Concurrently with a revision in the format of prescription orders and the construction and introduction of an outpatient ordering system, we examined a number of ways to provide patients with information about their prescriptions. We decided to introduce a “prescription card” containing the information printed on the prescription order. To evaluate the effectiveness of this program, which enables patients to track their own drug histories, we conducted surveys of patients and physicians.
The surveys were carried out in four stages. Patient surveys were carried out through personal interviews at the Pharmacy Department counter between the hours of 10: 00 a.m. and 4: 00 p.m. The results showed that 56% of all patients surveyed were being treated by several departments or at other institutions. With respect to what patients did with their prescription cards, the percentage of respondents who said that they saved the cards in “okusuri techo” was about 30%(103 patients) in the first stage, about 10%(162 patients) in the second stage, and about 40%(297 patients) in the third stage. However, about 10% of patients in all three stages said that they discarded their prescription cards. The percentage of patients who said that they showed their cards to their physicians or pharmacists was about 40% in the first stage, about 80% in the second stage, and about 50% in the third stage. These results show that further education is needed to instruct patients in the benefits provided by their prescription cards.
In the survey of physicians, almost all respondents (66 physicians) answered that the prescription cards were effective and beneficial. However, some responses pointed out limits to their effectiveness, for example, cases in which patients did not show their cards to physicians at other institutions because they did not want it to be known that they were receiving psychological care.
In the fourth stage of the survey, carried out eight months after the prescription card program was introduced, responses were obtained from 1, 195 patients. About 41% said that they saved their prescription cards in a notebook, and of those about 40% said they showed the cards to their physicians.
The provision of drug information to patients through the prescription card program constitutes the first step toward a system that will enable patients to track their own drug histories and to participate in their own drug treatment. Comprehensive menagement of drug information by patients themselves may contribute to improved drug therapy through the prevention of overprescriptions and mutual side effects.

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We conducted a survey to evaluate a system adopted by the Pharmacy Department of Tokyo University Hospital to address the problem of drug compliance under this system, patients are provided with a “Drug History Handbook”, or drug notebook. This survey attempted to determine the extent to which a “Drug History Handbook” helped patients understand the drug they were taking, and the extent to which it was utilized during visits to other institutions. Based on the results of the survey, we evaluated the efficacy of “Drug History Handbook” as a means to enable patients themselves to perform comprehensive drug information management.
Out of 288 patients responding to the survey, 149 (52%) had a “Drug History Handbook” 149 out of 286 respondents or 40% had been diagnosed at other institutions. The respondents who said they had shown their “Drug History Handbook” to pharmacists or physicians at other pharmacies, hospitals, or medical institutions were numbered 71 out of 149 (48%), including duplicate responses.
At community pharmacies conducted at the same time, responses were obtained from 48 pharmacies. Of the 48 responding pharmacies, 21 (44%) said that patients had presented either “Drug History Handbook” or “prescription cards” .
From these results, it is clear that the patients thus realized the importance of keeping a complete record of the drugs they had taken, and that presenting information about drug history can be a very valuable aid in both prescribing and preparing appropriate medications.
From thus survey, it was found that the use of a “Drug History Handbook” can help prevent the dispersal of information about purchase of over the counter drugs as well as prescription drugs. As a means of patient education, it can also be extremely effective for avoiding the duplicated administration of medications and drug-drug interactions.

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This study examined the actual condition on the use of beta-blocker eye drops, and the duplicated prescription of eye drops. Patients were thus surveyed on the rational use of beta-blocker eye drops carried out through personal interviews at our Pharmacy Department counter. The results showed that the practice rate of the “instillation of one drop of the eye drops” was 55 (78%) of 71 patients, while “eyelid closure for 1 minute after application” was 45%, and “nasolacrimal occlusion for 1 minute after application” was observed in 20%. The practice rates of “eyelid closure” and “nasolacrimal occlusion” were increased about 2 fold, respectively, as compared with the data obtained one year earlier. This may be due to the abouve extra consultation. However, these practice rates were still small. This indicates that many patients may be not fully aware of the importance of such practice. Therefore, further education will be needed to instruct patients in the rational use of the eye drops.
The results of prescription surveys in 6500 sheets for 3 months from November, 1995 to January, 1996 showed that the total number of over-prescription of beta-blocker eye drops and calcium antagonist internal medicine was found to be 105. These results show that we must constantly check for duplicated prescription to patients prescribed beta-blocker eye drops, while furthermore, comprehensive provision of drug information on the development and prevention of the systemic side effects of beta-blocker eye drops to oculists and physicians is also essential.

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In the present study, we investigated the effect of inter-individual variation and dispensing experience as a factor of variation when mixing digoxin powders.
Sixteen of the post-graduate trainees (non-experienced group) who entered the Department of Pharmacy, University of Tokyo Hospital in April 1996, and had no dispensing experience with powders, and six pharmacists (experienced group), who had individually amassed 3 to 5-years of dispensing experience, participated in our study.
The mean CV values (n=3) of the digoxin contents in the experienced group were 2.7% on the first experiment, 2.7% on the second and 2.5% on the third. Eight of the non-experienced group members produced a CV of less than 6.08% in all experiments. However, the CV values generated by the other eight members of the non-experienced group exceeded the standards of good mixing, and in addition, wide variations were observed. The eight above described trainees had received 3 weeks of training, and, when the mixing experiments were performed again, the registered CV values were less than 6.08% in all experiments.
These results showed that, even in the case of digoxin powders requiring a high degree of mixing, good mixing was obtained under our proposed mixing conditions in half of the trainees with no dispensing experience, and in addition, good mixing was generally obtained after all had received 3 weeks of training.

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