医薬分業下における外来慢性疾患患者の服薬アドヒアランスと医療サービス評価の関連性：残薬削減とかかりつけ薬局を志向した実証研究

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  • The Relationship between Medication Adherence and Medical-service Evaluation among Chronically-diseased Outpatients under the Separation of Prescribing and Dispensing: An Empirical Study Aiming at Reducing Unused Medicines and Promoting Family Pharmacies

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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.

収録刊行物

  • 社会薬学

    社会薬学 35 (1), 23-33, 2016

    日本社会薬学会

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