Compliance Instruction Research Articles

Best Practice Alerts: A Poke in the Eye or an Efficient Method for Safer Prescribing?

Best Practice Alerts: A Poke in the Eye or an Efficient Method for Safer Prescribing?

Pharmacists' Adherence Support System FollowNavi for Patients with Type 2 Diabetes.

In Japan, the Pharmaceutical and Medical Device Act was amended in December 2019 and now requires pharmacists to follow-up patients continuously during treatment to ensure proper use of medicines. According to some reports on patients with type 2 diabetes mellitus (T2DM), follow-up by doctors is effective for improving treatment. Enhanced face-to-face medication counseling by pharmacists leads to good glycemic control in patients with diabetes. However, the effects of information and communication technology (ICT)-based follow-up during the medication period are not well-understood. We determined the efficacy of pharmacists' follow-up using FollowNavi, a patient compliance instruction support system, and using our developed LINE tool for patients with T2DM. Through a before-after study, changes in glycemic control and medication adherence after 6 months of follow-up were investigated, and multiple regression analysis was performed to investigate the factors associated with changes in hemoglobin A1c (HbA1c) levels. Questionnaire surveys related to usability were completed by patients and pharmacists. In the 35 patients with T2DM, HbA1c levels decreased significantly after 6 months, although fasting blood glucose levels and medication adherence showed no significant differences. Changes in HbA1c levels were significantly associated with age (p = 0.044), baseline HbA1c levels (p < 0.001), and diabetes duration (p = 0.004). In the questionnaire, 81.8% of patients responded that they would prefer to continue using FollowNavi. These results suggest that follow-up using FollowNavi is useful for glycemic control in patients with T2DM.

Validating the Utilization of the Patient Compliance Instruction Support System “FollowNavi” for Follow-up Inhalation Instructions

Validating the Utilization of the Patient Compliance Instruction Support System “FollowNavi” for Follow-up Inhalation Instructions

The Effect of Manufacturer's Instructions for Use Compliance on Cook ZBIS Iliac-Branched Endograft Long-Term Outcomes

Current guidelines indicate iliac-branched endografts (IBDs) as the ideal means to preserve pelvic perfusion during endovascular aortic repair. Because patient vascular anatomy represents the main limitation to extensive use of these devices, off-label application may be considered to expand the number of patients being treated. The aim of this study is to evaluate long-term outcomes obtained using the Cook ZBIS endograft in the treatment of aortoiliac aneurysms as per or outside manufacturer's instruction for use (IFU). Data from all patients who underwent IBD implant in a single center were reviewed. Study population was divided into two subgroups: Group I treated as per manufacturer's IFU and group II treated outside IFU. During the study period (2008-2018), 119 patients were treated with 130 IBDs. Eighty-six patients were treated as per IFU (group I) and 44 outside IFU (group II). Overall technical success was 99.2%. Mean follow-up was of 63.5±38.3months for group I and 58.3±35.9months for group II (P=0.45). Freedom from reintervention at ten years was 79.8% in group I and 69.6% in group II (P=0.29). Freedom from IBD-related reintervention rate was 98.7% and 95.3% in groups I and II, respectively (P=0.240). Iliac-branched module thrombosis occurred significantly more in patients treated outside IFU with 4 cases in group I (4.7%) and 10 cases in group II (22.7%), (P=0.005). Cox regression analysis identified hypogastric artery aneurysm as the only independent predictor for both IBD thrombosis and hypogastric artery occlusion during follow-up. When used by an experienced team, Cook IBDs are safe and effective in the treatment of aortoiliac aneurysms both inside and outside IFU. Anyway a lower target hypogastric patency rate should be expected when treating patients with hypogastric aneurysms.

Effectiveness of a pharmaceutical instruction video for adherence to dermatopathy treatment in patients with cancer receiving the anti-epidermal growth factor receptor antibody.

Dermatopathy develops as a side effect in patients receiving anti-epidermal growth factor receptor antibody treatment. Topical moisturizers are used for the prevention and treatment of this dermatopathy. Active participation of patients in their own treatment is important for the appropriate application of topical preparations. We prepared a pharmaceutical instructional video for adhering to the topical application protocol. In this study, we investigated the effectiveness of this pharmaceutical instructional video on treatment adherence. Study participants were patients with cancer receiving the anti-epidermal growth factor receptor antibody for the first time. A pharmacist instructed the patients on how to use the pharmaceutical instruction video. Daily topical preparation use following the video demonstration was assessed. The effectiveness of the pharmaceutical instruction video was evaluated by assessing the adherence of patients who did not use the pharmaceutical instruction video for the past 2 periods (26 months; controls 1 and 2). The incidence of side effects was compared between the two control groups and the group of patients who received the pharmaceutical instruction video. The amount of topical preparation consumed (median, g/day) by patients who received patient compliance instructions using the pharmaceutical instruction video was 9.8 g/day, as compared with control group 1 (4.5 g/day) and control group 2 (5.5 g/day) (p < 0.001). There was no difference in the incidence of side effects during the three periods. The use of visual instructional media for patient compliance by pharmacists may be effective in maintaining and improving treatment adherence.

A survey of blood transfusion errors in Aichi Prefecture in Japan: Identifying major lapses threatening the safety of transfusion recipients

BackgroundDespite recent progress in blood systems, transfusion errors can occur at any time from the moment of collection through to the transfusion of blood and blood products. This study investigated the actual statuses of blood transfusion errors at institutions of all sizes in Aichi prefecture. Materials and methodsWe investigated 104 institutions that perform 98 % of the blood transfusions in Aichi prefecture, and investigated the errors (incidents/accidents) that occurred at these facilities over 6 months (April to September, 2017). Incident/accident data were collected from responses to questionnaires sent to each institution; these were classified according to the categories and risk levels. ResultsNinety-seven of the 104 institutions (93.3 %) responded to the questionnaire; a total of 688 incidents/accidents were reported. Most (682 cases; 99.2 %), were classified as risk level 2; however, 6 were level 3 and over, which included problems with autologous transfusion and inventory control. Approximately one-half of the incidents/accidents (394 cases; 57.3 %), were related to verification and the actual administration of blood products at the bedside; more than half of these incidents/accidents occurred at large-volume institutions. Meanwhile, a high frequency of incidents/accidents related to transfusion examination and labeling of blood products was observed at small- or medium-sized institutions. The reasons for most of these errors were simple mistakes and carelessness by the medical staff. ConclusionsOur results emphasize the importance of education, operational training, and compliance instruction for all members of the medical staff despite advances in electronic devices meant to streamline transfusion procedures.

副腎皮質ステロイド軟膏剤の適正使用に向けたFinger-tip unit による服薬指導の実態調査と製剤学的使用性の評価

副腎皮質ステロイド軟膏剤の適正使用に向けたFinger-tip unit による服薬指導の実態調査と製剤学的使用性の評価

保険薬局における服薬指導に関する‌患者・薬剤師間の双方向性調査

Medication compliance instructions in a community pharmacy should be carried out according to each patient's needs. However, much information needs to be imparted to patients, but it is difficult to provide sufficient explanations within the typically limited time constraints. Therefore, pharmacists might not be providing sufficient information to their patients when giving medication compliance instructions. In this study, in order to investigate the differences between the perspectives of patients and that of community pharmacists on the contents of medical compliance instructions, we investigated the importance and implementation ratio using a questionnaire asking what each considers important. The results indicated that all medication compliance instruction items are considered important by both patients and community pharmacists. On the other hand, the implementation ratio of medication compliance instruction items by community pharmacists was higher than the received ratio of medication compliance instruction items of patients in almost all the items except “Q14: the patient's own disease” and “Q16: the necessity of community pharmacists in medication compliance instructions etc.” Furthermore, there were some differences in emphasis between patients and community pharmacists. Particularly in “Q3: generic medicines,” “Q7: attention in life,” and “Q10: laboratory data,” the importance and implementation or received ratio were reversed between patients and community pharmacists. In conclusion, the matter of concern from the perspective of medication compliance instructions between patients and community pharmacists was illustrated by a comparative surveillance. It would be possible to create ideal improved medication compliance instructions suitable for the patient's needs based on the information derived from this type of assessment method.

Construction of a three-dimensional model of cardiovascular disease and deployment of a new method of fostering patient adherence to instruction

BackgroundFor the patient-oriented medical services, it is important to assist the patient in understanding the management of cardiovascular diseases. The strategy of medication instruction is particularly important to enhance medication adherence.Objective and methodsThe original model was newly constructed and covers multiple factors, including those related to renin–angiotensin, metabolism of glucose and lipids, blood coagulation, and the organic basis of the disease. The four factors of cardiovascular diseases and their relationship with the disease state are expressed in the form of a tetrahedral model.Results and discussionThis disease model illustrates in points, lines, surfaces, and spaces that the factors combine with each other and result in a pathological condition, as determined by the degree of involvement of each factor in a discontinuous manner. The model helps cardiovascular patients to understand visually that there is more than one pathological condition. Our model allowed patients to quickly comprehend the complex pharmacotherapy of cardiovascular diseases by presenting the information in the form of a three-dimensional structure. Lifestyle-related diseases, including cardiovascular diseases, involve complicated factors and require careful pharmacotherapy which is tailored to individual patient needs. In this regard, the development of instructional tools is particularly effective.ConclusionThe three-dimensional model shows optimum treatment by correctly considering both the quantity and quality of the four pathological factors associated with cardiovascular diseases. Appropriate patient compliance instruction based on life guidance is thought to be essential in the treatment of cardiovascular diseases.

Complying with OSHA's RNEP, CNEP, and VPP RAGAGEP

The OSHA Refinery National Emphasis Program (RNEP) and OSHA Voluntary Protection Program incorporate specific questions relative to many recognized and generally accepted good engineering practices (RAGAGEP). Many of the same RAGAGEP can be expected to be used in the OSHA Chemicals NEP as well. To comply with OSHA's process safety management (PSM) regulation and improve process safety at their sites, chemical industry personnel should be aware of what RAGAGEP OSHA is recognizing and inspecting against and their key requirements. This article will discuss: (1) OSHA's expectations for compliance with RAGAGEP, including some of the RAGAGEP OSHA references in compliance directives, instructions, and citations, (2) some citations issued by OSHA involving RAGAGEP, and (3) common RAGAGEP compliance issues ABSG Consulting observes when conducting PSM audits and assessments throughout the petrochemical and related industries. © 2011 American Institute of Chemical Engineers Process Saf Prog, 2011

SU‐GG‐T‐526: Clinical Implementation of a Novel Frameless and Maskless Stereotactic Radiosurgery Treatment

Purpose: To develop and implement the workflow of a novel frameless and maskless stereotactic radiosurgery treatment at the University of San Diego, California, including patient simulation, treatment planning, and treatment delivery. The procedure involves minimal head immobilization and continuous monitoring of the patient with surface imaging. Method and Materials: A head immobilization device made of an expandable foam is used for maximum comfort and minimal immobilization of the patient's head. During treatment, the patient's motion is continuously monitored with a surface‐imaging system that provides motion detection in 6 degrees of freedom. Based on motion information, the treatment is interrupted if motion thresholds are exceeded. End‐to‐end tests were performed to develop an optimal workflow for the treatment. The procedure development included providing instructions for patient compliance, simulation, treatment planning, imaging, and treatment delivery. The workflow was implemented and used to treat the first seven patients. Results: An optimal workflow was developed and implemented. Our first seven patients have been treated with the developed procedure. Some changes are planned based on our initial experience. Conclusion: We have successfully developed the workflow of a frameless and maskless stereotactic radiosurgery procedure. Pre‐planning for the process is important but adjustments are necessary based on actual clinical experience with the procedure. Clinical experience will be discussed as it becomes available.

薬学部学内実習でみられた服薬指導の「難しさ」を「やりがい」に変える学生の意識構造

We provided training to students to raise their understanding of patient compliance instruction as part of the community pharmacy practice curriculum in our pharmacy school.In this study,we investigated whether the training made patient compliance instruction worthwhile to students,and analyzed their thinking processes in this respect in order to clarify the process of professional socialization.The questionnaire used for these purposes consisted of 27 questions on learning and 1 extra question on whether students felt patient compliance instruction was worthwhile.Responses were evaluated according to a 7 point scale and it was given to 128 students who participated in the training in 2007.Questions on learning were prepared by the KJ-method based on the reports of 43 students who participated in patient compliance instruction training in 2006.The average for the response to the question on whether patient compliance instruction training is worthwhile was 6.27 (max.7).Further,factor analysis on the responses of 124 students who completed all items of the questionnaire,produced three factors:“skills required for patient compliance instruction”,“difficulty of patient compliance instruction”and “need for pharmacist intervention”.In addition,covariance structure analysis suggested that through the training,students felt the“difficulty of patient compliance instruction” which provided the opportunity to be aware of the“skills required for patient compliance instruction” and the“need for pharmacist intervention”.These two factors seemed to be involved in the thinking process by which students felt that patient compliance instruction was worthwhile.

Dual Antithrombotic Therapy’s Increased Risks Not Always Offset by Benefit

ily and community medicine at the University of Nevada in Reno, explained that patients need to be taught how to recognize when their symptoms are getting worse, what do when their symptoms worsen (such as proper use of their rescue inhaler), and when they need further medical assistance. For example, Stoloff suggested physicians have placebo inhalers on hand so patients can demonstrate during visits that they can properly use the device. Additionally, the guidelines recommend that families and school staff be included in asthma action plans and taught to recognize when a pediatric patient is in distress and how to help. PEDIATRIC PATIENTS Theguidelines’updatedtreatmentcharts highlightthespecialneedsofpediatricpatients with asthma. Prior to the revision, the charts contained step-by-step treatment instructions for 2 groups, children younger than 5 years and everyone else. However,recentdatathatsuggestchildren and adults respond differently to certain medications ledthepanel todividethe“5 years and older” category into 2 groups: childrenaged5to11yearsand individuals aged 12 years or older. Panel member Robert F. Lemanske, MD, professor of pediatrics and medicine at the University of Wisconsin, in Madison, explained that the evidence compiled to date suggests that inhaled corticosteroids are the most effective treatment for children, and that children may not derive any further benefit from the addition of long-acting -agonists. In contrast, individuals who are aged 12 years or older may benefit from such combination therapy. Additionally, stratifying patients into these 3 categories helps physicians deal with the specific treatment issues that may arise in each age category. Factors such as understanding instructions for medication use and compliance, for example, are going to differ for preschoolers compared with adolescents. “There are clearly developmental distinctions we need to be thinking about,” he said.

診療録と薬剤管理指導記録の一体化に関するアンケート―医療チームで情報を共有することの有用性―

In the Chukyo Hospital, two separate records of patient information had been kept by doctors and nurses and pharmacists in the past. Doctors and nurses had written it in medical records and pharmacists in pharmaceutical care records and patient compliance instruction records. These records have been unified recently and we carried out a questionnaire survey to see if doing this had been beneficial or not. Persons responding were 10 doctors (in neurosurgery and neurology) and 25 nurses The questionnaire revealed that the unified records had made patient information more accessible and shareable and had made it easier to view medication history at a glance. On the other hand, the greater amount of data and thicker files resulting from the unification were seen as a problem. However, overall, the unification of the medical records, pharmaceutical care records and patient compliance instruction records was seen as useful.

国立循環器病センターにおける薬剤管理指導に関する調査−パイロットスタディによる評価−

Conducting clinical pharmacy practice in consideration of inpatient needs is one of the most important activities of pharmacists. In view of this, we conducted a pilot study at the National Cardiovascular Center to evaluate the effectiveness of our practice of clinical pharmacy. During the study period, 892 drug compliance instructions were given to 312 patients and there were 1, 785 events that had to be managed. In order to manage these events, we provided information in 2, 007 instances to patients (65 %) or medical staff (35%). Among the events, the frequency of adverse reactions was 6.3 %, with a rate per drug compliance instruction of one in eight. Medical errors accounted for 1.9% of the events, giving a rate of one error per 24 drug compliance instructions. Twenty percent of all prescription changes arose from information provided by pharmacists and 6.0 % of changes in prescriptions were attributable to the medication errors detected by pharmacists. Thus, pharmacists were involved in about 25 % of prescription changes. As our conclusion, clinical pharmacy practice which helps to avoid adverse reactions and provides useful information to patients and medical staff is a prerequisite for effective pharmacotherapy.

Creation of Drug Compliance Instruction Program for Patients with Type 2 Diabetes and Evaluation of its Effectiveness

The aim of this study was to devise a Drug Compliance Instruction Program (DCIP) for patients with type 2 diabetes taking oral hypoglycemic agents (OHA) and to assess its effectiveness. The new program was devised to improve levels of understanding and implementation in drug therapy for diabetes with the aims of contributing to and evaluating the effectiveness of such therapy. As its major features, the program uses the level of drug therapy implementation as an indicator of drug compliance and gives patients instructions on several occasions to ensure that they continue to be effective. Subjects were 109 type 2 diabetes outpatients who had HbA1c levels of 7% or more and were taking OHA. To study the effectiveness of the instructions, patients were randomly assigned to two groups : a single instruction group (n=66), and a multiple instruction group (n=43), whose subjects received instructions at least twice.DCIP significantly improved the levels of understanding (p=0.001) and implementation (p=0.033) of the drug therapy. The status of glycemic control based on HbA1c levels was used as an indicator in the evaluation of instructions, whose educational effect was significantly higher in the multiple instruction group than in the single instruction group (p=0.042). By enhancing levels of understanding and implementation in drug therapy for diabetes, DCIP significantly improved glycemic control, and this was maintained when instructions were given on several occasions.

What doctors expect of a pharmacist's work--how a pharmacist is evaluated by doctors

In recent years, a pharmacists' work has changed in terms of therapeutic management and counseling of patients. Generally, a pharmacist has to provide pharmaceutical care in cooperation with a doctor. In the present study, a questionnaire survey on what a doctor expects of a pharmacist was conducted, and directors of hospital were interviewed on what they expect of a pharmacist. Eighty-two doctors participated in the survey. As results, doctors consider that a pharmacist's work is dispensing of drugs (41%), and highly evaluated the works of a pharmacist in advising doctors regarding pharmacotherapy (29%), checking the prescription (28%), providing patient compliance instructions (27%) and providing drug information (26%). Five directors of hospital expect the pharmacists to carry out risk managements and prescription checks, provide drug information, and consultation on drug costs. In addition, doctors want pharmacists to have more knowledge on pharmacotherapy. These results clearly show what doctors expect of a pharmacist's work.

薬剤管理指導業務における質の維持・向上に向けて オーディット（監査）制の導入

We have recently instituted an audit system with the goal of maintaining and improving quality in pharmaceutical management and counseling services, i.e., pharmaceutical care practices. This system was created to improve the quality of record keeping for counseling services. The audit system is composed of 5 supervising pharmacists. A meeting is held once a month, and an audit is carried out concerning the patient compliance instruction documents, medication history and practice records of 2 clinical departments. In addition, methods for improving business efficiency are also discussed. We herein report on the specific guidance given to the supervising pharmacists of each clinical department, based on a total of 12 audit conferences. As a result, four problems were identified : (1) fundamental description issues, (2) record keeping modes, (3) insurance demands, (4) pharmaceutical perspective. The following improvements were instituted after notifying the relevant pharmacists and all other pharmacy staff of these problems : a reduction in the leakage of specific items, corrections of the records explaining the pharmacological effects, establishment of a drug interaction checklist, simplification of laboratory data records, simplification of the format, utilization of a problem list field, and other issues. The role of this audit system in maintaining and improving the quality of pharmaceutical management and counseling services has become increasingly important because as the counseling services for patients continue to expand.

保険薬局実務実習に対する本学学生の意識調査

All students in the 4 th year at our university, perform 4 -week training in pharmaceutical health care practice (practical training in hospital pharmacy and community prescription pharmacy). We carried out a consciousness survey of 149 students who received training at a community prescription pharmacy. A questionnaire on the interest in community prescription pharmacy work revealed the reply, “the training arouse my interest” in 58% of the students who wish to work in hospital after graduation and in 60% of those who wish to work in pharmacies but only in 49% of those who wish to work at pharmaceutical companies and in 40% of those who wish to go graduate schools. Among the types of work of community prescription pharmacy, those that particularly arouse student interest were “home medical care”, “patient compliance instructions” and “patient reception”. Interest in patient compliance instruction was frequently observed in students who wish to work in hospitals, home medical care and the sale of OTC drugs in those who wish to work in pharmacies, and DI work in those who wish to go to graduate schools.Concerning the questions about the image of community prescription pharmacies (or the work performance), students who felt a strong attitude of pharmacists toward their work showed more interest in training in community prescription pharmacies. To enhance the students' consciousness of practical training in community prescription pharmacy, the contents of training should be improved by evaluating the training items students wish to learn and adjusting by classifying the pharmacies requested to accept students for training.

Developing compliance instructions for drug labeling

Clinical Pharmacology & Therapeutics (2000) 68, 586–591; doi: 10.1067/mcp.2000.110976