Challenges of Instituting a Prescription Refill System in Japan

Abstract

Establishing a prescription refill system in clinical sites is being considered in Japan, which would involve setting long-term prescriptions as these are the base of such a system. The purpose of this paper is to clarify the status of long-term prescriptions by investigating the current frequency of medical visits in patients with hypertension who are usually prescribed medication for a relatively long period of time. Furthermore, we investigated the burden on patients to clarify expectations for the refill system from the perspective of patients. The participants in the present study were 172 patients whose only disease was hypertension that was well-controlled with 1-2 antihypertension drugs, and who visited health insurance pharmacy chain stores over six days in May 2017. We collected data on the current frequency of medical visits, patients’ desired frequency of medical visits, and personal management of blood pressure. The results revealed that 79.7% (n=137) of patients visited a medical facility once monthly. Of the total number of patients, one fourth wished to reduce this frequency, and over half of these responded that the reason was that their “blood pressure was stable.” Additionally, 90.7% (n=156) of patients owned a blood pressure meter, but only 32.0% (n=55) measured their blood pressure daily. The results of a comparative analysis of different ages with respect to medication adherence showed that significantly fewer people aged 66 and over forgot to take their medication. In sum, there were few long-term prescriptions subject to refills among patients with stable hypertension. In order to decrease the burden on patients and implement an appropriate long-term prescription system, the pharmacist is expected to explain the importance of medication adherence to the patient and support at-home blood pressure monitoring and self-management.