保険薬局における腎機能低下患者に関する薬学的管理の現状と課題：

全国調査

抄録

Most patients suffering from chronic kidney disease (CKD) are outpatients, and renally excreted oral drugs are frequently dispensed at community pharmacies. Therefore, community pharmacists must verify the appropriateness of prescribed medications in such patients by examining their renal function profiles. This study aims to clarify the current status of pharmaceutical management of patients with impaired renal function at community pharmacies, and identify existing issues. A self-administered questionnaire survey was sent to randomly selected community pharmacies throughout the country, and 1,184 pharmacies returned completed response forms. Only about 7％ of all prescriptions filled by community pharmacists were accompanied by laboratory tests based on our calculation. Approximately half of the respondents reported prescription inquiries concerning overdosage of renally excreted drugs, which was virtually unchanged from a preceding study in 2013. Logistic regression analysis was employed to identify factors related to the prescription inquiries. Our results showed that “Experience with adverse drug events caused by inappropriate dosage for patients with CKD” (odds ratio: 9.59) and “Knowledge of the CKD sticker” (odds ratio: 2.04) were strongly associated. Nearly 80％ of the respondents recognized a lack of information about a patient’s renal function as a barrier to inquiries. Awareness of the CKD sticker was on an average about 23％, but varied across prefectures, correlating with the prescription inquiries in each prefecture (r = 0.32). Collectively, our findings emphasize a need to reconsider the mechanism by which medical institutions provide information to community pharmacies.