ラオス国サワナケート県におけるアルテミシニン併用療法に対する服薬遵守および医療従事者の認識と服薬指導

博士(保健学)琉球大

Improved Medication Adherence of an Elderly Diabetic Patient at a Dwelling Home Using a Pill Dispenser and Personal Health Records

Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient to take the medications. If the patient misses a dose, a designated contact, such as the patient’s child, is alerted. We conducted an experiment monitoring the use of a pill dispenser (Fookkun®) by an older patient. The participant was a 71-year-old woman with diabetes living in a dwelling home. The experiment lasted approximately 6 months. Fookkun® and the prototype data transmitter were installed at the patient’s home. Fookkun®’s medication history data are displayed on the electronic medication record book (E-MRB) and the patient’s pharmacist checks the patient’s medication history on the E-MRB. The Fookkun® was effective in facilitating medication adherence. The pharmacist and the patient’s daughter did not need to check the E-MRB because Fookkun® alerted them when the patient missed her medication. We believe that if the medication history data linked between a pill dispenser and an E-MRB can be shared among medical staff, this will contribute to a medical digital transformation in Japan in the future

Patients’ adherence to artemisinin-based combination therapy and healthcare workers’ perception and practice in Savannakhet province, Lao PDR

Abstract Background Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients’ adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients’ adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers’ perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR. Methods A prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted. Results Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients’ understanding of medication instructions. Conclusions Patient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients’ understanding of the instructions