「薬剤師外来」における薬学的処方介入とその評価

抄録

Kobe University Hospital has set up “Pharmaceutical Outpatient Clinics” for outpatients of the Departments of General Internal Medicine and Cardiovascular Surgery included in each ambulatory medical practice. Before the medical examination, the pharmacist in charge interviews each patient about medications in a separate room. Thereafter, the pharmacist participates in the medical examination for each patient, and intervenes in the prescription process by discussing with the medical doctor and each patient in the Departments of General Internal Medicine. In this study, the effects of the pharmacist's intervention in the “Pharmaceutical Outpatient Clinic” on the changes of prescribed drugs were evaluated. A total of 517 patients visited the “Pharmaceutical Outpatient Clinics” from May 2014 to March 2015. The pharmacist intervened in the prescriptions of drugs in patients visiting the “Pharmaceutical Outpatient Clinics” at a rate of 12.4％ (64 cases) and the doses were reduced at a rate of 5.6％ (29 cases), and both rates were significantly higher than those in patients without pharmacist's interventions (P < 0.01). No significant differences were observed in the frequency of adverse events due to the changed prescriptions with and without pharmacist's interventions (4.1％ vs 4.7％). The most frequent reason for the pharmacist's intervention was “an improvement of symptoms” in the outpatients of General Internal Medicine and “adaptation to the drug indication” in the outpatients of Cardiovascular Surgery, respectively. In conclusion, the “Pharmaceutical Outpatient Clinic,” in cooperation with medical doctors, helps to promote appropriate drug usage.