Open Access Open Access  Restricted Access Subscription or Fee Access

Community pharmacists’ current perceptions of medication counseling in Japan: classification by latent class analysis

Yoshiko Tominaga, Takeshi Uchikura, Michiko Watanabe, Mayumi Mochizuki


Rationale, Aims and Objectives: Under the latest government healthcare initiatives in Japan, community  pharmacists  are now required to undertake “person-oriented”, in addition to the material-oriented, work that has been their professional foundation. Medication counseling is regarded as integrated interpersonal work at community pharmacies, but there is no research on how practising community pharmacists view their mission as described by the Government. Our main objective was to investigate how Japanese community pharmacists perceive their medication counseling role and perform typology analysis using latent class analysis (LCA).

Methods: The study was a cross-sectional, self-administered, web-based survey of community pharmacists in Japan. A 5-item questionnaire with a 5-point scale was developed and the responses were employed for LCA. Respondents’ general behavior and attitudes in providing patient-centered pharmaceutical care were rated by 2 questions, which were part of a validated questionnaire for a behavioral pharmaceutical care scale. Demographic information and operational conditions at pharmacy level were also collected. These variables were used for logistic regression with the classes. Survey invitations were delivered to 2,600 pharmacies and all responses were collected in June and July 2016.

Results: A total of 1,332 pharmacists responded. More than 70% thought it difficult to understand the “true” medication adherence of patients. While more than 95% believed it was important to take patients’ personalities and characteristics into account, only 50% rated themselves as competent to communicate in an individually tailored manner with patients. LCA revealed 4 classes. Class 1 (“less enthusiastic,” 42%) comprised more women and had shorter experience of clinical practice. Class 2 (“challenge-seeking,” 34.3%) was younger and less confident but provided pharmaceutical care at the average level. Class 3 (“mature professional leadership,” 20.8%) had relatively longer experience of clinical practice and were more active in cooperating with physicians. Class 4 (“indifferent,” 2.9%) was less distinctive.

Conclusion: Japanese community pharmacists are aware of their expected roles in medication counselling, but are not sufficiently confident or enthusiastic in performing them. They are characterized as different types because underlying factors vary in individual pharmacists. Considering such heterogeneity could be helpful in designing better education and development programs for community pharmacists.


Community pharmacist, heterogeneity, Japan, latent class analysis, medication adherence, medication counseling, multidisciplinary collaboration, patient-centered pharmacies, person-centered healthcare, person-oriented tasks

Full Text:



Ministry of Health, Welfare and Labor of Japan. (2015). Vision for patient-centered pharmacies: From ‘Monzen’ (pharmacies in the vicinity of medical facilities) to “Kakaritsuke (family pharmacies) and ‘Chiiki’ (community)” 2015. [In Japanese] (Accessed 20 Feb 2018); Available at:

International Pharmaceutical Federation. From Making Medicines to Optimising Outcomes: The evolution of a profession 1912-2012. 2012. (Accessed 15 Jan 2018); Available at:

Hepler, C.D. & Strand, L.M. (1990). Opportunities and responsibilities in pharmaceutical care. American Journal of Hospital Pharmacy 47 (3) 533-543.

Ministry of Health, Welfare and Labor of Japan. (2015). General Assemby of Central Social Insurance Medical Council - Reimbursement No.2. [In Japanese]. (Accessed 15 Jan 2018). Available at:

Alaqeel, S. & Abanmy, N.O. (2015). Counselling practices in community pharmacies in Riyadh, Saudi Arabia: a cross-sectional study. BMC Health Services Research 15, 557.

Boeni, F., Arnet, I. & Hersberger, K.E. (2015). Adherence counseling during patient contacts in Swiss community pharmacies. Patient Preference and Adherence 9, 597-605.

Nik, J., Lai, P.S.M., Ng, C.J. & Emmerton, L. (2016). A qualitative study of community pharmacists' opinions on the provision of osteoporosis disease state management services in Malaysia. BMC Health Services Research 16, 448.

Akinbosoye, O.E., Taitel, M.S., Grana, J., Hill, J. & Wade, R.L. (2016). Improving Medication Adherence and Health Care Outcomes in a Commercial Population through a Community Pharmacy. Population Health Management 19 (6) 454-461.

Gariepy, G., Malla, A., Wang, J., Messier, L., Strychar, I., Lesage, A. & Schmitz, N. (2012). Types of smokers in a community sample of individuals with Type 2 diabetes: a latent class analysis. Diabetic Medicine 29 (5) 586-592.

Greig, F., Hyman, S., Wallach, E., Hildebrandt, T. & Rapaport, R. (2012). Which obese youth are at increased risk for type 2 diabetes? Latent class analysis and comparison with diabetic youth. Pediatric Diabetes 13 (2) 181-188.

Jaeger, S., Pfiffner, C., Weiser, P., Kilian, R., Becker, T., Längle, G., Eschweiler, G.W., Croissant, D., Schepp, W. & Steinert, T. (2012). Adherence styles of schizophrenia patients identified by a latent class analysis of the Medication Adherence Rating Scale (MARS): A six-month follow-up study. Psychiatry Research 200 (2-3) 83-88.

Trivedi, R.B., Ayotte, B.J., Thorpe, C.T., Edelman, D. & Bosworth, H.B. (2010). Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach. Patient Preference and Adherence 4, 255-262.

Peacock, A., Degenhardt, L., McRim, G.C., Larance, B., Nielsen, S., Hall, W., Mattick, R.P. & Bruno, R. (2016). A Typology of Predictive Risk Factors for Non-Adherent Medication-Related Behaviors among Chronic Non-Cancer Pain Patients Prescribed Opioids: A Cohort Study. Pain Physician 19 (3) E421-E434.

Tominaga, Y., Aomori, T., Hayakawa, T., Isawa, M. & Mochizuki, M. (2018). Multidimensional quantitative analysis of pharmaceutical care by community pharmacists: A Japanese nation-wide survey. European Journal for Person Centered Healthcare 6 (3) 390-399.

Hughes, C.M., Hawwa, A.F., Scullin, C., Anderson, C., Bernsten, C.B., Björnsdóttir, I., et al. (2010). Provision of pharmaceutical care by community pharmacists: a comparison across Europe. Pharmacy World & Science 32 (4) 472-487.

Watanabe, M. (2001). Statistical analysis for capturing causal relationship and structure: Latent Class Analysis. [in Japanese] In: Mathematical Modeling in Marketing. Okamoto, A., Kijima, M. & Moriguchi, T. (Eds.), pp. 73-113. Tokyo: Asakura Publishing Co., Ltd.

Nylund, K.L., Asparoutiov, T. & Muthen, B.O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling - a Multidisciplinary Journal 14 (4) 535-569.

Zeller, A., Ramseier, E., Teagtmeyer, A. & Battegay, E. (2008). Patients’ Self-Reported Adherence to Cardiovascular Medication Using Electronic Monitors as Comparators. Hypertension Research 31 (11) 2037-2043.

Garber, M.C., Nau, D.P., Erickson, S.R., Aikens, J.E. & Lawrence, J.B. (2004). The concordance of self-report with other measures of medication adherence - A summary of the literature. Medical Care 42 (7) 649-652.

Nippon Pharmacy Association. (2015). 2014 survey research report on community pharmacists [in Japanese]. (Accessed 20 Feb 2018); Available at:

Koster, E.S., Philbert, D., Blom, L. & Bouvy, M.L. (2016). “These patients look lost” - Community pharmacy staff’s identification and support of patients with limited health literacy. International Journal of Pharmacy Practice 24 (6) 403-410.

Krass, I., Schieback, P. & Dhippayom, T. (2015). Adherence to diabetes medication: a systematic review. Diabetic Medicine 32 (6) 725-737.

Jackson, C.A., Clatworthy, J., Robinson, A. & Horne, R. (2010). Factors Associated With Non-Adherence to Oral Medication for Inflammatory Bowel Disease: A Systematic Review. American Journal of Gastroenterology 105 (93) 525-539.

Norris, S.L., Engelgau, M.M. & Narayan, K.M.V. (2001). Effectiveness of self-management training in type 2 diabetes - A systematic review of randomized controlled trials. Diabetes Care 24 (3) 561-587.

Omran, D., Guirguis, L.M. & Simpson, S.H. (2012). Systematic Review of Pharmacist Interventions to Improve Adherence to Oral Antidiabetic Medications in People with Type 2 Diabetes. Canadian Journal of Diabetes 36 (5) 292-299.

Herzberg, F., Mausner, B. & Snyderman, B.B. (2011). The Motivation to Work. Piscataway, NJ: Transaction Publishers.



  • There are currently no refbacks.