診療報酬改訂に伴う「投与日数規制の原則廃止」の薬物療法管理に及ぼす影響

Abstract

The proclamation of April 2002 of a Ministry of Health, Labor and Welfare ordinance has enabled doctors to prescribe drugs for an outpatient without a limit on the length of prescription terms except for a few drugs. There is a concern that the prescription term deregulation could cause careless drug therapy management in order to extend the interval between patient hospital visits. The purpose of this study is to make pre-and post-deregulation comparisons of two items, prescription terms and implementation of clinical examination that complied with package-insert precautions, and to discuss the approaches to increase safety. Prescription terms have lengthened progressively. In the preregulation period of January to March 2002, the mean prescription term was 19.9 days; in the post-regulation period of July to September 2002, it was 24.9 days; and in July to September 2003, 28.6 days. Even for anti-tumor agents, there were prescriptions over 90 days after deregulation. There was no signiˆcant diŠerence between the pre-and post-deregulation compliance ratios for the package-insert precautions in eight drugs of investigated nine. However, one case had a delay in detection of liver dysfunction, which was caused by deviation from the once-a-month testing indicated in the package-insert precautions for prolonged prescription terms. The evidence suggested that the deregulation led to negligent drug therapy management. To assure safe therapy, the following should be addressed:ˆrst, su‹cient function of a computerized prescriber order entry system and second, creation of a new framework with pharmacists' active involvement such as collaborative therapy management with physicians.

Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis

“…In Japan, newly listed drugs can be prescribed only in quantities sufficient for 14 days’ treatment [22]; therefore, patients have to visit their doctors repeatedly to get their prescriptions. This dispensing-day restriction is removed 1 year after launch, except for narcotic and psychotropic drugs.…”

Potential drug‐induced constipation: A retrospective study using a Japanese claims database

“…Our findings suggest that DIC may account for approximately 11% of all treated constipation cases, indicating that it is relatively common in clinical practice. The median period between the first prescription of the CD and pDIC diagnosis was 38.0 days, which may reflect early complaints of constipation by patients, because prescriptions are typically given on a 30‐day cycle, especially for chronic diseases in Japan 20 . However, it does not rule out that the patients or healthcare providers did not suspect the association between constipation and the prescribed CDs when constipation occurred after long‐term use of the CDs.…”

“…The median period between the first prescription of the CD and pDIC diagnosis was 38.0 days, which may reflect early complaints of constipation by patients, because prescriptions are typically given on a 30‐day cycle, especially for chronic diseases in Japan. 20 However, it does not rule out that the patients or healthcare providers did not suspect the association between constipation and the prescribed CDs when constipation occurred after long‐term use of the CDs. Considering that DIC may lead to poor adherence to the medication for the primary disease, physicians should be aware of the possibility of DIC when prescribing the CDs.…”