Topics Held the Pharmaceutical Manufacturers Association of Japan (PMAJ) Media Forum. Aiming for Appropriate Use of Drugs - To deliver reliable drug information to patients
On July 19, 2022, the Pharmaceutical Manufacturers Association of Japan (PMAJ) held the "Pharmaceutical Manufacturers Association of Japan Media Forum" in an online format. This time, Ms. Tomiko Tawaraki, President of the Council for the Proper Use of Drugs, gave a lecture titled "Toward the Proper Use of Drugs - To Deliver Reliable Drug Information to Patients". She gave a detailed explanation on how to deal with the polypharmacy problem that has recently become an issue and how to provide reliable drug information to patients. Fourteen journalists from 11 companies attended the event.
Response to the Polypharmacy Problem
What is polypharmacy?
Polypharmacy has become a hot topic recently, with its introduction on TV and in the news. Polypharmacy is a coined word from "Poly (many)" and "Pharmacy (dispensing)," and refers not only to a large number of drugs, but also to a condition that leads to problems such as increased risk of adverse drug events, medication errors, and poor adherence to medications. In correcting polypharmacy, it is necessary to optimize prescribing from the perspective of ensuring safety, etc., rather than focusing solely on the uniform number of drugs/types of drugs.
Japan Association for the Proper Use of Drugs
Ms. Tomiko Tawaraki, President of the Council for the Proper Use of Drugs, Inc.
Problems in Pharmacotherapy for the Elderly
With the rapid aging of the population, problems associated with drug therapy for the elderly such as changes in pharmacokinetics due to decreased liver and kidney function and changes in body composition, increased polypharmacy due to complications, increased side effects due to polypharmacy, and drug-drug interactions are becoming more apparent.
In addition, it was pointed out that information on drugs is provided on a single drug basis, and that there is a risk that patients are not being alerted to the comprehensive use of multiple drugs, or that many patients have a high need for medication management, such as forgetting to take their medication.
Number of drugs used
Regarding the number of types of drugs used in each dispensing fee statement, a look at the composition ratio of the number of cases by type of drug class for both in-hospital and out-of-hospital prescriptions shows that "one type" and "two types" were common in both cases, but the ratio of "seven or more types" was high for patients aged 75 and older for both in-hospital and out-of-hospital prescriptions by age group (Figure 1). The situation was explained ( Fig. 1 ).
Figure 1 Number of drugs used
Number of drugs and frequency of adverse events
Using data, he introduced the fact that the risk of adverse drug events increases when the number of drugs prescribed increases to six or more among the elderly ( Figure 2 ).
Figure 2 Number of drugs and frequency of adverse events
Problems of polypharmacy
When patients visit a new medical institution or department each time they have a new medical condition, the number of drugs they take can add up to two or three prescriptions, and when new medical conditions are treated with drugs, a vicious cycle called a "prescription cascade" can occur, in which patients continue to use drugs to treat adverse drug events, which can lead to polypharmacy. polypharmacy ( Figure 3 ). Other problems associated with polypharmacy included an increase in the frequency of adverse drug events and an increase in large amounts of leftover drugs (drugs that were dispensed but not taken or used) that may have resulted from forgotten or missed doses or changes in symptoms.
Figure 3 Problems of drug therapy for the elderly
Measures against polypharmacy
The MHLW established the Study Group on the Appropriate Use of Medicines for the Elderly in 2017 and published the "Guidelines for the Appropriate Use of Medicines for the Elderly (General Overview)" in 2018, which outlines basic considerations when treating and prescribing medicines. In addition, the "Guidelines for the Appropriate Use of Medicines for Elderly Patients (each section (by medical care environment))," which summarizes considerations for each medical care environment for elderly patients, was published in 2019. These guidelines were compiled for physicians, dentists, and pharmacists, but the study group also pointed out the importance of educating patients and the public about polypharmacy. In response to this point, the Council for the Proper Use of Drugs and the Pharmaceutical Manufacturers Association of Japan created materials (leaflets, cards with QR codes, and posters) for the general public in 2020 ( Fig. 4 ). In cooperation with related organizations (Japan Pharmaceutical Association, Japan Hospital Pharmacists Association, Japan Health Insurance Pharmacy Association, and Japan Chain Drug Stores Association), we are making efforts to widely promote and educate the public so that these materials can be actively used by distributing them at the counter of pharmacies, etc. and at various events. In 2022, we will be promoting the use of polypharmaceuticals.
Figure 4 Creation of public awareness materials 2020
In 2022, with the aim of further raising awareness of polypharmacy, the Council for the Proper Use of Drugs and the Pharmaceutical Manufacturers Association of Japan (PMAJ) will be releasing a new, easy-to-understand video version of the booklet on their websites (see Figure 5 ). (Fig. 5) The video version was also shown on the day of the seminar.
Figure 5 Video Introduction "How Many of Your Drugs Are You Taking?"
Providing reliable drug information
Where to obtain drug information for the general public
According to a survey conducted by the Council for the Proper Use of Drugs, 57.5% of respondents "use the Internet" to look up information on prescription drugs. The use of the Internet has increased to the same level as obtaining information through medical professionals such as "ask the pharmacist" and "ask the doctor" ( Figure 6 ).
Fig. 6 Where the general public can obtain drug information
Drug Bookmark
The Council for the Proper Use of Drugs provides the "Drug Bookmark" as a guide to explain medication to patients ( Fig. 7 ). Based on the package inserts of ethical drugs, the bookmarks are compiled on a single A4-size sheet in expressions that are easy for patients and their families to understand. Approximately 180 pharmaceutical companies have produced this guide, and it currently covers about 75% of the items listed on the NHI drug price list. He also introduced that an English version has been prepared and can be used for foreign residents in Japan. The average monthly PV access to the Drugs Guidebook is 10 million, 75% of which is from the general public.
Fig. 7 Drug bookmarks
Drug bookmark milsil site to be launched in April
In order to further promote the use of the Drug Bookmark, the existing Drug Bookmark website was completely renewed, and the "Drug Bookmark Milsil site," a platform-type site for patients to "see and learn about drugs," was launched in April 2022 ( Fig. 8 ). (Fig. 8) The site will serve as a portal site for patient information centered on the Drug Guidebook, and information for patients created by pharmaceutical companies will be posted in conjunction with the Drug Guidebook, with each company beginning the registration process. Data from the Drug Guidebook is used in more than 50 systems, including the Electronic Medication Record Book, to provide information to a large number of patients ( Figure 9 ).
Fig. 8 Drug bookmark milsil site opened in April
Fig. 9 Linking drug bookmark data to various systems
Patient participation is necessary for proper use of medicines
It is important for patients to access and correctly understand drug information so that early symptoms of side effects can be detected. He expressed his hope that the Pharmaceuticals Bookmark Milsil site would become a hub of communication between medical professionals and patients ( Fig. 10 ).
Fig. 10 For good communication between healthcare professionals and patients
Closing Remarks
Through this lecture, the importance of pharmaceutical companies' efforts for the proper use of drugs was reaffirmed by the Council for the Proper Use of Drugs and the Pharmaceutical Manufacturers Association's (PMA) response to the polypharmacy issue and the easy-to-understand information about the Drugs Bookmark Milsil site. The Pharmaceutical Manufacturers Association of Japan (PMAJ) will continue its efforts to promote the proper use of drugs in cooperation with the Council for the Proper Use of Drugs.
( Masaya Fujimoto, WG for Promotion of Proper Pharmaceutical Use, Industrial Policy Committee)