論文ID: 2024-0022-OA
It is desirable for community pharmacists to be involved in promoting and maintaining the oral health of local residents. In this study, we conducted a questionnaire survey of Japanese community pharmacists to understand the actual conditions and the attitudes of these pharmacists regarding oral healthcare advice. A web-based anonymous self-administered questionnaire survey was completed by community pharmacists from March 26 to 29, 2021. We received responses from 324 pharmacists. A majority of respondents (66.0%) regarded dealing with “daily oral health issues and oral care” as a role of community pharmacists. Respondents also reported being consulted by patients or customers about mouth ulcers (70.1%) and xerostomia (54.6%). However, the frequency of consumer inquiries about these oral conditions was less than once per week. Just over half of the respondents (52.2%) said they were confident about dealing with mouth ulcers, whereas less than 40% were confident about handling other oral problems. The most common anxiety was a “lack of knowledge about appropriate responses to oral symptoms” (60.2%). The respondents desired education and training (75.6%) to better promote oral health-related activities. Japanese community pharmacists believe that they have a role to play in oral health issues and oral care, but their level of confidence in their ability to respond to oral health issues is low. Pharmacists are concerned about their lack of knowledge about oral healthcare and they desire more opportunities for education and training so that they can perform pharmacy-based maintenance and promotion of oral healthcare for local residents.
Oral healthcare is not only important for eating but is also known to be related to quality of life.1 Periodontal disease, a serious oral disease, is one of the most common diseases worldwide2 and is associated with systemic diseases such as diabetes mellitus,3,4 aspiration pneumonitis,5,6 and stroke.7,8 Therefore, the maintenance of oral health, which is important for the prevention of a range of health problems, may also provide long-term health benefits and prolong healthy living. In Japan, periodontal disease is the second most common major disease behind hypertension.9 In addition, only 52.9% of adults have regular dental check-ups,10 which may delay the detection of oral diseases.
Community pharmacies have an important role to play in preventing diseases and maintaining the health of local residents by providing advice about lifestyle choices and by recommending visits to healthcare facilities. Since October 2016, community pharmacies in Japan that meet the criteria for providing health support and primary care can submit a notification as a “Health Support Pharmacy” to the Ministry of Health, Labour, and Welfare. Because periodontal disease is associated with systemic diseases, Japanese community pharmacies are expected to contribute to the maintenance and promotion of local residents’ health through the maintenance of oral health. Oral care items are available at community pharmacies and pharmacists should advise residents on how to select and use those items.
Since September 2015, a Japanese national policy has allowed saliva tests to be used to conduct oral health check-ups at community pharmacies. In our previous study, a majority of the dentists we surveyed approved of oral health check-ups performed at community pharmacies and they wanted community pharmacies to recommend that patients visit a dental clinic.11 Additionally, we previously reported that local residents were very satisfied with the oral health check-ups and information about oral self-care provided by community pharmacies in addition to showing their potential to improve oral self-care and dental care-seeking behavior.12
Several medicines can cause adverse effects in the oral cavity, including xerostomia caused by anti-cholinergic agents, mouth ulcers caused by anti-cancer agents, and osteonecrosis of the jaw caused by anti-resorptive agents. Pharmacists have a role to play in the early detection and prevention of medicine-related adverse effects in the oral cavity by assessing the oral health status of patients and giving advice on appropriate oral care. Community pharmacists can also suggest the use of oral moisturizing agents to patients who complain of xerostomia because oral care items are available at community pharmacies and drug stores.
In surveys of pharmacists in Australia,13,14 England,15 and Malaysia,16 a majority of respondents stated that it was part of their role to deliver oral healthcare advice to the community and to provide oral healthcare services to local residents. Pharmacists in those countries are recognized as the first point of contact with healthcare professionals in the community and most of them reported the provision of oral healthcare advice and services to consumers.13,15
In Japan, the actual conditions and the attitudes of community pharmacists toward providing oral healthcare advice to local residents have not been investigated. In this study, we conducted a questionnaire survey of Japanese community pharmacists to understand the actual conditions and the attitudes of pharmacists regarding oral healthcare advice.
A web-based anonymous self-administered questionnaire survey was circulated to community pharmacists recruited from among registered members of a research company (Nextit Soken, Japan) from March 26 to 29, 2021. The sample size was set to at least 300 pharmacists to provide a target having roughly a 5% margin of error for population percentage estimates with a 95% level of confidence. The survey was closed when the target number of responses was reached. The questionnaire contents were adapted from previously published studies of other groups evaluating the role of community pharmacists in oral healthcare.13,14,15 The questionnaire covered the following contents: 1) the basic characteristics of the participants and the community pharmacies where they worked; 2) their perception of their role in oral healthcare; 3) their experiences in dealing with medicine-related oral adverse effects as well as other daily oral health issues and oral care at community pharmacies; 4) level of confidence in providing advice about daily oral health issues and oral care; and 5) their anxieties and needs regarding provision of oral healthcare advice to local residents (Appendix 1). The aims of the study, to elucidate the actual conditions and the attitudes of community pharmacists regarding oral healthcare advice, were explained at the top of questionnaire, along with a statement that return of the completed questionnaire would be considered to indicate consent to participate in the study.
Statistical analysisAll data were entered into Microsoft Excel to enumerate the survey responses. The Mann–Whitney U test was used to compare pharmacists’ perceptions of their role in oral healthcare. All statistical analyses were performed using SPSS Statistics ver. 27 (IBM, Armonk, NY, USA). Statistical significance was recognized for P < 0.05.
Ethics approvalThe study protocol was approved by the research ethics committee of the Faculty of Pharmacy, Keio University (approval number: 210323–2).
We received responses from 324 pharmacists and all of them (100%) were included in the analysis. The basic characteristics of the respondents are shown in Table 1. Nearly half of the respondents (47.8%) had 10–19 years of experience practicing as a pharmacist; a large minority (37.7%) had 20 or more years of experience. Roughly two-thirds (64.8%) of the respondents were pharmacy managers, and about 20% of the respondents’ pharmacies had submitted a notification as a Health Support Pharmacy. Additionally, 65.4% of community pharmacies carried oral care items such as toothpaste and toothbrushes and/or over-the-counter drugs for toothache and mouth ulcers, whereas just over one-third (34.6%) did not carry either product.
| Characteristic | n (%) |
|---|---|
| Age, years | |
| 20–29 | 9 (2.8) |
| 30–39 | 93 (28.7) |
| 40–49 | 129 (39.8) |
| 50–59 | 68 (21.0) |
| >60 | 25 (7.7) |
| Sex | |
| Male | 178 (54.9) |
| Female | 146 (45.1) |
| Years of experience | |
| <5 | 13 (4.0) |
| 5–9 | 34 (10.5) |
| 10–19 | 155 (47.8) |
| >20 | 122 (37.7) |
| Pharmacist position | |
| Pharmacy manager | 210 (64.8) |
| Employee pharmacist | 114 (35.2) |
| Notification of Health Support Pharmacy submitted | |
| Yes | 65 (20.1) |
| No | 259 (79.9) |
| Carries oral care items and/or oral-related OTC drugs at community pharmacies | |
| Yes | 212 (65.4) |
| No | 112 (34.6) |
OTC, over-the-counter.
When asked about their views on the role of pharmacists in oral healthcare, 87.6% of respondents said that it was within their role as a pharmacist to deal with the adverse effects of drugs in the oral cavity (Fig. 1A). In addition, 66.0% considered dealing with oral health issues and oral care to be within their role as a pharmacist. The perception of their role in oral health issues and oral care among those whose pharmacy carried oral care items and/or oral-related over-the-counter drugs was significantly higher than those whose pharmacy did not carry such items (P = 0.001, Fig. 1B). However, this perception was not different between the respondents who had submitted a notification as a Health Support Pharmacy (64.6%) and those who had not (66.4%).
Pharmacists’ perceptions of their roles in oral healthcare.
(A) Pharmacists’ perceptions of their roles in dealing with adverse effects of drugs in the oral cavity as well as oral health issues and oral care (n = 324). (B) Association between carrying oral care items and/or oral-related over-the-counter drugs and perception of their role in oral health issues and oral care. Mann–Whitney U test: **P < 0.01.
Respondents reported being consulted by patients or advising them about medicine-related oral adverse effects, including xerostomia (78.1%), oral candida (46.6%), and mouth ulcers (41.4%) (Fig. 2A). When they dealt with these medicine-related oral side effects, they requested consultation with the prescribing doctor (83.7%), provided guidance on oral care (37.4%), and provided information to the prescribing doctor (36.4%) (Fig. 2B). In addition, more than half of the respondents reported being consulted by patients or customers about oral health issues such as mouth ulcers (70.1%) and xerostomia (54.6%) (Fig. 3A). Only 8.0% had never been consulted about oral health issues. The frequency of consumer inquiries about oral health issues was less than once per week (Fig. 3B). When they responded to those inquiries, they recommended visiting a dental clinic (54.7%) and provided guidance on oral care (39.3%) (Fig. 3C).
Experiences dealing with adverse effects of drugs in the oral cavity at community pharmacies.
(A) Percentage of respondents who were consulted by patients or advised them about medicine-related oral adverse effects at community pharmacies (n = 324, multiple answers allowed). (B) Action taken when advised about medicine-related oral adverse effects (n = 313, multiple answers allowed).
Inquiries about oral health issues and oral care at community pharmacies.
(A) Percentage of respondents who were consulted about various oral health issues and oral care at community pharmacies (n = 324, up to three answers allowed). (B) Frequency of consultation about oral health issues and oral care. Only those who selected each issue in (A) answered this question. (C) Action taken when consulted about oral health issues and oral care (n = 298, multiple answers allowed).
The confidence levels of participants in terms of responding to oral health issues and oral care is shown in Table 2. Regarding mouth ulcers, 52.2% of respondents agreed or somewhat agreed that they could confidently deal with customer concerns. For other oral health issues and oral care, the percentage of those who agreed or somewhat agreed that they could confidently handle customer concerns was less than 40%. Of particular note, only 12.7% of respondents were confident in their ability to deal with denture problems.
| Oral health issue | Agree | Somewhat agree | Neither agree nor disagree | Somewhat disagree |
Disagree |
|---|---|---|---|---|---|
| Mouth ulcers | 32 (9.9) | 137 (42.3) | 120 (37.0) | 24 (7.4) | 11 (3.4) |
| Xerostomia | 14 (4.3) | 110 (34.0) | 160 (49.4) | 28 (8.6) | 12 (3.7) |
| Tumidity/bleeding of gums | 9 (2.8) | 92 (28.4) | 142 (43.8) | 58 (17.9) | 23 (7.1) |
| Taste disorder | 13 (4.0) | 87 (26.9) | 150 (46.3) | 52 (16.0) | 22 (6.8) |
| Toothache | 10 (3.1) | 90 (27.8) | 153 (47.2) | 48 (14.8) | 23 (7.1) |
| Oral care items | 4 (1.2) | 69 (21.3) | 147 (45.4) | 69 (21.3) | 35 (10.8) |
| Oral malodor | 4 (1.2) | 64 (19.8) | 156 (48.1) | 69 (21.3) | 31 (9.6) |
| Oral care for children | 4 (1.2) | 41 (12.7) | 108 (33.3) | 105 (32.4) | 66 (20.4) |
| Denture problems | 8 (2.5) | 33 (10.2) | 106 (32.7) | 105 (32.4) | 72 (22.2) |
Data given as number (percentage).
The respondents worried that they lacked both sufficient knowledge about oral symptoms (54.9%) and sufficient knowledge to adequately deal with oral symptoms (60.2%) (Fig. 4A). Furthermore, they desired education and training about oral healthcare for pharmacists (75.6%) and the establishment of oral healthcare guidelines for pharmacists (45.1%) to facilitate the maintenance and promotion of oral health in local residents (Fig. 4B).
Pharmacists’ anxieties and needs regarding provision of oral healthcare advice at community pharmacies.
(A) Pharmacists’ anxieties about responding to oral health issues and providing oral healthcare advice (n = 324, multiple answers allowed). (B) What pharmacists need to provide oral healthcare advice (n = 324, up to three answers allowed).
This is the first study to investigate the perceptions of Japanese community pharmacists regarding the handling of oral health issues and oral care. The results indicated that a majority of community pharmacists in Japan consider dealing with oral health issues and oral care to be within their role as a pharmacist. However, they expressed concern regarding their lack of knowledge of oral healthcare and had low confidence in their ability to respond to oral healthcare issues. Therefore, the results of this study suggest that Japanese community pharmacists need opportunities for further education and training.
Most respondents (87.6%) considered it their role to deal with adverse effects of drugs in the oral cavity. This is likely because pharmacists recognize their own expertise in drugs. Furthermore, nearly 70% of respondents considered that they had a role to play in oral healthcare, although this level was lower than that of Australian (93%)14 and British (99%)15 community pharmacists. This finding suggests the need to change the perception of Japanese community pharmacists by raising awareness of the importance of pharmacists’ involvement in oral healthcare. We also found an association between respondents’ perceptions and carrying oral care items and/or oral-related over-the-counter drugs. This association suggests that carrying oral care items at community pharmacies may improve pharmacists’ perceptions of their role in oral health issues and that consultations on oral health issues from patients improved the pharmacists’ perceptions and may lead them to carry oral care items.
Over 90% of the Japanese community pharmacists surveyed reported being consulted by patients or customers about oral health issues and oral care. However, the frequency of such consultations was found to be very low, with about 80% of respondents receiving less than one inquiry per week. In contrast, it was reported that over half of Australian community pharmacists received more than one inquiry about mouth ulcers, xerostomia, or toothache per week.14 Among Japanese consumers, the main purpose of visiting community pharmacies is to receive prescription medicines rather than to seek advice on health issues, which may explain in part why community pharmacists receive so few inquiries about oral health issues. Despite the importance of prevention and early detection of oral diseases and the ease of access to dental clinics, only around half of Japanese people have regular dental check-ups.10 For this reason, Japanese community pharmacists should play an active role in facilitating the maintenance and promotion of oral health by raising awareness of the importance of oral care and providing oral healthcare advice.
The confidence of Japanese pharmacists in responding to inquiries about oral health issues and oral care was lower than that of Australian and British community pharmacists.14,15 Less than 40% of Japanese pharmacists surveyed provided guidance on oral care to patients when they dealt with adverse effects in the oral cavity as well as oral health issues and oral care. Because the respondents worried that they lacked sufficient knowledge about oral symptoms and how to adequately deal with oral symptoms, improving such knowledge might increase their confidence in dealing with oral health issues. Such education and training could be expected to lead to more Japanese pharmacists providing guidance on oral care. In fact, the surveyed pharmacists expressed a desire for education and training on oral healthcare, similar to Australian, British, and Malaysian community pharmacists.13,14,15,16 At present, oral healthcare education and training are not provided to pharmacy students and pharmacists in Japan. Therefore, opportunities to learn about oral healthcare are needed, including instruction by dentists or support from academic societies specializing in oral care. Furthermore, over 40% of the respondents expressed a desire for the establishment of oral healthcare guidelines for pharmacists, something that was also highly requested in the survey of Malaysian pharmacists.16 The surveyed Japanese pharmacists stated that it would be helpful for them to refer to guidelines when dealing with oral health issues and providing oral healthcare advice.
The major limitation of this study is that the participants were limited to pharmacists who were registered members of a web-based survey company, who were different in gender and age from the actual distribution of Japanese community pharmacists.17 In addition, the respondents in this study may be biased toward pharmacists who were more interested in oral health. Therefore, generalizability is limited and further study with a larger, more general population of pharmacists is needed.
In conclusion, the results of our study suggest that Japanese community pharmacists believe that they have a role to play in oral health issues and oral care. However, their confidence in handling oral health issues and their perception of their role in oral healthcare need to be improved. The concern of pharmacists regarding their lack of knowledge about oral healthcare suggests the need for more educational and training opportunities, which could help them to play a greater role in maintaining and improving oral health in their local communities.
We thank the pharmacists who participated in this study. This work was supported by the Keio University Academic Development Funds for Individual Research and the Ministry of Health, Labour, and Welfare (Program Grant Number JPMH23KC1004).
The authors have declared that no conflict of interest exists.
