Factors Related to Medication Adherence of Cognitively Impaired Patients in Community Pharmacies

DOI: 10.4236/pp.2012.33050   PDF   HTML     4,399 Downloads   8,592 Views   Citations


Objective: The objective of the study was to identify factors related to donepezil medication adherence ("adherence") of cognitively impaired patients in community pharmacies. Methods: One hundred and twenty community pharmacies in 28 regions in Japan were randomly selected. Questionnaires were mailed to these pharmacies. The pharmacists answered based on the medication profiles ("YAKUREKI") of the patients given donepezil at their pharmacies. The survey items were "adherence", "who is the key person" and ‘the key person’s understanding and awareness of donepazil and its symptoms. The χ2 test and decision tree modeling analysis were performed to examine factors affecting adherence. A 5% level of statistical significance was used in the χ2 test. Results: Questionnaires with data on 479 patients were returned. The most common level of adherence was “take as instructed” (81.2%), followed by “forget once or twice a week” (10.2%). The χ2 test revealed that adherence was good if "key person" was professional caretaker (P = 0.004). Also, adherence was better if key person understood medication about dosage, P < 0.001; effect, P = 0.002; and general side effects,, P < 0.001. According to decision tree analysis, the key person had the strongest relationship with adherence. Conclusions: It was confirmed that the key person’s understanding of the medication and symptoms of cognitive impairment are related to adherence. In particular, it was suggested that there is a strong relationship between the key person and adherence and that factors related to adherence differ according to who the key person is. It is essential in the treatment of cognitive impairment to accurately identify the "key person", in order to provide better pharmaceutical care in community pharmacies.

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Y. Nanaumi, M. Onda, Y. Mukai, R. Tanaka, K. Tubota, S. Matoba, Y. Tanaka and Y. Arakawa, "Factors Related to Medication Adherence of Cognitively Impaired Patients in Community Pharmacies," Pharmacology & Pharmacy, Vol. 3 No. 3, 2012, pp. 368-380. doi: 10.4236/pp.2012.33050.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Japan Ministry of Health, Labor and Welfare, “Survey of Medical Care Activities in Public Health Insurance 2007”, 2007.
[2] Seed Planning, Inc. “Japanese Patient Population Analysis and Epidemiological Survey”, Japan, 2007
[3] Bassil N, Grossberg GT., “Novel regimens and delivery systems in the pharmacological treatment of Alzheimer’s disease”, CNS Drugs. 2009;23(4):293-307.
[4] Tanaka K, Obara T, Kobayashi M, Shinki T, Shibamiya T, Nishimura M, Gonokami K, Hara A, Ohkubo T, Oide S, and Imai Y, “Medication Compliance and Intentional Discontinuation of Taking Medication among Outpatients,” Research on drug interactions vol.32, No.3 2009, pp131-137.
[5] Barr RG, Somers SC, Speizer FE, Camango CA Jr, “Patient factors and medication guideline adherence among older women with asthma,” Arch. Intern. Med. Vol.162, 2002, pp1761-1768.
[6] Bloom BS, “Daily regimen and compliance with treatment.” BMJ(clinical research ed.), Sep 22, 2001, 323(7324), 647.
[7] J. Okuno, H. Yanagi, S. Tomura, “Is cognitive impairment a risk factor for compliance among Japanese elderly in the community?”, EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, Vol.57 No.8, OCT. 2001, pp589-594
[8] Monane M, Bohn RL, Gurwitz JH, Glynn RJ, Levin R, Avorn J. “The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population based study in the elderly,” Am. J. Hypertense, 10, 1997, pp697-704
[9] Payne KA, Esmonde-White S. “Observational studies of antihypertensive medication use and compliance: is drug choice a factor in treatment adherence?” Curr. Hypertens. Rep, 2, 2000, pp515-524.
[10] Martin-Rayes F, Rodriguez-Moran M. “Family support of treatment compliance in essential arterial hypertension”, Salud. Publica. Mex, Vol.43, 2001, pp336-339.
[11] Kerse N, Buetow S, Mainous AG Ⅲ, Young G, Coster G, Arroll B. “Physician-patient Relationship and medication compliance: a primary care investigation,” Ann. Fam. Med., 2, 2004, pp455-461.
[12] Harris LE, Luft FC, Rudy DW, Tierney WM. “Correlates of health care satisfaction in inner-city patients with hypertension and chronic renal insufficiency,” Soc Sci. Med, 41,1995 pp1639-1645.
[13] Van Wijk BL, Klungel OH, Heerdink ER, deBoer A. “Generic substitution of antihypertensive drugs does it affect adherence?” Ann. Pharmacother, 40, 2006, pp15-20
[14] Gadzhanova S, Roughead L, Mackson J. “Anticholinesterase duration in the Australian veteran population,” Aust N Z J Psychiatry, Vo.44, No.5 2010,pp469-474
[15] Hermann N, Binder C, Daiziel W, Smyth S, Camacho F. “Persistence with cholinesterase inhibitor therapy for dementia: an observational administrative health database study,” Drugs Aging, Vol.26, No.5, 2009, pp403-407.
[16] Mauskopf JA, Paramore C, Lee WC, Snyder EH, “Drug Persistency Patterns for Patients Treated with Rivastigmine or Donepezil in Usual Care Settings,” Journal of Managed Care Pharmacy, Vol.11, No.3, 2005, pp231-239.
[17] Borah B, Sacco P, Zarotsky V, “Predictors of adherence among Alzheimer’s disease patients receiving oral therapy,” Curr Med Res Opin, Vol.26, No.6, 2010, pp1957-1965.
[18] Blais L, Kettani Z, Perreaulf S, Leroux JC, Forget A, Kergoat MJ, “Adherence to cholinesterase inhibitors in patients with Alz-heimer’s disease,” J Am Geriatr Soc, Vol.57, No.2, 2009, pp366-368.
[19] Schwalbe O, Scheerans C, Freiberg I, Schmidt-Pokrzywniak A, Stang A,”Compliance assessment of ambulatory Alzheimer patients to aid therapeutic decisions by healthcare professionals,” BMC Health Services Research, 2010, pp10-232.
[20] Belle SH, Zhang S, Czaja SJ, Burns R, Schulz R, “Use of cognitive enhancement medication in persons with Alzheimer disease who have a family caregiver: results from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) project,” Am J Geriatr Psychiatry, Vol.12, No.3,2004 pp250-257.
[21] Sevilla C, Jiménez Caballero PE, Al-fonso V, González-Adalid M.,”Current treatments of Alzheimer disease: are main caregivers satisfied with the drug treatments received by their patients?” Dement Geriatr Cogn Disord, Vol.28, No.3, 2009, pp196-205.
[22] Makoto Hayashi, Eriko Takeo, Morihiro Okada, Kazusumi Gotou, Ken Iritani, Tatsuo Suzuki, “Questionnaire Survey on Taking Medicine, and a Study of the Improved Compliance in Ischemic Heart Disease Patients,” Journal of Japanese Society of Hospital Pharmacists, Vol.41, No.11,2004 1403-1406.
[23] Kazuhisa Ishida, “Compliance for Oral Antidiabetic Agents and its Improvement by One dose Package,” Journal of Japanese Society of Hospital Pharmacists Vol.26, No.6, 2000,pp 674-678.
[24] Keiko Yamaoka, Shigeyasu Fukuzumi, Kazutosi Yosizumi, Emiko Iguchi, Mariko Sasaki, Yasuo Nakajima, Toshikazu Yamauchi, “An Evaluation of Compliance for α-glucosidase Inhibitor,” Journal of Jap-anese Society of Hospital Pharmacists,Vol.25, No.2,1999, pp204-211.
[25] Masayuki Tatemichi, Tsutahiro Hama-guchi, Munetaka Hashira, Takeshi Hayashi, Masato Ito, Atsushi Nakatani, Hisanori Hiro, Koji Mori, Yasushi Ookubo, Takafumi Ezaki, Hiroki Sugimori, Katsumi Yo-shida, “Acceptability and Long-Term Compliance with Drug Treatment for Hypercholesterolemia in Japanese Male Workers: I. Acceptability of Drug Treatment,” Journal of Occupational Health, Vol.44, 2002, pp166-175.
[26] Miwako Kamei, Mitsuko Onda,”Effects of deregulation on prescription term for outpatients’ drug therapy,” The Journal of Japan Society for Health Care Management, Vol.4, No.3, 2003, pp377-383.
[27] Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz CD, Mukherjee J, “Can simple clinical measurement detect patient noncompliance?” : Hypertens Vol.2,1980, pp757-764,
[28] Paul M, Cara J, Elizabeth H, Jiang H, Donald M, Larry S, Webber and Marie KW, “Defining the Minimal Detectable Change in Scores on the Eight Item Morisky Medication Adhererance Scale,” The Annals of Pharmacotherapy, Volume 45, May, 2011, pp569-575.
[29] Hiratuka S, Kumano H, Katayama J, Kishikawa Y, Hishinuma T, Yamauchi Y, Mizugaki M, Drug Compliance ScaleⅠ―Development of Drug Compliance Scale―Yakugaku Zasshi Vol.120, No.2, 2000, pp224-229.
[30] Cotrell V., Wild K., Bader T., “Medication management and adherence among cognitively impaired older adults,” J. Getrontol Soc Work, Vol.47, No.3-4, 2006: pp31-46.
[31] KEMUYAMA Shoko, “Recognition of depression state in dementia by care workers and nurses and problems encountered,” Health Sciences Bulletin Akita University, Vol.17, No.2, 2009-10 pp59-69.
[32] Jane R. Mort, Mary K. Tasler, “Managing Dementia-Related Behavior in the Community,” Journal of the American Pharmaceutical Association Vlo.NS36, No.4 April 1996.
[33] Sonia Sen-Roy, “Alzheimer’s disease: A review,” Pharmacy Practice (Mississauga), vol.18, Iss.4. Apr 2002 Pg. C1
[34] KOBAYASHI Yoko, “The Recognition of Caregiving and the Factors Affecting It of Elderly Husbands Caring tor Demented Wives,” Journal of Japan Academy of Gerontological Nursing, Vol.9, No.2, Mar, 2005, pp64-76.
[35] Ocana GG, Robles RG, Vinuesa DS, De Castro FL, “Family repercussions due to Alzheimer disease,” Rev Enferm, Vol.30, No.3, Mar, 2007, pp59-64.

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