Objective: From the viewpoint of drug cost reduction, many generic drugs have appeared in the eye drops market.  Although the price of eye drops is defined on a per bottle (or per mL) basis, the difference in the total number of drops per bottle between the original drug and its generic drug may alter the drug cost reduction effect greatly.  Moreover, the difference in the total number of drops per bottle may also affect the number of pharmacy visits made by a patient in one year.
Methods: The total number of drops per bottle of an original drug and a generic drug was computed, and the influence of the number of drops on the drug cost reduction effect, including drug cost, was evaluated.
Results: Distinct differences in the volume per drop and the total number of drops per bottle were observed between the original drug and its generic drug, and those differences were found to clearly influence the drug cost reduction effect.  Moreover, in a survey of patients who shifted to generic eye drops, there were some patients who returned to the original eye drops because they could not apply the generic eye drops with ease or their eyes started to smart after using the generic eye drops.
Conclusion: This study revealed the need to take into consideration patient’s ease of use and the drug cost reduction effect, in the selection of eye drops.

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: 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.

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.

Objective: In our country, the measure for the spread of the generic has been introduced over several-time as part of the moderation in health care cost plan.  However, not having related to an enough spread unlike Europe and America yet is a current state.  Then, we investigated from the view point of patients.  A detailed examination was performed for the acknowledgment level and attitude toward the generic drug.
Design and Method: The questionnaire survey was performed for the patient who used the community pharmacy for dispensing prescription.  The investigation was performed for two weeks (June and July, 2008) at the 50 drugstores in Hokkaido.  The patient attribute, source of information, and kind of the taking medicine were examined as a factor to affect decision making for generic drug substitution.
Result: The main results are as follows.  The patients who did not know generic drugs accounted 52% of the total and the patients who did not know the words called generic drugs was 16%.  This result shows that the degree of the recognition about generic drugs at that time was still low.  The information source for the patients who learned generic drugs were articles of the newspaper, a TV program, and advertising with accounted 52% of the total.  Also, the patients who prefer generic drugs in the future were 64%.  In the relationships between presence of wish for generic drugs and the source of information, the case of from the doctor, was significant (p<0.05) and the case from the pharmacist showed the tendencies of statistical significance (p=0.076).
Conclusion: From the viewpoint of medicine costs restraint in our country, it seems that the pharmacist contributes for the patient’s generic drugs selection expected positively.

Objective: To clarify the relationship between the awareness of pharmacists regarding instructions on the use of inhaled corticosteroids and the instructions conveyed.
Design: Fact-finding-survey using self-administered questionnaires.
Methods: The survey items consisted of age, years of clinical experience, number of prescriptions from asthmatics per month (“number of prescriptions”), items to concern when giving instructions (“items to concern”) time required to give instructions on inhaler usage (“time required”), and the pharmacists’ awareness regarding instructions on the inhaler usage (“awareness items”).  There were six awareness items for which responses were solicited on a four-grade scale.  Respondents were divided into two groups: a “high awareness” group giving responses of “completely agree” (or “completely disagree” for diametrically opposed items) and a “low awareness” group giving other responses.  T test was used to compare the average of age, years of clinical experience, number of prescriptions, concern degree, and time required between 2 groups.
Results: This showed the higher consciousness that “instructions on inhaler usage are important issue relating to the patient’s asthma therapy” was significantly-high degree of concern and time required.  Also, the consciousness that “instructions on inhaler usage are a specialized activity performed by pharmacists” was related to age, years of clinical experience and level of concern degree.  Additionally, this suggested the pharmacists giving negative responses with respect to the notions that “the effect of instructions on inhaler usage is not worth the trouble” and “patients have insufficient desire to master of inhaler usage” had a higher degree of concern.
Conclusions: For significance and importance of instructions on inhaler usage, there was confirmed to be relationship between pharmacists’ awareness and the information conveyed and time spent on the instructions.  This suggested that it was important to improve awareness of instructions on inhaler usage in both the clinical and educational setting.