2026 年 52 巻 9 号 p. 630-637
Pharmacist secondment was initiated in 2024. This study aimed to evaluate the implementation of pharmaceutical care associated with pharmacist secondment and identify challenges in medication information sharing during care transitions. A 6-month period before and after the initiation of secondment was retrospectively compared, focusing on the number of pharmaceutical management interventions and pharmacist-led discharge counseling in the host hospital. During the six months following secondment, pharmacist-initiated queries and clinical proposals in the host hospital were descriptively assessed. For patients transferred from the core hospital during the period, discrepancies between medication information in referral documents and admission medication lists were assessed, and the implementation rate of pharmacist-led discharge counseling in the core hospital was examined. After the initiation of secondment, the number of pharmaceutical management interventions increased, and pharmacist-led discharge counseling tended to increase in the host hospital. During the six months following secondment, pharmacist-initiated queries and clinical proposals were made for 61 of 379 inpatients (16.1％), of whom 53 patients (86.9％) had their proposals accepted by physicians. Among the 98 patients transferred from the core hospital, discrepancies between referral documents and admission medication lists were identified in 44 patients, while pharmacist-led discharge counseling at the core hospital was provided to only seven patients (7.1％). Based on these findings, a “transfer medication management summary” was proposed as a tool to improve medication information sharing at hospital transfer. In conclusion, pharmacist secondment to other hospitals may contribute to strengthening systems for implementing inpatient pharmaceutical services and pharmaceutical interventions related to hospital transitions.
