title: Physician strategies for addressing patient adherence to prescribed psychotropic medications in Japan: a qualitative study.
abstract: OBJECTIVE
  Effective psychiatric care requires physicians to address the problems of patient adherence to prescribed medications. The aim of this study was to understand physician-perceived barriers to, and effective strategies for, prescribing anti-depressants in Japan.
  
  
  METHODS
  A qualitative study using semi-structured and key-informant interviews with a purposive sample of Japanese psychiatrists and key-informant physicians who had practiced in both the US and Japan.
  
  
  RESULTS
  Japanese psychiatrists recognize patient misperceptions, social stigma and resistance to acceptance of prescribed anti-depressant medication. Physicians also recognize that selective serotonin reuptake inhibitors (SSRIs) decrease rather than reinforce patient resistance. Physicians initially underdose, employ euphemisms and accept patient decisions to decline treatment by medication.
  
  
  CONCLUSIONS
  Even after the introduction of SSRI anti-depressants in 1999, Japanese psychiatrists' primary adherence strategy to initially underdose prescribed anti-depressants remains. The unstated physician strategy is to allow the pharmaceutical industry to address patient misperceptions, social stigma and the resistance to prescription therapies.
  
  
  CONCLUSIONS
  The results of this study delineate the fundamental strategies employed by Japanese physicians to address patient adherence to prescribed psychotropic medications, primarily to reduce the initial dose rather than to stress patient education.
authors.affiliation: Graduate School of Medicine, University of Tokyo, Tokyo, Japan. bts-tky@umin.ac.jp
authors.forename: B T
authors.initials: BT
authors.lastname: Slingsby
authors.forename: G A
authors.initials: GA
authors.lastname: Plotnikoff
authors.forename: T
authors.initials: T
authors.lastname: Mizuno
authors.forename: A
authors.initials: A
authors.lastname: Akabayashi
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions; D006801:Humans; D007564:Japan; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D010349:Patient Compliance; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D036301:Qualitative Research; D015203:Reproducibility of Results; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors