Kenya Ie

Background: Understanding how patient trust in healthcare providers is related to readiness to deprescribe is essential for optimizing deprescribing. This study examined this association among older adults with polypharmacy in the U.S. and Japan. Methods: We conducted cross‐sectional surveys involving Japanese older adults receiving care from a community hospital and primary care clinic (Kawasaki City, n = 185) and American older adults recruited to a research registry within a university hospital system (Pittsburgh, n = 107). Cohorts were recruited using similar inclusion criteria (5+ prescriptions, community‐resident, stable regimens, recent physician care, no dementia). Participants completed the 11‐item Patient Perceptions of Deprescribing short form to assess readiness to deprescribe (range 6–30) and trust in healthcare providers (range 5–25). Results: Greater trust in providers was associated with lower readiness to deprescribe across both samples, with no significant interaction by location. A higher number of medications was associated with greater readiness. Although U.S. participants had higher readiness (16.7 vs. 15.4, p < 0.05) and trust (21.9 vs. 19.8, p < 0.001), the greater readiness observed among U.S. participants remained after adjustment for demographics and clinical characteristics (+2.45 points, p < 0.01). Conclusions: Greater trust in healthcare providers was consistently associated with lower readiness to deprescribe across both samples. Although U.S. older adults demonstrated greater readiness to deprescribe compared to Japanese counterparts, the association between trust and motivation was similar across settings. This finding suggests that how trust functions in patient–provider relationships may be important for designing shared decision‐making interventions for deprescribing.

PURPOSE Understanding patients’ perspectives and readiness regarding deprescribing—a concept broader than mere drug cessation, encompassing dynamic interaction between patients and health care professionals—is essential for developing feasible and effective deprescribing interventions. The goal of our study was to qualitatively explore the perspectives of older adults regarding proactive deprescribing, as well as its barriers and enablers. METHODS We conducted semistructured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more regular medications to explore their perceptions and experiences related to deprescribing. The interviews were transcribed and the data were thematically analyzed to identify major concepts. RESULTS Placing a low value on medication was an important trigger of patients’ proactive attitudes toward deprescribing. Patients were open to deprescribing conversations if they trusted the prescriber. Conversely, patients who had a positive perspective on medication or considered themselves incapable of participating in decision making preferred to defer to a physician. On the basis of medication valuation, decision-making preferences, and openness to deprescribing, we developed a new typology with 5 types of patients: indifferent (15% of study patients), satisfied and risk-averse (10%), compliant (30%), fearful but passive (20%), and proactive (25%). CONCLUSIONS Patients’ attitudes toward deprescribing varied considerably according to their medication valuation, preference for involvement in decision making, and openness to deprescribing. Focusing on patients’ proactiveness and understanding these barriers and enablers is essential for patient-centered decision making and for developing strategies to optimize the appropriateness of medication.

The aging population presents critical challenges to global healthcare systems, with Japan expected to have 35% of its population aged 65 or older by 2040. Older adults often experience multimorbidity, cognitive impairments, and physical frailties, increasing healthcare utilization and costs. Traditional medical approaches that focus on organ‐specific diagnoses are insufficient for addressing these multifaceted needs. The Age‐Friendly Health Systems (AFHS) framework, introduced in the U.S., offers a patient‐centered, value‐based approach to geriatric care, encompassing the "4Ms": Mentation, Mobility, Medication, and What Matters. These pillars prioritize cognitive health, physical function, appropriate medication use, and patient values. However, Japan has yet to implement this system widely. The integration of AFHS, with an additional focus on "Multicomplexity" (5Ms), aligns well with the core competencies of General and Family Medicine. This specialty is crucial in leading interdisciplinary efforts to enhance geriatric care, addressing fragmentation and variability in healthcare delivery. To successfully implement AFHS in Japan, general medicine physicians must be trained in managing complex conditions and coordinating care across specialties. This shift toward holistic, patientcentered care is essential for improving outcomes for older adults and reducing healthcare costs. Future research should focus on developing effective strategies for AFHS implementation and training healthcare teams for comprehensive care delivery.

Background: Deprescribing is a critical component of clinical practice, especially in geriatric medicine. Nevertheless, the attributes of patients who are prepared for, interested in, and could potentially benefit from deprescribing have not been well examined. The Patient Perceptions of Deprescribing (PPoD) evaluates patients' overall readiness for deprescribing and is complemented by an 11‐item validated short form (SF‐PPoD). The objective of this study was to develop a Japanese version of the SF‐PPoD and assess its reliability and validity within Japanese older adults with polypharmacy.Methods: The SF‐PPoD was translated, back‐translated, and assessed in a cognitive interview. We conducted a cross‐sectional survey with 196 patients aged 65 years or older with five or more medications using the Japanese version to test for reliability and validity. We examined internal consistency and construct validity to determine if the Japanese sample responses reproduce the two subscales in the original SF‐PPoD. Finally, we examined intra‐person replicability using the intraclass correlation coefficient, in which 100 participants were invited and 93 participated.Results: 118 males and 78 females, with a mean age of 79.2 [SD 6.5] years, completed the survey. Confirmatory factor analysis of the Japanese version of SF‐PPoD revealed satisfactory structural validity with two‐dimensional structure, “Motivation for Deprescribing” and “Primary Care Physician Relationship.” Cronbach's alpha showed good internal consistency, and test–retest demonstrated acceptable intra‐rater reliability.Conclusions: We developed and validated a Japanese version of SF‐PPoD with an 11‐item, two‐dimensional structure consistent with the original SF‐PPoD. This scale may facilitate shared decision‐making for medication optimization among older adults living with multimorbidity.

Importance: There is currently no consensus on clinically effective interventions for polypharmacy among older inpatients.Objective: To evaluate the effect of multidisciplinary team-based medication optimization on survival, unscheduled hospital visits, and rehospitalization in older inpatients with polypharmacy.Design, Setting, and Participants: This open-label randomized clinical trial was conducted at 8 internal medicine inpatient wards within a community hospital in Japan. Participants included medical inpatients 65 years or older who were receiving 5 or more regular medications. Enrollment took place between May 21, 2019, and March 14, 2022. Statistical analysis was performed from September 2023 to May 2024.Intervention: The participants were randomly assigned to receive either an intervention for medication optimization or usual care including medication reconciliation. The intervention consisted of a medication review using the STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert to Right Treatment) criteria, followed by a medication optimization proposal for participants and their attending physicians developed by a multidisciplinary team. On discharge, the medication optimization summary was sent to patients’ primary care physicians and community pharmacists.Main Outcomes and Measures: The primary outcome was a composite of death, unscheduled hospital visits, and rehospitalization within 12 months. Secondary outcomes included the number of prescribed medications, falls, and adverse events.Results: Between May 21, 2019, and March 14, 2022, 442 participants (mean [SD] age, 81.8 [7.1] years; 223 [50.5%] women) were randomly assigned to the intervention (n = 215) and usual care (n = 227). The intervention group had a significantly lower percentage of patients with 1 or more potentially inappropriate medications than the usual care group at discharge (26.2% vs 33.0%; adjusted odds ratio [OR], 0.56 [95% CI, 0.33-0.94]; P = .03), at 6 months (27.7% vs 37.5%; adjusted OR, 0.50 [95% CI, 0.29-0.86]; P = .01), and at 12 months (26.7% vs 37.4%; adjusted OR, 0.45 [95% CI, 0.25-0.80]; P = .007). The primary composite outcome occurred in 106 participants (49.3%) in the intervention group and 117 (51.5%) in the usual care group (stratified hazard ratio, 0.98 [95% CI, 0.75-1.27]). Adverse events were similar between each group (123 [57.2%] in the intervention group and 135 [59.5%] in the usual care group).Conclusions and Relevance: In this randomized clinical trial of older inpatients with polypharmacy, the multidisciplinary deprescribing intervention did not reduce death, unscheduled hospital visits, or rehospitalization within 12 months. The intervention was effective in reducing the number of medications with no significant adverse effects on clinical outcomes, even among older inpatients with polypharmacy.Trial Registration: UMIN Clinical Trials Registry: UMIN000035265

A 54-year-old Japanese man presented with a 5-day history of nausea, and epigastric and back pain. He was taking vilanterol/fluticasone furoate, pranlukast, ketotifen, and carbocysteine for bronchial asthma, and Shin’iseihaito herbal medicine for a chronic cough associated with bronchial asthma. His vital signs were normal. Physical examination revealed tenderness in the epigastric and right lumbar regions. Laboratory tests were unremarkable. Computed tomography showed wall thickening and submucosal oedema in the ascending colon, and multiple linear calcifications along a mesenteric vein from the ileum to transverse colon ( Fig. 1), suggestive of mesenteric phlebosclerosis. He was admitted, stopped taking Shin’iseihaito, which he had been taking for the past 10 years, and acetaminophen was administered for pain relief. The pain decreased and he resumed eating on hospital Day 4 and was discharged on Day 7. Epidemiologically, mesenteric phlebosclerosis is characterized by an average age in the 60s, is slightly more common in women, and has only been reported in Asians (mainly Japanese) [ 1]. In mesenteric phlebosclerosis, calcification of the mesenteric veins causes impaired venous return, leading to chronic ischaemic changes in the intestinal tract [ 2–4]. Right-sided abdominal pain, diarrhoea, nausea, and vomiting may be present, and severe cases may result in bowel obstruction; however, some cases are asymptomatic, detected on faecal occult blood testing [ 2, 3]. Radiography and computed tomography show colon wall thickening and linear calcifications along the intestinal wall or mesenteric veins, and endoscopy shows oedematous dark purple- or bronze-coloured mucosa, mainly in the right hemicolon [ 1–6]. Most cases are associated with taking Chinese herbal medicines, particularly Kamishoyosan, Orengedokuto, and Shin’iseihaito [ 3–5], which all contain Gardenia, and Gardenia use is reported in 86% of cases [ 4]. The risk of mesenteric phlebosclerosis increases with internal use of Gardenia for more than 5 years [ 3]. Chronic use of herbal medicines containing Gardenia fruit may be one of the main associations of mesenteric phlebosclerosis [ 3, 5, 6]. Geniposide, the main component of Gardenia, reacts with proteins during absorption from the ascending colon and passage through the mesenteric veins, forming a blue pigment that causes mesenteric vein fibrosis and calcification [ 4, 5]. Although several causes of mesenteric venous sclerosis have been described, including diabetes mellitus, cirrhosis and other liver disorders, postoperative changes, exposure to toxins, genetic factors, and association with collagen disease, nothing is definite [ 1, 7], and at present, there are no other reports strongly suggesting a link other than Gardenia. Treatment includes discontinuation of the suspected drug, and anticoagulant therapy. In some cases, intestinal resection may be required due to repeated bowel obstruction and abdominal pain [ 3–5]. Long-term internal use of herbal medicines containing Gardenia should be carefully monitored because of the risk of mesenteric phlebosclerosis.

Background: Studies have shown that a usual source of care increases the receipt of child preventive care; however, the relationship between having a usual source of primary care and COVID‐19 parental vaccine hesitancy has not been fully investigated. The aims of this study were to elucidate the characteristics of mothers with a primary care physician, and to explore the relationship between having a usual source of primary care and COVID‐19 parental vaccine hesitancy among mothers in Japan.Method: This cross‐sectional survey‐based study included 4516 mothers. Using a chi‐square test, the characteristics of mothers with and without a primary care physician were compared. Poisson regression was applied to evaluate the relationship between having a usual source of primary care and parental COVID‐19 vaccine hesitancy.Results: Mothers with a usual source of primary care had higher education, lower mental distress, had younger children, and were less hesitant toward the child's COVID‐19 vaccination. Vaccine hesitancy was observed in 39.8% of mothers with a usual source of primary care and 45.5% of those without. Poisson regression analysis showed that mothers with a primary care physician were less vaccine‐hesitant (IRR = 0.90, 95% CI = 0.84–0.96) after adjusting for potential confounders.Conclusion: This study suggested that having a usual source of primary care may contribute to lower parental COVID‐19 vaccine hesitancy. However, the high vaccine hesitancy rate, even among mothers with a usual source of primary care, warrants healthcare providers to be equipped to help parents make informed decisions about vaccination through the continuity of care.