Effects of Pharmacists' Checkup for Unused Prescribed Medications Using a Bag (Setsuyaku Bag) on Patients' Adherence to Medication

Abstract

Pharmacists are expected to help reduce increasing healthcare costs. This study assessed the effects of pharmacists at community pharmacies checking for unused prescribed medications using a bag in which patients put medications (Setsuyaku Bag). We examined whether this check improved medication adherence and also measured the costs of the unused medications. Patients aged ≥ 20 years who brought the bag to community pharmacies were followed-up for 6 months. They took the bag to pharmacies if they had unused medications including those recently prescribed. Medication adherence scores at the first visit and after 6 months were assessed by patients (good 0-bad 4) and by pharmacists (good 1-bad 4). Changes in scores were analyzed using paired t-tests. Costs of unused medications were calculated, grouped as reused, saved, or discarded. The patient adherence score for 73 patients (mean age 71.3 years) decreased from a mean of 1.8, SE 0.1 at the first visit to 0.8, 0.1 at the 6-month visit (P < 0.001). The pharmacist adherence score also decreased over this period from a mean of 2.4, SE 0.1 to 1.5, 0.8 (P < 0.001). The mean cost of total unused medications during the 6-month per person was 9,962 yen: reused 6,523 yen (65.5％), saved 1,506 yen (15.1％), and discarded 1,933 yen (19.4％). Pharmacists＇ checkup for unused medications using a Setsuyaku Bag was likely to be effective for improving medication adherence, indicating that pharmacists can contribute indirectly to reducing healthcare costs through medication adherence and directly by lowering medication costs. 緒 言 平成 27 年度のわが国の医療費は 41.5 兆円と， 国民医療費は年々増大しており，そのなかでも調 剤医療費の伸びは大きく（ http://www.mhlw.go.jp/ topics/medias/year/15/dl/iryouhi_data.pdf, 2017 年 3 月 10 日） ，医療費抑制を目指した取り組みは，薬 剤師にとって重要な責務である．一方で，処方薬 の飲み残し等の残薬の実態は，生活習慣病患者で は 4 割以上の患者が薬を飲み残しており（