Continuity of Visiting Pharmacist Services and Factors Related to Service Discontinuation Among Older Adults in Japan: A Retrospective Cohort Study

Abstract

This study describes the continuity of visiting pharmacist services and investigates factors associated with service discontinuation in a homebound older population in Japan. This retrospective cohort study used medical and long-term care claims data from older adults aged ≥ 65 years in a city in Tokyo, Japan, who began to receive visiting pharmacist services between April 2014 and March 2019. Participants were followed until service cessation (defined as the absence of service claims for 2 consecutive months) or 12 months from initiation. Reasons for cessation were categorized into death, relocation, hospitalization/institutionalization, or discontinuation based on claims data. Multivariable competing-risk Cox regression analysis determined factors associated with discontinuation. Death and hospitalization/institutionalization were considered competing risks, and relocation was considered non-informative censoring. The study included 3952 older adults, with 353 (8.9%) having terminal cancer. The median time to any-cause cessation was 11 and 2 months for all participants and those with terminal cancer, respectively. Death was the most common reason for cessation, with a 12-month cumulative incidence of 0.25 (95% confidence interval: 0.24-0.27). Factors associated with a lower likelihood of discontinuation included higher long-term care need levels, polypharmacy of more than five medications, recent hospitalization, and cancer diagnosis. Conversely, living at home compared to residential facilities, ischemic heart disease, and receiving services from pharmacies providing 24-h support were linked to a higher discontinuation risk. This study enhances the current understanding of continuity in visiting pharmacist services for older adults. Care should be tailored, considering factors influencing service duration and potential discontinuation.

Keywords: cancer; claims data; home visits; long‐term care; pharmacists.

FIGURE 1

Algorithm for classifying reasons for cessation of visiting pharmacist service use. Claims data from the final month of service use and the subsequent month were analyzed to classify the reasons for service cessation.

FIGURE 2

Cumulative incidence of selected events. (A) All participants; (B) Stratified by terminal cancer status.

FIGURE 3

Factors associated with discontinuation of visiting pharmacist services. Abbreviations: aHR, adjusted hazard ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease.