Naomi Iihara

Comparing patient dissatisfaction and rational judgment in intentional medication non-adherence versus unintentional non-adherence

Patients poor adherence to medications is reported to be related to the individual patients beliefs and cognitions and their trust of the medical staff. However, the causes of the two forms of non‐adherence, intentional and unintentional behaviours, have yet to be clarified. This study compared psychological latent factors associated with intentional and unintentional non‐adherence to chronic medication regimens, focusing on the potential effects of (i) patients dissatisfaction with treatment and their relationships with the medical staff and (ii) patients subliminal rational thinking processes, which weighed the positive values such as their expectations of benefits from treatment against negative values such as their dissatisfaction.

Factorial invariance of a questionnaire assessing medication beliefs in Japanese non-adherent groups

Objective The aim of our study was to verify invariance of latent factors derived from the BMQ (Belief about Medicines Questionnaire) among Japanese adherent and non-adherent groups (adherent to medication and intentionally, unintentionally, and overlapping non-adherent groups) and to estimate mean differences of the latent factors among the groups. Setting A Japanese university hospital. Methods After administration of a cross-sectional survey, covariance structure analyses of the two-factor model were conducted. Groups that exhibited factorial invariance were identified, and structured mean analyses estimated the differences of the latent means of the factors between groups using the bootstrap method without relying on theoretical assumptions for sampling distributions. Effect size was employed as an indicator of these differences. Main outcome measure The differences in the latent means of the two factors (the necessity and concerns factors for prescribed medications) across the groups exhibiting factorial invariance, which reflect true differences between them. Results Factorial invariance was demonstrated only across adherent and unintentionally non-adherent groups. Unintentionally non-adherent patients had significantly lower latent means for the necessity factor than adherent patients, with a very close to medium effect size (−0.49; 95% CI −0.84, −0.14; bootstrap method). Conclusion A meaningful comparison of BMQ scale scores can be made between adherent and unintentionally non-adherent groups of Japanese patients.

Risk of hypoglycemia associated with thyroid agents is increased in patients with liver impairment

OBJECTIVEnTo determine the risk of developing hypoglycemia from drugs that affect glucose homeostasis and evaluate the elevation of that risk by liver impairment as judged by a decrease of liver reserve or the severity of abnormal values in liver function tests.nnnMETHODSnA hospital-based case-control study was carried out. The base population consisted of all patients aged 20 years and older attending a university hospital in Japan from 2002 - 2004 who had received drugs and serum glucose measurements. Cases were defined as having had at least one episode of hypoglycemia as determined by a serum glucose concentration below 70 mg/dl. Up to 5 controls for each case were matched for the year of serum glucose measurement, out- or inpatient status, clinical departments visited, and age difference within 5 years, taken randomly from the base population without hypoglycemia. The odds ratio for developing hypoglycemia was estimated using conditional logistic regression analysis.nnnRESULTSnFrom a base population of 10,011, 245 cases and 1,194 controls were enrolled. Of the drugs investigated, levothyroxine use was associated with an increased risk of hypoglycemia in patients with liver impairment (adjusted odds ratio; non-use with normal liver (reference), non-use with liver impairment 0.91 (95% CI 0.62, 1.33), use with normal liver 4.50 (0.58, 34.76), use with liver impairment 14.68 (1.57, 137.4), p for trend 0.007). The risk elevation likely depended on the lowering of liver reserve.nnnCONCLUSIONnClinicians and pharmacists should carefully monitor serum glucose concentrations in levothyroxine users with liver impairment, especially those with lower liver reserve.

Polypharmacy of medications and fall-related fractures in older people in Japan: a comparison between driving-prohibited and driving-cautioned medications

Polypharmacy is a risk factor for fall‐related fractures. However, it is unclear whether polypharmacy itself is a direct risk factor. The aim of this study was to assess the association between the risk of fall‐related fractures and polypharmacy of driving‐prohibited and driving‐cautioned medications in older outpatients.

Patient Preference for Aggressive Medication Therapies with Potentially Stronger Adverse Drug Reactions Revealed Using a Scenario-based Survey

u2003Some patients do not inform healthcare professionals of adverse drug reactions (ADRs) because they fear termination of aggressive medication therapies. Preferences for aggressive medication therapies may differ between patients and pharmacists. The goal of this study was to estimate whether pharmacists were able to accurately assess patient preference for aggressive medication therapies with potentially stronger ADRs. A cross-sectional study was conducted of hospitalized patients (35 to 74 years of age) receiving oral medications for a chronic disease or systemic chemotherapy at three hospitals in Japan. We estimated the extent of agreement between patient responses and pharmacist predictions using a scenario-based investigation (1) to examine the choice between an aggressive medication therapy and the standard therapy, and (2) to assess increased life expectancy as a result of aggressive medication therapy. The extent of agreement was estimated using the kappa statistic. Of 113 patients, 43 (38.1%) chose the aggressive medication therapy. Pharmacists correctly predicted the choice of 25 (58.1%) of these patients [kappa 0.32 (95% confidence interval 0.15-0.50)]. Of 111 patients, 42 (37.8%) expected one additional life expectancy year. However, pharmacists predicted that as many as 36 (85.7%) of these patients would require more years of added life expectancy before choosing an aggressive medication therapy [kappa 0.24 (0.08-0.40)]. Agreement between patients and pharmacists on the choice of aggressive medication therapy was generally poor. Pharmacists should make an effort to identify patients who might prefer more aggressive medication therapies with potentially stronger ADRs in order to minimize ADR risk.

Effect of endurance for adverse drug reactions on the preference for aggressive treatments in cancer patients

PurposeCancer patients receiving chemotherapy will sometimes conceal their discomfort, but an excessive endurance for adverse drug reactions (ADRs) can lead to a poorer prognosis. The aim of this study was to clarify the association between ADR endurance and a preference of cancer patients for aggressive treatments.MethodsA cross-sectional study was undertaken of inpatients under 75xa0years of age receiving injectable systemic chemotherapy or oral chronic medications at hospitals in Japan. Subjects were asked to respond to a validated questionnaire to assess the extent of their ADR endurance and whether they would choose a novel, more aggressive therapy if their life expectancy was estimated at 2xa0years.ResultsStudy participants were separated into the chemotherapy group (nu2009=u200936) and the non-chemotherapy group (nu2009=u200978). In the chemotherapy group, patients who had moderate ADR endurance scores were more likely to choose the new therapy (0–33, 34–67, and 68–100 points: 0.0, 54.5, and 27.3xa0%; χ2 test, pu2009=u20090.15). Additionally, every patient on long-term chemotherapy (≥3xa0years) had high ADR endurance scores but did not choose the new, riskier treatment. In the non-chemotherapy group, the proportion of those choosing the new therapy was linearly associated with higher ADR endurance scores (25.9, 38.2, and 64.7xa0%; pu2009=u20090.04).ConclusionCancer patients may prefer aggressive therapies, even when self-estimations of ADR endurance are not very high, especially if they have been receiving chemotherapy for a short period of time. These patients should be observed with great caution.

Changes in attitudes among Japanese patients after Pharmacist Law revision

Objective To assess changes in patients’ perception of their medications and their adherence to regimens after enactment of the Japanese Pharmacist Law revision of 1997, which stipulated provision of drug information to patients as one of the principal duties of pharmacists. Setting A university hospital in Japan. Method Comparison of cross sectional analyses between two time periods: shortly after enactment of the Pharmacist Law revision and about a half-decade later. Main Outcome Measure Patient’s knowledge of the medications, anxiety level, individual beliefs regarding taking medications without anxiety, and adherence to the medication regimens. Results There were 141 and 151 patients who participated during each period, respectively. The proportion of non-adherent patients significantly decreased from 68.8 to 53.6% (Pxa0=xa00.008). Multiple logistic regression analysis indicated that the features of the intentionally non-adherent patients have changed; they have switched from persons who lack general comprehension about the medications (Pxa0=xa00.01), ones who place an importance on knowing the side effects (Pxa0=xa00.04), or who place no value on mutual reliance on their doctors (Pxa0=xa00.03) into persons who place no value on understanding the purpose of taking their medications (Pxa0=xa00.04) or who place value on multiple items to take medications without anxiety (Pxa0=xa00.03), i.e., supposedly people who prefer thinking about their drug therapy from their own point of view based on comprehension of their disease and medications. Conclusions The rapid progression of drug information disclosure after enactment of the Pharmacist Law revision has likely resulted in drastic changes in patients’ perception of their medications and led to improvements in medication adherence.