimens, issues that have been previously treated in isolation in the existing literature. By comparing their respective inter-relationships and influencing factors, we conducted a re-analysis of the relationship between insurance pharmacies and patients. We collected data from patients with diabetes and high blood pressure via an Internet survey. Responses on loyalty, patient satisfaction, overall perceived quality, and degree of medication adherence were obtained, as well as responses on the factors believed in a cross-sectional sense across research disciplines to contribute to the above, and the results measured on a quantitative scale. Path analysis was then used, with a model defined using overall perceived quality as a parameter and measuring the degree of satisfaction, loyalty, and medication adherence. In addition, a multiple-group analysis was simultaneously performed. Although there was variance by ailment in terms of patient satisfaction and loyalty, factors contributing to perceived quality were the strongest, followed by the rating of the prescribing doctor. However, for adherence, only self-efficacy and prescribing doctor rating contributed. Ultimately, no correlation was found between patient satisfaction, loyalty, and adherence, and the contributing causes were found to vary, so improving these various vectors would seem to require respectively differing strategies. In terms of medication adherence, the results suggested the need for strategies to increase patients’ self-efficacy, partner with prescribing doctors, and improve the perceived rating of prescribing doctors; different quality improvements are needed by medical area, whether medicine or dispensary practice.

Objective: As a “family pharmacy and pharmacist,” high-quality medical service is demanded.  Many patient satisfaction investigations are performed to evaluate community pharmacies, but it has been impossible until now to do so using an improvement index of the medical quality.  Therefore, I investigated the influence and evaluation structure of two evaluation concepts regarding quality of medical service and patient satisfaction and intention to use again, which becomes the important key as a “family” pharmacy.
Methods: I used anonymous patient survey data gathered for the purpose of duties improvement in July 2009.  I subjected the responses to factor and covariance structure analyses.
Results: Dates for four dimensions were obtained for factor analysis.  As a whole, covariance structure analysis showed that, in terms of privacy and only for service quality, entertainment primarily influenced satisfaction.  The ingestion instruction had a big effect on both sides.  General satisfaction was also substantially influenced by service quality.  The difference in influence degree was confirmed at each parameter.
Conclusion: It was found that not only satisfaction but also quality of service were equally demanded in community pharmacies.  It is necessary to increase these because most are influenced by ingestion instruction as a factor in service quality.  However, future investigation is necessary to clarify the detailed ingestion instruction contents.

A “Okusuri-techo,” which refers to a prescription record, is utilized in medical institutions as an information tool necessary for the prevention of side effects, drug-interaction, and/or in case of emergency medication. However, the record is not shared sufficiently between patients and pharmacists and thus remains underutilized. To explore how the record could be used more effectively, a survey was conducted with the pharmacists of 73 community pharmacies that were members of the Otaru Pharmaceutical Association, and patients who received prescriptive medicines from these pharmacies. A total of 148 pharmacists and 157 patients responded. Approximately 80.9% of the patient group responded that the prescription record was useful, whereas 100% of the pharmacists answered that it was helpful. In the cross-analysis of the patients’ responses, the presentation of the prescription record to medical staff was correlated with the degree of helpfulness of the record. It was suggested that the function and effective usage of the record were rarely shared between patients and pharmacists. Sufficient understanding of the value and effective usage of such a record will therefore promote its active utilization among patients and pharmacists.

Objective: Many studies on patient satisfaction are conducted in community pharmacies.  In contrast, the present study assess the community pharmacy function and to the best of our knowledge, appears to be the first to evaluate the professional functions of pharmacists.
Methods: In September 2010, in 1 week, we conducted a survey that focused on pharmacists’ professional abilities.  I subjected the responses to factor analysis and covariance structure analysis.
Results: We obtained 2,506 effective responses (appropriately completed and returned questionnaires) of the 4,633 questionnaires originally distributed.  Data of seven dimensions were obtained for factor analysis.  In all, the various information provision services rendered by a pharmacist were not significant.  According to the covariance structure analysis, “safety” (a pharmaceutical management item) and “responsiveness” (a complimentary element) were significant factors.  Differences in the degree of influence were confirmed for each parameter in the analysis, depending on the parameter.  In addition, the information provision services were significant during the acute period.
Conclusion: Because the information provision services were not significant, the influence of “asymmetric information” warrant further analysis according to the specialty.  I believe that it is necessary to examine asymmetric information in greater detail in the future.  In addition, I think that an interventional study that is based on these results is also necessary.

Objective: The objective of this study was to identify the perceived importance of various pharmacy functions among residents in the community health care system.Methods: We conducted an online survey of nationwide panelists enrolled by a research company to assess the perceived degree of importance of having a pharmacy that performs various functions in the community health care system (i.e., “comprehensive importance”).Results: “Comprehensive importance” was compared among 2,400 respondents disaggregated into several groups. The results revealed that “encouragement for medical consultations at medical institutions” had a strong effect on “comprehensive importance”.Conclusion: The results of this survey highlight the need for preventive medical care and a further expansion of the consultation function at pharmacies in the future.

Objective: This study aimed to elucidate the factors that affect medication adherence in outpatients with depression using multivariate analysis.Methods: A web-based survey on medication adherence, medication attitude (Drug Attitude Inventory-10; DAI-10), medication self-management, and satisfaction with the prescribing physician/pharmacy for outpatients with depression was conducted in January 2018. T-tests and path analysis were performed to evaluate comparisons of responses based on gender, high/low importance of medication guidance, high/low intention to consult, and high/low frequency of consultations.Results: For mean scores, no significant difference was observed between males and females according to a t-test. In terms of the importance of medication guidance, the high importance group had significantly higher prescribing physician/pharmacy satisfaction and better self-management. In terms of intention to consult, respondents with high intention to consult had significantly higher scores on the DAI-10, better self-management, and higher prescribing physician/pharmacy satisfaction. In terms of frequency of consultations, only pharmacy satisfaction was significantly higher in the high-frequency group. Path analysis revealed that, in general, adherence was influenced by medication attitude and self-management, and prescribing physician/pharmacy satisfaction and self-management were influenced by medication attitude. In the intergroup comparison, pharmacy satisfaction did not affect medication adherence in males or the group with low importance of medication guidance. In addition, medication attitude did not affect adherence only in the non-consultation group.Discussion: These results suggest that it is necessary to improve the medication support measures at pharmacies for outpatients with depression. Furthermore, in order for the measures to improve medication attitudes and adherence to be effective, it is necessary for patients to understand the benefits and importance of using pharmacists effectively, including medication support and consultation, and to be actively involved in the maintenance and promotion of patients' health.

The purpose of this study was to assess the negative effects of some factors on medicine-taking behavior. For the patients taking oral medication who visited a health insurance pharmacy, we enacted the actual situation of medication and conducted an attitude survey on the feeling of burden and resistance of taking the drugs. The survey also covered the factors that can influence medicine-taking behavior and the extent of the influence. For differences in each factor such as patient characteristics, lifestyle, and medication status, we used the 2 test to analyze the association with medicine-taking behavior. We found significant differences in age, dietary habits, occupation, periodic consultation with the pharmacy/doctor, and unpleasant experiences. In addition, in patients with multiple factors that cause noncompliance with medication, we observed a strong influence of age and occupation. From the factor analysis, we obtained data on time, quantity, and pharmaceutical factors (three factors called regular factors). These factors negatively influenced the use of medication by the patients. Next, in the covariance structure analysis, the influence of time and the quantity factor on medication-related stress was the observed to be the strongest, whereas the influence of the regular factors was not significant. Furthermore, there were differences in the influence of these factors depending on patient characteristics.

Objective: 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.
Method: 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.”
Results: 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.”
Conclusions: It is crucial to pay special attention to the objectives of using inhaled steroids and how to cope with asthma attacks when guiding patients.

Objective: This study quantitatively analyzes the factors causing dispensing errors in community pharmacies and explores the characteristics of these factors and their order of importance.
Design and Methods: 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.
Results: 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 (p=0.539).
Conclusions: 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.