Objectives: Studies on the state of medication compliance in Japanese elderly patients are not comprehensive with respect to the patient's perception of health, modifying factors of medication, and likelihood of the patient actually taking the medication. The present study was conducted to investigate factors that influence medication compliance in elderly patients, compared with factors in younger patients.
Methods: One hundred and one elderly (65 years or older) and 105 younger outpatients (younger than 65 years) who were receiving drug therapy in the Department of Internal Medicine of Oita Medical University Hospital were directly interviewed using a questionnaire based on the health belief model for compliance behavior.
Results: When compared with younger patients, even though more elderly patients took greater numbers of different pharmaceutical preparations of drugs and received prescriptions from 2 or 3 physicians, the medication compliance score was better in elderly patients (p<0.01). The results showed that the length of drug therapy, past experience with adverse drug reactions, patient-physician relationship, anxiety about drug therapy, and patients' judgment about the effects of drug therapy were the factors that influence the medication compliance in both elderly and younger patients. However, factors such as sex, the frequency of medications per day, dosage, the number of prescriptions, and knowledge of drugs did not correlate with medication compliance in either group.
Conclusions: When compared with younger patients, elderly patients showed better medication compliance among outpatients of the university hospital. The present study suggests that the role of medical staff (physicians, nurses, pharmacists) in decreasing patients' anxieties with respect to the safety and effectiveness of drugs taken and in making better communication with patients is important in improving patient's compliance behavior.

View full abstract

We prepared patient-oriented drug information sheets for 220 drugs, which were distributed to the out-patients at 24 hospitals and clinics. The effects of providing the drug information sheets were evaluated using questionnaires not only for the patients but also for the medical staff. We received the questionnaires from 1396 patients and 88 medical staff personnel including 36 doctors, 18 pharmacists and 27 nurses. The results were as follows; 1) Fifty-four percent of the medical staff answered that the drug information sheets were effective in improving the patient-doctor relationship.Sixty-six percent of the patients answered that they had felt more at ease to communicate with the doctor and 63% of patients answered that they had come to feel that the doctor was more reliable. 2) Eighty-six percent of the medical staff answered that the drug information sheets would improve the drug compliance. In fact, they actually improved the drug compliance of the patients especially of those whose drug compliance had been poor before trial. 3) Ninety-six percent of the medical staff answered that the drug information sheets would be effective in prophylaxis or early detection of the drug adverse reactions. They helped the patients recognize an adverse reaction ; that was, 30% of the patients answered that they noticed they had suffered or were suffering from an adverse reaction of the drug. 4) Although the patients answered that the information, especially that concerning adverse reactions and the effect of a drug should be more detailed, the medical staff answered that the sheets should be simpler. The present study showed that, although beneficial effects of providing the drug information sheets with patients were recognized not only by the patients but also by the medical staffs, the evaluation of their contents by the medical staff differed from that by the patients.

View full abstract

To investigate the effects of aging on the pharmacokinetics of MCI-186, a novel agent for cerebrovascular disease, we performed a comparative study in parallel groups of young and elderly subjects. The subjects were 14 healthy male volunteers, 7 forming the elderly group (age 65-71 years) and 7 in the young group (age 25-34 years). Five subjects of each group received 100 ml of saline containing 0.5 mg/kg of MCI-186 intravenously via a 30-minute drip infusion, while the remaining 2 subjects in each group received only 100 ml of saline as placebo. The preparations were given twice a day (8: 00 and 20: 00) for two days; 4 times in total. Plasma and urinary concentrations of MCI-186 and its metabolites (glucuronide conjugate, MG and sulfate conjugate, MS) were determined. MCI-186 was well tolerated in all except for one elderly subject who complained of chest discomfort during the first administration. This problem was resolved quickly without treatment during the infusion and was not reproducible. Plasma concentrations of MCI-186 were almost identical in each group and statistical differences were not found among the calculated pharmacokinetic parameters such as maximum concentration (C_max), minimum concentration (C_min), area under the curve (AUC) or elimination half life (t_1/2). Although there was no statistically significant difference, C_max in the elderly group was slightly higher than in the young group (1040.7±105.8 ng/ml vs 887.6±171.3 ng/ml, elderly vs young, mean±SD, p=0.127), which could reflect a decrease in the volume of distribution in the elderly group.Ratios of the plasma concentration of the parent drug and the metabolites were almost the same in both groups. Thus, a modification of the dose of MCI-186 for elderly subjects is not required, although a minimum increase of C_max was found.

View full abstract

The effects of drugs on the central nervous system can be evaluated using a large number of tests in human. Since each test has a different sensitivity, to obtain pharmacodynamic parameters direct comparison of the results obtained by different tests is sometimes misleading. Thus, the choice of methods for evaluation likely affects the results of studies on sedative effects of drugs . Analysis of saccadic eye movement is reported to be a highly selective method to evaluate the sedative effect of benzodiaze-pines. This study was performed using computerized eye movement analysis to validate their application for evaluation of the effects of the anxiolytic, nitrazepam.
A randomized, double-blind, placebo-controlled cross-over study was carried out with eight healthy volunteers. Nitrazepam (5 mg) or its placebo was administered in each occasion with a 2 week wash-out period. Pharmacodynamic tests (saccadic eye movement, smooth persuit and VAS) were performed before intake and 30, 45, 60, 75, 90, 105, 120, 135, 150, 180, 240, 360 and 480 minutes after the drug administration. Serum nitrazepam concentrations were measured by HPLC. Pharmacokinetic parameters of nitrazepam were as follows: C_max: 75.78±28.86 ng/ml, t_max: 1.56±1.24 hr, t_1/2: 27.10±6.09 hr. The t_max and t_1/2 were similar to those reported in Caucasians. However, the C_max of Japanese subjects was about two-fold higher than that of Caucasians. A significant decrease in saccadic peak velocity was observed in every subject after nitrazepam administration (treatment effect, p=0.002). Saccadic latency was significantly prolonged in the nitrazepam group (treatment effect, p=0.04). No significant effects on smooth pursuit performance were found (p=0.07).
The concentration-effects relationship for saccadic peak velocity was described by a linear-model or clock-wise type.
Measurement of saccadic peak velocity and saccadic latency have been used successfully to characterize the sedative effects of nitrazepam in healthy subjects. The computerized eye movement analysis is a simple, sensitive and reproducible method without pre-test exercise and can be applied for the evaluation of effects of other CNS acting drugs.

View full abstract

The overdose and interaction of medication, combined with the high expenses of medicine, has become an important issue concerning the rational use of medication in health care. It is necessary to take preventive measures against irrational use of medication during medical treatment.
The prescription order entry system for outpatients was started in July 1994 at Tokyo University Hospital. A decision-making support function (duplicate prescription check) was added to the system. In our study, we have investigated the prescription order entry database of our hospital information system from April 1996 to June 1996. According to the result of our investigation, duplicate prescription occurs most frequently with the Central Nervous System (CNS) drugs (8.6%) and the Circulatory System drugs (11.2%). The clinicians' opinion survey also indicated the high risk of duplicate prescriptions. Hence, a duplicate prescription warning system is needed . By comparing the occurrences of duplicate prescriptions before and after the system implementation, we found that for the Circulatory System drugs, the rates of duplicate occurrence before and after using the system were 11.2% and 5.1%, respectively, for the CNS drugs, the corresponding percentages were 8.6% and 4.6%, respectively . Therefore, the system clearly proved effective in helping reduce duplicate prescriptions.
In the process of prescription order entry, we consider it crucial to provide physicians with relevant medicine information while they make treatment decisions . Such a support system will certainly help eliminate duplicate prescriptions and improve the quality of health care.

View full abstract