title: Failure mode and effects analysis of medication adherence in patients with chronic myeloid leukemia.
abstract: BACKGROUND
  Poor adherence to ABL tyrosine kinase inhibitors (ABL TKIs) is associated with reduced treatment efficacy and increased healthcare costs. To examine the hazards associated with poor adherence, we implemented failure mode and effects analysis (FMEA).
  
  
  METHODS
  We surveyed 54 chronic myeloid leukemia (CML) patients treated at Saga University Hospital from October 2012 to May 2014. The survey consisted of items regarding the type of ABL TKI used, adherence to ABL TKIs, the appearance of adverse effects, utilisation of the high cost medical care benefit system, and factors affecting adherence. Four factors that likely affected adherence were identified, including the level of understanding of ABL TKIs treatment outcomes, adverse effects, the high cost of medications, and careless slips in the taking of medicine. Results of the survey were analysed by FMEA.
  
  
  RESULTS
  The risk priority number was highest for careless slips in the taking of medicine at 7.0 ± 1.0 (mean ± SEM), followed in descending order by the inadequate understanding of treatment outcomes (4.9 ± 0.6), adverse effects (3.8 ± 0.8), and high medication cost (2.2 ± 0.5). Thus, the prevention of careless slips was the most important factor affecting adherence to ABL TKIs. Contrary to our preoccupation, FMEA revealed that high medication cost was the lowest risk factor for poor adherence. This finding may be attributed to the high utilisation (96.3 %) of the high cost medical care benefit system.
  
  
  CONCLUSIONS
  These findings suggest that an inadequate medication-taking habit such as careless slips may represent a potential target to improve and maximize adherence in CML patients.
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Hosoya
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Mochinaga
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Emoto
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yokoo
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tokushima
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Egoshi
authors.affiliation: Department of Pharmacy, Saga University Hospital, Saga, Japan.|Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sueoka-Aragane
authors.affiliation: Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan. shkimu@cc.saga-u.ac.jp.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D000067495:Healthcare Failure Mode and Effect Analysis; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016315:Proto-Oncogene Proteins c-abl / Q000037:antagonists & inhibitors*; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D016315:Proto-Oncogene Proteins c-abl
keywords: ABL tyrosine kinase inhibitor; Adherence; Chronic myeloid leukemia; Failure mode and effects analysis