Summary
Community pharmacists play a vital role in delivering person-oriented services, such as addressing prescription inquiries, providing home care services, and conducting medication follow-ups. Despite their significance, no nationwide surveys have assessed the efficacy of these pharmaceutical activities. Therefore, this study aimed to collect information on these three pharmacist tasks and investigate their effectiveness in preventing serious adverse drug reactions and reducing medical costs. Ten percent of insurance pharmacies in each prefecture were randomly selected to participate in the survey. Data were collected on basic pharmacy information, prescription inquiries, home care services, and medication follow-up, which spanned from 12 June to 18 June 2023. Of the 561 pharmacies pre-registered for the study, valid responses were obtained from 433 pharmacies (77.2%). The reported cases included 3064 prescription inquiries, 765 home care services, and 326 medication follow-ups. Prescription inquiries prevented serious adverse drug reactions in 122 cases, home care services in 209 cases, and medication follow-ups in 13 cases. The cost reductions associated with these activities were ¥28291790, ¥58285600, and ¥2544950, respectively, resulting in a total cost reduction of ¥89122340. The annual cost reduction was ¥33229078321.7, assuming a severity rate of 6.7%. The estimated annual reduction in medical costs specifically attributed to prescription inquiries was ¥8732177830. This study indicates that pharmacists prevent adverse drug reactions and contribute to the safety of drug treatment through prescription inquiries, home care services, and medication follow-up. These tasks reduced annual medical costs by approximately ¥42 billion, highlighting the economic and healthcare benefits of community pharmacy services.
INTRODUCTION
Concretely demonstrating how pharmacists’ activities contribute to improving healthcare quality is essential given the “Pharmacy Vision for Patients”1) presented by the Ministry of Health, Labour, and Welfare in 2015, which emphasized a shift in pharmacists’ roles from object- to person-oriented tasks. Key person-oriented tasks contributing to the safety and efficacy of pharmacotherapy include prescription inquiries, home care services, and medication follow-up.
An important measure of the effectiveness of pharmacists’ pharmaceutical interventions is their ability to prevent adverse drug reactions (ADRs). A previous study focused on prescription inquiries,2) yet the content of these inquiries and their efficacy changed owing to the aging population, the widespread adoption of protocol-based pharmacotherapy management (PBPM),3,4) and increased use of information technology. Additionally, comprehensive data on ADRs prevention achieved through home care services or medication follow-ups has not been systematically collected. Evidence from home care services suggests that pharmacists optimize prescriptions by providing suggestions or information to physicians without relying on prescription inquiries.5,6) Moreover, in a previous study on follow-up,7) information gathered during follow-ups was used to make prescription recommendations to physicians. Several reports8,9) further highlight cases where follow-up contributed to the early detection of ADRs, such as in patients with cancer undergoing chemotherapy. These findings suggest that follow-ups play a substantial role in preventing ADRs. Although several studies have reported cases where pharmacists’ interventions successfully prevented or mitigated ADRs,10–12) nationwide surveys evaluating community pharmacists’ effectiveness in this area are limited. Besides a previous study on prescription inquiries,10) this gap remains largely unaddressed.
Therefore, this study aimed to evaluate the quality of pharmacy practice by focusing on prescription inquiries, home care services, and medication follow-up. The objective was to investigate the extent to which these activities prevent serious ADRs (sADRs) and reduce associated medical costs reduction. Additionally, drug cost reductions achieved through prescription inquiries were also evaluated. This study represents a partial analysis of “The Japanese Nationwide Pharmacy Collaboration Survey of 2023,” commissioned by the Japan Pharmaceutical Association. Follow-up analyses have been reported previously.7)
MATERIALS AND METHODS
1. Research Methods and ParticipantsFrom the lists of insurance pharmacies (as of 01 April 2023), as published on the websites of Regional Bureau Health and Welfare, 10% of the insured pharmacies in each prefecture (rounded down to the nearest whole number) were randomly selected using a random number generator. A survey request letter was sent to the selected pharmacies by mail. For data collection, a system was developed to allow participants to enter data via a web-based platform. Unique IDs and passwords were issued and managed for participating pharmacies to prevent unauthorized external access to the web system.
The survey period was from 12 June to 18 June 2023. The participants of the survey included patients for whom prescription inquiries were made, patients receiving home care services, and patients undergoing follow-up for medication during the survey period. Patients with prescriptions paid out-of-pocket or those who explicitly refused participation were excluded.
2. Data Collection2-1. Basic pharmacy informationThe following information was collected as basic information: pharmacy name, telephone number, location, organizational form, number of employees, number of prescriptions dispensed in the month before the survey period (May 2023), number of dispensing medical institutions, number of dispensing fee statements, calculation status of the Japanese dispensing fee on the last day of the previous survey period (31 May 2023), number of medicines in the pharmacy, and the number of medical institutions with PBPM.
2-2. Information on each caseThe following data was collected in cases of prescription inquiries: age, sex, medical institution issuing the prescription, prescription type (number of times dispensed in the case of refill prescriptions), number of drugs prescribed, presence or absence of a family pharmacist, how the inquiries were discovered, details of the inquiries, results of the inquiries, response after the inquiries, changes in the prescribed drugs before and after the inquiries, calculation status of dispensing fees to prevent duplication and interactions of prescription drugs, and whether or not sADRs were avoided (if yes, details of the avoidance were collected).
The prescription inquiries were categorized into “pharmaceutical inquiries” requiring pharmaceutical knowledge and “other inquiries.” For pharmaceutical inquiries, the content into six categories was classified based on established criteria2): “question about dosage and administration,” question about the number of days, frequency of dosing, and the total number of pieces,” “question about safety,” “question about compliance and QOL,” “question about dispensing,” and “other.” Furthermore, respondents were asked to select and enter detailed information for each category.
The following data was collected in home care service cases: age, the details of information provided to the physician, and whether or not sADRs were avoided (if yes, details of the avoidance were collected).
The following data was collected in follow-up cases: age, whether information was provided to the physician after the follow-up (including details of the information and whether prescription suggestions were made), and whether or not sADRs were avoided (if yes, details of the avoidance were collected).
2-3. Extraction of sADR prevention casesAn sADR was identified based on the adverse event names listed in the Ministry of Health, Labour, and Welfare’s manual for dealing with sADRs according to disease. Cases that reported preventing sADRs were reported.
The amount of medical cost reduction from preventing sADRs was estimated as previously described,13) which was also used in our previous report.2) This method is based on the Diagnosis Procedure Combination/Per Diem Payment System, which is Japan’s diagnostic group classification. The contents of pharmaceutical inquiries were checked, and data that was unlikely to lead to preventing ADRs were excluded to increase objectivity. The daily score for each diagnosis group classification in the comprehensive evaluation was calculated based on the 2022 diagnosis group classification score table provided by the Ministry of Health, Labour, and Welfare.
3. Calculation Procedure3-1. Calculation of prescription inquiry and change ratesAs in our previous report,2) the percentage of prescriptions for which inquiries were made relative to the total number of prescriptions filled during the survey period was defined as the “proportion of inquiries to prescriptions.” Similarly, the percentage of inquiry cases relative to the total number of prescriptions filled during the survey period was defined as the “proportion of inquiries to cases.” The percentage of pharmaceutical inquiry cases among all inquiry cases was calculated as the “proportion of pharmaceutical inquiries to prescriptions.” The proportion of prescriptions that were changed as a result of pharmaceutical inquiries was calculated as the “proportion of prescription change after pharmaceutical inquiries.”
The formulas for each calculation are as follows:
・Proportion of inquiries to prescriptions (%)=(Number of prescriptions with inquiries during the survey period/Total number of prescriptions filled during the survey period)×100.
・Proportion of inquiries to cases (%)=(Number of inquiry cases during the survey period/Total number of prescriptions filled during the survey period)×100.
・Proportion of pharmaceutical inquiries to total inquiries (%)=(Number of pharmaceutical inquiry cases/Total number of inquiry cases during the survey period)×100.
・Proportion of prescription change after pharmaceutical inquiries (%)=(Number of inquiry cases resulting in prescription changes among pharmaceutical inquiries/Total number of pharmaceutical inquiry cases)×100.
3-2. Calculation of medical cost reduction from preventing sADRs through prescription inquiries, home care, and medication follow-up and estimation of annual cost reductionThe medical cost reduction from preventing sADRs was calculated for each case using the formula below. Additionally, based on these results, the annual medical cost reduction made at pharmacies nationwide was estimated using the formula below.
・Estimation of annual medical cost reduction from preventing sADRs through prescription inquiries=Number of prescriptions filled nationwide in 2022× Proportion of inquiries to cases (%)×Proportion of pharmaceutical inquiries to total inquiries (%)×Medical cost reduction per sADR prevented (yen)×(Number of cases in which sADRs were prevented/Number of pharmaceutical inquiries)×Rate of ADRs becoming serious (6.7%).14)
・Estimation of annual medical cost reduction from preventing sADRs through home care and follow-up (yen)=Medical cost reduction in this study×(Number of prescriptions filled nationwide in 2022/Number of prescriptions filled during the study period)×Rate of ADRs becoming serious (6.7%).
3-3. Calculation of drug cost reduction through inquiries and estimation of annual cost reductionThe following formula, which was also used in our previous report,2) was used to calculate the “changes in drug costs before and after pharmaceutical inquiries during the survey period” and “change in drug cost per pharmaceutical inquiry.” The results were used to estimate annual drug cost reduction through inquiries by community pharmacists. To calculate the estimate, the number of prescriptions filled nationwide in 2022 was multiplied by the proportion of inquiries to cases, the proportion of pharmaceutical inquiries to total inquiries, and the drug cost reduction per pharmaceutical inquiries (average value).
In addition, drug costs associated with prescription omissions were excluded, as these represent costs for medicines that should have been prescribed and are not considered appropriate to treat as increased drug costs. Drug costs were calculated based on the “drug price,” which refers to the official price of prescription drugs in Japan’s health insurance system.
・Drug cost reduction through inquiries during the survey period (yen)=Total difference in drug cost before and after pharmaceutical inquiries.
・Change in drug costs per pharmaceutical inquiry (yen)=Drug cost reduction through inquiries during the survey period (yen)/Number of pharmaceutical inquiries.
・Estimation of annual drug cost reduction through inquiries by community pharmacists=Change in drug costs per pharmaceutical inquiry (yen)×Number of prescriptions filled nationwide in 2022×Proportion of inquiries to cases (%)×Proportion of pharmaceutical inquiries to total inquiries (%)×(Number of pharmaceutical inquiries excluding prescription omissions/Number of pharmaceutical inquiries excluding cases per the exclusion criteria).
3-4. Statistical analysisThe representative values of numerical data were presented as the mean±standard deviation for data with a normal distribution and as the median (first quartile, third quartile) for data without a normal distribution. The annual reduction in drug cost reduction through medical inquiries was estimated along with the 95% confidence interval (CI). Statistical analysis was performed using SPSS Statistics (version 27, IBM Corporation, Chicago), with the significance level set at 5%.
The number of community pharmacies required for this study was calculated based on 60951 pharmacies in Japan (as of 2020). Using interval estimation with a CI of 95%, a margin of error of 5%, and a population proportion of 50%, the minimum required sample size was determined to be 382 pharmacies.
4. Ethical ApprovalThis study complied with the “Ethical Guidelines for Medical and Health Research Involving Human Participants” issued by the Government of Japan. The Clinical and Epidemiological Research Ethics Committee of Japan Pharmaceutical Association approved this study (application no. 2023-001-02).
RESULTS
1. Basic Pharmacy InformationThe characteristics of the participating pharmacies are presented in Table 1. A total of 6086 pharmacies were sent survey requests, of which 33 were undeliverable because of unknown addresses, resulting in a final pool of 6053 pharmacies, of which 561 pharmacies completed the pre-registration process, and 433 pharmacies entered all survey items during the survey period (response rate: 77.2%).
Table 1. Characteristics of Participating Pharmacies
| Pharmacies, n | 433 |
| Management, n (%) |
| Individual | 29 (6.7) |
| Corporate | 404 (93.3) |
| Operated a single pharmacy | 66 (16.3) |
| Operated 2–10 pharmacies | 178 (44.1) |
| Operated 11–20 pharmacies | 19 (4.7) |
| Operated 21 or more pharmacies | 141 (34.9) |
| Medicine inventory, n | 1269.2±1228.7 |
| Full-time pharmacists, n | 2.2±1.3 |
| Prescriptions per month, n | 1336.7±917.9 |
| Medical institutions issuing prescriptions, n | 57.5±71.8 |
| Dispensing fee claims per month, n | 1176.4±832.4 |
| Experience in accepting refill prescriptionsa), n (%) | 44 (10.2) |
| Home visit patients per month, n | 10.8±33.2 |
| Pharmacies with no home care patients, n (%) | 137 (31.6) |
| Pharmacies with one home care patient, n (%) | 61 (14.1) |
| Pharmacies with 2–9 home care patients, n (%) | 149 (34.4) |
| Pharmacies with ≤10 home care patients, n (%) | 86 (19.9) |
| Pharmacies with PBPM agreements, n (%) | 148 (34.2) |
| The distribution of basic dispensing fees, n (%) |
| Basic dispensing fee 1 | 305 (70.4) |
| Basic dispensing fee 2 | 15 (3.5) |
| Basic dispensing fee 3-i | 16 (3.7) |
| Basic dispensing fee 3-ro | 38 (8.8) |
| Basic dispensing fee 3-ha | 53 (12.2) |
| Special basic dispensing fee | 6 (1.4) |
a)Two pharmacies with a reception count of 99999 were excluded. PBPM: Protocol-based pharmacotherapy management.
Among the corporate-operated pharmacies, 16.3% operated a single pharmacy, whereas large chain pharmacies with 21 or more pharmacies accounted for 34.9%. The number of home care patients over the past month was 10.8±33.2. Pharmacies with no home care patients accounted for 31.6%, those with one patient made up 14.1%, and those with 2–9 patients accounted for 34.4%.
The distribution of basic dispensing fees was as follows: basic dispensing fee 1 (70.4%), basic dispensing fee 2 (3.5%), basic dispensing fee 3-i (3.7%), basic dispensing fee 3-ro (8.8%), basic dispensing fee 3-ha (12.2%), and special basic dispensing fee (1.4%). The proportions of pharmacies claiming regional support system add-on fees (“Chiiki Shien Taisei Kasan”) were: Add-on 1 (16.2%), Add-on 2 (23.8%), Add-on 3 (6.5%), Add-on 4 (3.5%), and no add-on (50.1%). The distribution was as follows for the generic drug dispensing add-on: Add-on 1 (15.9%), Add-on 2 (38.8%), Add-on 3 (28.6%), and no add-on (16.6%).
2. Prescription Inquiry and Change RatesA total of 143701 prescriptions were received during the survey period, with 2907 prescriptions involving medical inquiries and 3064 medical inquiries cases in total. The “Proportion of inquiries to prescriptions” was 2.0%, and the “Proportion of inquiries to cases” was 2.1%. “Proportion of pharmaceutical inquiries to total inquiries” was 95.0% and “Proportion of prescription changes after pharmaceutical inquiries” was 83.8% (Table 2).
Table 2. Number of Prescriptions and Inquiries during the Survey Period
| Total prescriptions, n | 143701 |
| Number of inquiries |
| Prescriptions subjected to inquiry, n | 2907 |
| Proportion of inquries to prescriptions, % | 2.0 |
| Inquiries, n | 3064 |
| Proportion of inquries to cases, % | 2.1 |
| Pharmaceutical inquiries, n | 2910 |
| Proportion of pharmaceutical inquiries to total inquiries, % | 95.0 |
| Prescription changes after pharmaceutical inquiries, n | 2440 |
| Prescription changes after pharmaceutical inquiries, % | 83.8 |
Cases of preventing sADRs were reported in 167 of 3064 cases of inquiries, 211 of 765 cases of home care, and 14 of 326 cases of follow-up. Thirty-three cases of inquiries were excluded based on the exclusion criteria in which the sADR was “other,” five cases of “incomplete entry in the prescription,” two cases of “excess/shortage of number of days,” one case of “adjustment of the number of days and pieces owing to residual drugs,” one case of “question about dosing methods to facilitate ingestion or application of drugs,” one case of “excess/shortage of the total number of pieces,” one case of “tablet crushing, capsule opening, and other dosing methods are not allowed,” and one case of “prescription of drugs for which long-term use is prohibited.” Two and one cases of home care and follow-up, respectively, in which the sADRs were “other” were excluded. The final number of cases used to reduce medical expenses was 122 (4.0%) cases of inquiries, 209 (27.3%) of home-based work, and 13 (4.0%) of follow-up (Fig. 1).
The average age of patients in cases of sADR prevention through prescription inquiries was 55.8±25.8 years. The content of the inquiries was as follows: “question about safety” accounted for 59.0% (72 cases), “question about dosage and administration” for 36.9% (45 cases), “other” for 3.3% (four cases), “question about compliance and QOL” for 0.8% (one case) (Table 3).
Table 3. The Content of Pharmacists’ Activities That Could Have Prevented Serious Adverse Drug Reactions
| Community pharmacists’ inquiry cases (n=122) |
|---|
| The content of the inquiries | Number of cases | Proportion (%) |
|---|
| Category | Subcategory |
|---|
| Question about safety | Duplication with other drugs for same indications | 22 | 18.0 |
| History of adverse reactions | 12 | 9.8 |
| Checking the purpose of prescription | 9 | 7.4 |
| Contraindication | 9 | 7.4 |
| Interactions | 7 | 5.7 |
| Suspicion of adverse reactions | 4 | 3.3 |
| History of allergy | 3 | 2.5 |
| Careful administration | 3 | 2.5 |
| Prohibited/inadequate combination | 3 | 2.5 |
| Question about dosage and administration | Excessive dosage | 24 | 19.7 |
| Dosing method of oral medicine | 13 | 10.7 |
| Dosing method of injection | 3 | 2.5 |
| Shortage of dosage | 2 | 1.6 |
| Dosing method of topical drugs | 1 | 0.8 |
| Dosing (application) interval | 1 | 0.8 |
| Questions about site of use | 1 | 0.8 |
| Question about compliance and QOL | Questions about lifestyle and occupation of a patient | 1 | 0.8 |
| Other | | 4 | 3.3 |
| Community pharmacists’ home care cases (n=209) |
|---|
| The content of the information provided to physicians | Number of cases | Proportion (%) |
|---|
| Adherence information | 208 | 99.5 |
| Ease of use or suitability of the medication | 204 | 97.6 |
| Information regarding the patient’s lifestyle and living environment | 204 | 97.6 |
| Suspicion of drug-induced adverse reactions | 204 | 97.6 |
| Symptom control failure or worsening | 203 | 97.1 |
| Symptom improvement or resolution | 202 | 96.7 |
| Avoidance of duplicate prescriptions and drug interactions | 201 | 96.2 |
| Deviation from clinical guidelines | 1 | 0.5 |
| Multiple responses allowed. |
| Community pharmacists’ follow-up cases (n=13) |
|---|
| The content of the information provided to physicians | Number of cases | Proportion (%) |
|---|
| Adherence information | 11 | 84.6 |
| Suspicion of drug-induced adverse reactions | 7 | 53.8 |
| Ease of use or suitability of the medication | 6 | 46.2 |
| Information about the patient’s lifestyle and living environment | 2 | 15.4 |
| Symptom improvement or resolution | 2 | 15.4 |
| Information about visits to other medical departments | 2 | 15.4 |
| Multiple responses allowed. |
In cases of home care services, the average age of patients was 89.0±7.3 years. The content of the information provided to physicians (multiple responses allowed) included: “adherence information” in 99.5% (208 cases), “ease of use or suitability of the medication” in 97.6% (204 cases), “information regarding the patient’s lifestyle and living environment” in 97.6% (204 cases), “suspicion of drug-induced adverse reactions” in 97.6% (204 cases), “symptom improvement or resolution” in 96.7% (202 cases), “symptom control failure or worsening” in 97.1% (203 cases), “avoidance of duplicate prescriptions and drug interactions” in 96.2% (201 cases), and “deviation from clinical guidelines” in 0.5% (1 case).
In follow-up cases, the average age of patients was 78.7±9.0 years. Information was provided to the physician after follow-up in all 13 cases, and prescription suggestions were made in two of these cases. The content of the information provided (multiple responses allowed) included: “adherence information” in 84.6% (11 cases), “suspicion of drug-induced adverse reactions” in 53.8% (7 cases), “ease of use or suitability of the medication” in 46.2% (6 cases), “information about the patient’s lifestyle and living environment,” “symptom improvement or resolution,” and “information about visits to other medical departments” in 15.4% (2 cases) each.
3-2. Estimation of the economic impact of preventing sADRsThe most common potentially preventable sADRs were drug-induced liver injury (14 cases) in prescription inquiry cases (Table 4); drug-induced liver dysfunction (99 cases), bleeding tendencies (28 cases), and toxic epidermal necrolysis (20 cases) in home care service cases (Table 5); and peptic ulcers and hypoglycemia (3 cases) in follow-up cases (Table 6). The results showed costs of ¥28291790 for cases involving prescription inquiries (¥231899.9 per case), ¥58285600 for home care cases (¥278878.5 per case), and ¥2544950 for follow-up cases (¥195765.4 per case). Each estimated annual cost reduction was calculated as ¥10543064299.1 for prescription inquiry cases, ¥21736905862.5 for home care cases, and ¥949108160.1 for follow-up cases, totaling ¥33229078321.7 (Table 7).
Table 4. Serious Adverse Drug Reactions That Could Have Been Prevented through Community Pharmacists’ Inquiries and Their Effect on Medical Costs
| Major category | Minor category (adverse events) | Number of cases | DPC/PDPS disease name | Hospitalization A | Hospitalization B | DPC/PDPS Points | Cost per case | Number of cases | Medical cost |
|---|
| Days | Points/d | Days | Points/d |
|---|
| Skin | Stevens–Johnson syndrome | 2 | Severe drug eruption | 7 | 2877 | 15 | 2041 | 36467 | ¥364670 | ×2 | ¥729340 |
| Toxic epidermal necrolysis | 7 | Severe drug eruption | 5 | 2805 | 9 | 1990 | 21985 | ¥219850 | ×7 | ¥1538950 |
| Drug-induced hypersensitivity syndrome | 2 | Drug eruption, toxic eruption | 5 | 2805 | 10 | 1990 | 23975 | ¥239750 | ×2 | ¥479500 |
| Drug-induced contact dermatitis | 1 | Eczema, dermatitis | 5 | 2818 | 9 | 1999 | 22086 | ¥220860 | ×1 | ¥220860 |
| Liver | Drug-induced liver injury | 14 | Fulminant hepatitis, acute hepatic failure, acute hepatitis | 5 | 3003 | 11 | 2130 | 27795 | ¥277950 | ×14 | ¥3891300 |
| Kidney | Acute renal failure (acute tubular necrosis) | 4 | Acute renal failure | 6 | 2896 | 13 | 2055 | 31761 | ¥317610 | ×4 | ¥1270440 |
| Antineutrophil cytoplasmic antibody associated angiitis | 1 | Rapidly progressive glomerulonephritis | 4 | 3405 | 14 | 2145 | 35070 | ¥350700 | ×1 | ¥350700 |
| Hypokalemia | 1 | Hypokalemia | 6 | 2966 | 11 | 2104 | 28316 | ¥283160 | ×1 | ¥283160 |
| Blood | Bleeding tendency | 4 | Hemorrhagic disease (others) | 7 | 2993 | 15 | 2187 | 38447 | ¥384470 | ×4 | ¥1537880 |
| Thrombosis (thromboembolism, embolism, infarction) | 1 | Arteriosclerosis obliterans | 3 | 3397 | 10 | 2181 | 25458 | ¥254580 | ×1 | ¥254580 |
| Respiratory organs | Interstitial pneumonia (pneumonitis, alveolitis, pulmonary fibrosis) | 2 | Interstitial lung disease | 8 | 2974 | 16 | 2134 | 40864 | ¥408640 | ×2 | ¥817280 |
| Asthma due to non-steroidal anti-inflammatory drugs | 1 | Asthma | 3 | 2394 | 6 | 1959 | 13059 | ¥130590 | ×1 | ¥130590 |
| Acute respiratory distress syndrome | 2 | Acute respiratory distress syndrome | 8 | 3485 | 18 | 2583 | 53710 | ¥537100 | ×2 | ¥1074200 |
| Digestive tract | Peptic ulcer | 9 | Gastroduodenal ulcer | 4 | 2961 | 8 | 2101 | 20248 | ¥202480 | ×9 | ¥1822320 |
| Severe diarrhea | 7 | Other digestive disorders | 3 | 2954 | 6 | 2096 | 15150 | ¥151500 | ×7 | ¥1060500 |
| Heart circulation | Ventricular tachyarrhythmia | 3 | Tachyarrhythmia | 2 | 3205 | 5 | 2450 | 13760 | ¥137600 | ×3 | ¥412800 |
| Congestive heart failure | 5 | Heart failure | 8 | 2866 | 16 | 2033 | 39192 | ¥391920 | ×5 | ¥1959600 |
| Neural system and musculoskeletal system | Drug-induced parkinsonism | 2 | Parkinsonian syndrome | 8 | 2613 | 16 | 1854 | 35736 | ¥357360 | ×2 | ¥714720 |
| Rhabdomyolysis | 3 | Extremity muscle injury | 6 | 2825 | 12 | 2004 | 28974 | ¥289740 | ×3 | ¥869220 |
| Peripheral neuropathy | 2 | Dystonia, myasthenia | 4 | 3095 | 10 | 2330 | 26360 | ¥263600 | ×2 | ¥527200 |
| Dyskinesia | 2 | Dystonia, myasthenia | 5 | 2896 | 9 | 2054 | 22696 | ¥226960 | ×2 | ¥453920 |
| Spasm, epilepsy | 1 | Epilepsy | 2 | 3770 | 6 | 2206 | 16364 | ¥163640 | ×1 | ¥163640 |
| Ataxia | 3 | Myopathy (others) | 4 | 3104 | 10 | 2348 | 26504 | ¥265040 | ×3 | ¥795120 |
| Mental function | Malignant syndrome | 5 | Parkinsonian syndrome | 8 | 2613 | 16 | 1854 | 35736 | ¥357360 | ×5 | ¥1786800 |
| Drug-induced depression | 1 | Mood (emotional) disorder | 3 | 2800 | 12 | 1884 | 25356 | ¥253560 | ×1 | ¥253560 |
| Benzodiazepine dependence | 3 | Mental and behavioral disorders due to psychoactive substance use | 1 | 3762 | 2 | 2669 | 6431 | ¥64310 | ×3 | ¥192930 |
| Medication-induced delirium | 6 | Mental and behavioral disorders due to psychoactive substance use | 1 | 3762 | 2 | 2669 | 6431 | ¥64310 | ×6 | ¥385860 |
| Serotonin syndrome | 2 | Drug toxicity (other toxicity) | 1 | 4002 | 3 | 2244 | 8490 | ¥84900 | ×2 | ¥169800 |
| Metabolism and endocrine organs | Hypoglycemia | 8 | Hypoglycemia | 2 | 2988 | 5 | 2298 | 12870 | ¥128700 | ×8 | ¥1029600 |
| Hyperglycemia | 3 | Other diabetes (diabetic ketoacidosis) | 4 | 2687 | 10 | 2017 | 22850 | ¥228500 | ×3 | ¥685500 |
| Hypersensitivity | Anaphylaxis | 5 | Unspecified injuries | 1 | 3013 | 2 | 2138 | 5151 | ¥51510 | ×5 | ¥257550 |
| Sensory organs (eyes) | Glaucoma | 1 | Glaucoma | 1 | 2674 | 3 | 1897 | 6468 | ¥64680 | ×1 | ¥64680 |
| Oral cavity | Drug-induced stomatitis | 1 | Stomatitis, oral disease | 3 | 2968 | 7 | 2105 | 17324 | ¥173240 | ×1 | ¥173240 |
| Bone | Osteoporosis | 2 | Spinal osteoporosis | 9 | 2504 | 18 | 1776 | 38520 | ¥385200 | ×2 | ¥770400 |
| Urinary organs | Urinary retention, urination difficulty | 5 | Lower urinary tract disease | 3 | 2777 | 7 | 2102 | 16739 | ¥167390 | ×5 | ¥836950 |
| Gynecology | Immune-related adverse events | 1 | Systemic autoimmune disease with severe organ involvement | 3 | 3530 | 13 | 2212 | 32710 | ¥327100 | ×1 | ¥327100 |
| Total | 122 | | ¥28291790 |
Thirty-three cases that selected the following were excluded: “other,” five cases that selected “Incomplete entry in the prescription,” two cases that selected “excess/shortage of number of days,” one case that selected “adjustment of the number of days and pieces due to residual drugs,” one case that selected “question about dosing methods to facilitate ingestion or application of drugs,” one case that selected “excess/shortage of the total number of pieces,” one case that selected “tablet crushing, capsule opening, and other dosing methods are not allowed,” and one case that selected “prescription of drugs for which long-term use is prohibited.”
DPC/PDPS, Diagnosis Procedure Combination/Per Diem Payment System.
Table 5. Serious Adverse Drug Reactions That Could Have Been Prevented through Community Pharmacists’ Home Care and Their Effect on Medical Costs
| Major category | Minor category (adverse events) | Number of cases | DPC/PDPS disease name | Hospitalization A | Hospitalization B | DPC/PDPS Points | Cost per case | Number of cases | Medical cost |
|---|
| Days | Points/d | Days | Points/d |
|---|
| Skin | Stevens–Johnson syndrome | 2 | Severe drug eruption | 7 | 2877 | 15 | 2041 | 36467 | ¥364670 | ×2 | ¥729340 |
| Toxic epidermal necrolysis | 20 | Severe drug eruption | 7 | 2877 | 16 | 2041 | 38508 | ¥385080 | ×20 | ¥7701600 |
| Liver | Drug-induced liver injury | 99 | Fulminant hepatitis, acute hepatic failure, acute hepatitis | 5 | 3003 | 11 | 2130 | 27795 | ¥277950 | ×99 | ¥27517050 |
| Blood | Bleeding tendency | 28 | Hemorrhagic disease (others) | 7 | 2993 | 15 | 2187 | 38447 | ¥384470 | ×28 | ¥10765160 |
| Thrombosis (thromboembolism, embolism, infarction) | 3 | Arteriosclerosis obliterans | 3 | 3397 | 10 | 2181 | 25458 | ¥254580 | ×3 | ¥763740 |
| Digestive tract | Severe diarrhea | 2 | Other digestive disorders | 3 | 2954 | 6 | 2096 | 15150 | ¥151500 | ×2 | ¥303000 |
| Heart circulation | Ventricular tachycardia | 2 | Tachyarrhythmia | 2 | 3205 | 5 | 2450 | 13760 | ¥137600 | ×2 | ¥275200 |
| Neural system and musculoskeletalsystem | Rhabdomyolysis | 6 | Extremity muscle injury | 6 | 2825 | 12 | 2004 | 28974 | ¥289740 | ×6 | ¥1738440 |
| Spasm, epilepsy | 11 | Epilepsy | 2 | 3770 | 6 | 2206 | 16364 | ¥163640 | ×11 | ¥1800040 |
| Ataxia | 2 | Myopathy (others) | 4 | 3104 | 10 | 2348 | 26504 | ¥265040 | ×2 | ¥530080 |
| Mental function | Akathisia | 1 | Degenerative diseases of the basal ganglia | 6 | 2711 | 12 | 1945 | 27936 | ¥279360 | ×1 | ¥279360 |
| Metabolism and endocrine organs | Hypoglycemia | 16 | Hypoglycemia | 2 | 2988 | 5 | 2298 | 12870 | ¥128700 | ×16 | ¥2059200 |
| Hyperglycemia | 16 | Other diabetes (diabetic ketoacidosis) | 4 | 2687 | 10 | 2017 | 22850 | ¥228500 | ×16 | ¥3656000 |
| Gynecology | Urinary retention, urination difficulty | 1 | Lower urinary tract disease | 3 | 2777 | 7 | 2102 | 16739 | ¥167390 | ×1 | ¥167390 |
| Total | 209 | | ¥58285600 |
Two cases that selected “other” were excluded.
Table 6. Serious Adverse Drug Reactions That Could Have Been Prevented through Community Pharmacists’ Follow-up and Their Effect on Medical Costs
| Major category | Minor category (adverse events) | Number of cases | DPC/PDPS disease name | Hospitalization A | Hospitalization B | DPC/PDPS Points | Cost per case | Number of cases | Medical cost |
|---|
| Days | Points/d | Days | Points/d |
|---|
| Skin | Drug-induced hypersensitivity syndrome | 1 | Drug eruption, toxic eruption | 5 | 2805 | 9 | 1990 | 21985 | ¥219850 | ×1 | ¥219850 |
| Blood | Bleeding tendency | 1 | Hemorrhagic disease (others) | 7 | 2993 | 15 | 2187 | 38447 | ¥384470 | ×1 | ¥384470 |
| Digestive tract | Peptic ulcer | 3 | Gastroduodenal ulcer | 4 | 2961 | 8 | 2101 | 20248 | ¥202480 | ×3 | ¥607440 |
| Severe diarrhea | 1 | Other digestive disorders | 3 | 2954 | 6 | 2096 | 15150 | ¥151500 | ×1 | ¥151500 |
| Neural system and musculoskeletalsystem | Rhabdomyolysis | 1 | Extremity muscle injury | 6 | 2825 | 12 | 2004 | 28974 | ¥289740 | ×1 | ¥289740 |
| Mental function | Drug-induced depression | 1 | Mood (emotional) disorder | 3 | 2800 | 12 | 1884 | 25356 | ¥253560 | ×1 | ¥253560 |
| Serotonin syndrome | 1 | Drug toxicity (other toxicity) | 1 | 4002 | 3 | 2244 | 8490 | ¥84900 | ×1 | ¥84900 |
| Metabolism and endocrine organs | Hypoglycemia | 3 | Hypoglycemia | 2 | 2988 | 5 | 2298 | 12870 | ¥128700 | ×3 | ¥386100 |
| Gynecology | Urinary retention, urination difficulty | 1 | Lower urinary tract disease | 3 | 2777 | 7 | 2102 | 16739 | ¥167390 | ×1 | ¥167390 |
| Total | 13 | | ¥2544950 |
One case that selected “other” was excluded.
Table 7. Estimation of Annual Medical Cost Reduction by Preventing Serious Adverse Drug Reactions through Community Pharmacists’ Activities
| 1) Calculation of medical cost reduction during the study period |
| Medical cost reduction through inquiries | ¥28291790.0 |
| Medical cost reduction through inquiries per case | ¥231899.9 |
| Medical cost reduction through home care | ¥58285600.0 |
| Medical cost reduction through home care per case | ¥278878.5 |
| Medical cost reduction through follow-up | ¥2544950.0 |
| Medical cost reduction through follow-up per case | ¥195765.4 |
| 2) Estimation of annual medical cost reduction |
| Estimation of annual medical cost reduction through inquiries | ¥10543064299.1 |
| 799873743 (prescriptions)×0.0213×0.95×231899.9 (yen)×122/2910×0.067 |
| Estimation of annual medical cost reduction through home care | ¥21736905862.5 |
| 278314.5 (yen)×799873743 (prescriptions)/143701 (prescriptions)×0.067 |
| Estimation of annual medical cost reduction through follow-up | ¥949108160.1 |
| 210970.7 (yen)×799873743 (prescriptions)/143701 (prescriptions)×0.067 |
| 2) Total | ¥33229078321.7 |
For the 2907 prescriptions subjected to inquiries, the sex distribution of patients was 44.7% male and 55.3% female. The average age of the patients was 60.8±25.7 years, with 9.9% under the age of 15, 40.7% between 15 and 69 years old, and 49.4% aged 70 or older. Furthermore, 2.9% of these patients agreed to receive guidance under the family pharmacist (Table 8).
Table 8. Overview of Prescription Inquiry Cases
| Male sex, n (%) | 1299 (44.7) |
| Age, years | 60.8±25.7 |
| <15, n (%) | 288 (9.9) |
| 15–69, n (%) | 1183 (40.7) |
| ≤70, n (%) | 1436 (49.4) |
| Patients agreed to receive guidance under the family pharmacist, n (%) | 85 (2.9) |
| Medical institutions issuing the prescription, n (%) |
| Clinics | 1803 (62.0) |
| Hospitals | 1097 (37.7) |
| Dental clinics | 7 (0.2) |
| Number of prescription drugs, n | 5.2±3.4 |
| The calculation status of dispensing fees, n (%) |
| Residual medication adjustment (30 points) | 340 (11.7) |
| Not related to residual medication adjustment (40 points) | 287 (9.9) |
| A means of discovering inquiriesa), n (%) |
| Based on the prescription details | 1754 (51.5) |
| Through interviews | 1131 (33.2) |
| Based on the medication history | 327 (9.6) |
| Based on the contents of the medication handbook | 131 (3.8) |
| Other reasons | 58 (1.7) |
| Based on online eligibility verification | 4 (0.1) |
| The timing of inquiry detection, n (%) |
| Prescription review before dispensing | 1749 (60.2) |
| Guidance during medication delivery (medication guidance) | 750 (25.8) |
| During the inspection of dispensed medications | 199 (6.8) |
| During the medication preparation | 183 (6.3) |
| Others | 26 (0.9) |
n=2907. a)Multiple responses allowed, n=3405.
The medical institutions issuing the prescriptions were categorized as clinics (62.0%), hospitals (37.7%), and dental clinics (0.2%). The average number of drugs prescribed was 5.2±3.4. Regarding the calculation status of dispensing fees to prevent duplication and interactions of prescription drugs, dispensing fees related to residual medication adjustment (30 points) accounted for 11.7%, and dispensing fees not related to residual medication adjustment (40 points) accounted for 9.9%.
“Based on the prescription details” accounted for the largest proportion of the discovered inquiries at 51.5%, followed by “through interviews with the patient or family (medication guidance)” at 33.2%. Other reasons included “based on the medication history” (9.6%), “based on the contents of the medication handbook” (3.8%), “other reasons” (1.7%), and “based on online eligibility verification” (0.1%) (multiple responses allowed, n=3405) The most common timing of inquiry detection was during the prescription review before dispensing (60.2%), followed by during medication delivery (medication guidance; 25.8%), during the inspection of dispensed medications (6.8%), and during the preparation of medications (compounding and assembling; 6.3%).
4-2. Content of prescription inquiries and changes in drug costs before and after inquiriesThe classification of pharmaceutical prescription inquiries and the changes in drug costs before and after the inquiries are shown in Table 9. Among the 2910 pharmaceutical prescription inquiries, the most common categories were “question about dosage and administration” (25.3%), “question about the number of days, frequency of dosing, and total number of pieces” (25.0%), and “question about safety” (24.7%), with similar proportions. These were followed by “other” (15%), “question about compliance and QOL” (9.5%), and “question about dispensing” (0.4%). In terms of subcategories, the most frequent issue was “adjustment of the number of days and pieces owing to residual drugs” (12.6%), followed by “dosing method of oral medicine” (11.3%), “incomplete entry in the prescription (including shortages and dosage changes)” (10.2%), and “unable to obtain prescribed medication” (9.7%).
Table 9. Changes in Drug Costs Before and After Pharmaceutical Inquiries (According to Inquiry Category)
| Category | Subcategory | Number of inquiries | Proportion (%) | Difference (yen) | Subtotal of difference (yen) |
|---|
| Question about dosage and administration | Dosing method of oral medicine | 328 | 11.3 | 16648.9 | −74768.1 |
| Dosing method of topical drugs | 81 | 2.8 | 1591.4 |
| Dosing method of injection | 5 | 0.2 | −3972.0 |
| Dosing (application) interval | 6 | 0.2 | −13018.2 |
| Questions about site of use | 37 | 1.3 | −134.4 |
| Excessive dosage | 135 | 4.6 | −163614.8 |
| Shortage of dosage | 145 | 5.0 | 87731.0 |
| Question about the number of days, frequency of dosing, and total number of pieces | Excess/shortage of number of days | 190 | 6.5 | −64439.6 | −753361.0 |
| Prescription of drugs for which long-term useis prohibited | 84 | 2.9 | −28943.1 |
| Adjustment of the number of days and pieces owing to residual drugs | 368 | 12.6 | −701605.7 |
| Excess/shortage of the total number of pieces (topical drug, injection) | 72 | 2.5 | 41755.9 |
| Excess/shortage of frequency of dosing (potion) | 14 | 0.5 | −128.5 |
| Question about safety | Checking the purpose of prescription (including questions about insurance applications) | 156 | 5.4 | −279798.1 | −202345.4 |
| Incomplete entry in the prescription (including shortages and dosage changes) | 296 | 10.2 | 245175.0 |
| Prohibited combination/Inadequate combination | 5 | 0.2 | 30.0 |
| Contraindication | 14 | 0.5 | 3080.2 |
| Careful administration | 7 | 0.2 | −163.4 |
| History of allergy | 6 | 0.2 | −12853.7 |
| History of adverse reactions | 26 | 0.9 | −9358.3 |
| Suspicion of adverse reactions | 13 | 0.4 | −2137.9 |
| Influence on pregnancy | 2 | 0.1 | 0.0 |
| Influence on lactation | 3 | 0.1 | −397.5 |
| Duplication with other drugs for same indications | 172 | 5.9 | −135201.6 |
| Interactions | 20 | 0.7 | −10720.1 |
| Question about compliance and QOL | Questions about dosing methods to facilitate ingestion or application of drugs (including change in formulation, single-pack dispensing, tablet crushing, capsule opening, and simple suspension) | 243 | 8.4 | −140935.2 | −139946.8 |
| Questions about lifestyle and occupation of apatient | 5 | 0.2 | −2060.8 |
| Patient’s request for selection of original/generic drugs | 29 | 1.0 | 3049.2 |
| Question about dispensing | Single-pack dispensing is not allowed | 2 | 0.1 | −11.2 | −919.9 |
| Tablet crushing, capsule opening, and otherdosing methods are not allowed | 9 | 0.3 | −908.7 |
| Simple suspension methods are not allowed | 0 | 0.0 | 0.0 |
| Other | Unable to obtain prescribed medication | 282 | 9.7 | −48422.1 | −153427.1 |
| Cases other than those listed above | 155 | 5.3 | −105005.0 |
| Total | 2910 | 100.0 | −1324768.3 | −1324768.3 |
The change in drug costs before and after pharmaceutical prescription inquiries resulted in a reduction of ¥1324768.3 (n=2910). Excluding inquiries related to “incomplete entry in the prescription (including shortages and dosage changes),” the reduction increased to ¥1569943.0 (n=2614). Each inquiry led to an average cost reduction of ¥600.6 (95% CI: −¥3648.0 to ¥798.0).
4-3. Estimation of annual drug cost reduction through inquiries by community pharmacists nationwideThe cost of prescriptions filled nationwide in 2022 was ¥799873743. Based on this study, the proportion of inquiries to cases was 2.1%, the proportion of pharmaceutical inquiries to total inquiries was 95.0%, the number of pharmaceutical inquiries excluding prescription omissions was 2614, and pharmaceutical inquiries was 2910. Therefore, the estimation of annual drug cost reduction through inquiries by community pharmacists was calculated as follows: ¥600.6×(799873743×0.0213×0.95×2614/2910)=¥8732177830.8.
DISCUSSION
This study evaluated the effects of prescription inquiries, home care services, and medication follow-up conducted by community pharmacists on preventing sADRs and reducing medical costs. The findings indicate that these activities prevented sADRs, potentially leading to an annual medical cost reduction of approximately ¥33 billion. Additionally, prescription inquiries alone resulted in an annual drug cost reduction of approximately ¥8.7 billion. These results highlight that community pharmacists enhance the quality of pharmacological therapy and contribute significantly to reducing medical costs through these three patient-centered activities.
This study found that 6.7% of pharmacies were individually operated, whereas 93.3% were corporate-operated, a distribution consistent with the results of the 23rd Medical Economic Survey of Medical Institutions and Other Facilities (2021) (individual: 4.5%, corporate: 95.5%).15) The average number of pharmacists per pharmacy was 2.2, similar to the average number of 2.6 reported in the 2020 Survey on the Functions of Pharmacies.16)
Regarding the number of medicines stocked, this study reported an average of 1269.2 items per pharmacy, closely aligned with the 1128.5 items reported in the 2022 survey.17) Each pharmacy filled an average of 1336 prescriptions per month, which was slightly higher than the nationwide average of 1113 prescriptions per month, calculated by dividing the total number of prescriptions dispensed in May 2023 (69931980 prescriptions dispensed across 62828 pharmacies).18,19) Given that the average number of pharmacists per pharmacy in this study was 2.2, and the regulatory limit is 40 prescriptions per day per pharmacist, this monthly prescription volume was within acceptable limits. Dispensing fee distributions were comparable to national averages, with 70.4% of pharmacies applying basic dispensing fee 1, while the distribution for other fee categories mirrored figures reported by the Japan Federation of Health Insurance Pharmacies in July 2022.20) Based on these results, the data collected in this study can be considered representative of the overall population.
The rate of prescription inquiries was analyzed in terms of “proportion of inquiries to prescriptions” (2.0%) and “proportion of inquiries to cases” (2.1%), both showing a slight decrease from our previous survey (2.6% and 2.7%, respectively).2) In contrast, the rate of “proportion of pharmaceutical inquiries to total inquiries” increased significantly from 78.1 to 95.0%. This shift likely reflects a reduction in formal inquiries owing to the adoption of PBPM and the growing focus on safety and efficacy issues in pharmacotherapy. Notably, 34.2% of pharmacies reported having established PBPM agreements, and the rate of prescription changes after pharmaceutical inquiries was 83.8%, higher than previously reported rates.2) These findings indicate an increase in inquiries related to critical safety and efficacy issues in pharmacotherapy.
In terms of sADR prevention, 122 sADRs were identified out of 3064 prescription inquiry cases, 209 sADRs out of 765 home care cases, and 13 sADRs out of 326 follow-up cases. The proportion of prescription inquiries was similar to the previously reported rate (5.1%).2) Other studies on sADR prevention in hospitals reported that in 3.9% of intervention cases, sADRs were potentially prevented.10) Additionally, a survey on pre-avoidance reports in pharmacies indicated that 4.1% of reported cases involved the prevention of sADRs.11) Previous reports also suggested that 2.6–5.2% of pharmacological interventions contribute towards preventing the progression of ADRs.12) In the present study, 344 sADR prevention cases were documented across all activities, representing 8.3% of reported cases. This higher-than-previously reported rate highlights the effectiveness of these pharmacist-led activities in enhancing the safety of pharmacotherapy.2,10,12) In prescription inquiries for which sADRs could have been prevented, the most common concern was excessive dosage, followed by redundancy for other drugs for the same indications. Additionally, seven cases with drug interactions were reported, highlighting the importance of pharmaceutical experts in preventing sADRs. Furthermore, in several cases, sADRs were prevented by considering the patients’ histories of adverse reactions and allergies; this underscores the importance of medication history and continuous drug therapy management. In follow-up cases, information was provided to the physician after follow-up in all 13 cases; for 7 of these cases, information about suspected adverse reactions was available. Although follow-ups can lead to the early detection of adverse reactions for certain medications, such as chemotherapy drugs,11,12) in the present study, we demonstrate that follow-ups also contribute to the early detection of ADRs in clinical practice. To ensure the safety of drug therapy, it is crucial for pharmacists to provide medication follow-up and ongoing guidance, utilizing medication history.
The estimated annual cost savings attributed to sADR prevention were approximately ¥10.5 billion from inquiries, ¥21.7 billion from home care services, and ¥900 million from follow-ups, totaling approximately ¥33 billion. These results demonstrate improved pharmacological outcomes and substantial economic benefits. Moreover, a recent meta-analysis21) reported an sADR rate of 1.35–9.1%; thus, the sADR detection rate observed in the present study, i.e., 6.7%, is still considered reasonable.
Regarding the nature of prescription inquiries, the most common category of inquiry was “question about dosage and administration,” consistent with previous findings.2) Inquiries regarding “question about the number of days, frequency of dosing, and total number of pieces” and “question about safety” were reported at similar rates. Overall, the primary content of inquiries showed little change from the previous report.2) However, when examining subcategories, “unable to obtain prescribed medication” accounted for 9.7%, making it the third most common category, suggesting that pharmacists are struggling to cope with the recent shortage of pharmaceuticals.22)
Among the methods used to identify prescription inquiries, 33.2% were identified through “interviews with patients or their families (medication guidance),” making it the second most common method after “based on the prescription details.” Kaneko et al.23) solely focused on the prevention of adverse reactions and found that “patient complaints” were the starting point for discovery in 31.4% of cases, a result similar to ours. This finding highlights that community pharmacies, which are being encouraged to transition from product-focused tasks to patient-centered services,1) are effectively adapting to this shift by identifying prescription inquiries through patient interactions.
Regarding the category of inquiries, the cost reduction effect of “inquiries about safety” improved significantly compared to our previous report,2) suggesting that pharmacists are increasingly contributing to the safety of pharmacotherapy. The subcategory with the largest cost reduction was “adjustment of the number of days and pieces owing to residual drugs,” with a per-case reduction of ¥1906.5, consistent with previous findings.2)
The reduction in drug costs per pharmaceutical inquiry was ¥600.6, slightly lower than the ¥643.2 reported previously.2) This decrease likely reflects the effect of drug price revisions, increased use of generic drugs, and the influence of PBPM, making direct comparisons challenging. However, given that drug prices have been reduced by approximately 5% with each price revision and that the adoption of lower-cost generic drugs has increased, the decrease does not appear significant. The estimated annual reduction in drug costs resulting from prescription inquiries conducted by pharmacists nationwide was approximately ¥8.7 billion, a 20% decrease compared to the ¥10.3 billion in a previous report.2) However, when considered within the context of three drug price revisions since 2016 and the cost-saving impact of PBPM—estimated to reduce monthly healthcare costs by approximately ¥1 million for 7100 prescriptions24)—the overall reduction effect remains comparable.
One limitation of this study is that for home care and follow-up cases, only data regarding the medical cost reduction achieved through sADR prevention were collected. In home care, cost reduction effects from proactive information sharing and prescription suggestions without formal inquiries have been reported.5,6) Similarly, follow-up may also contribute towards the optimization of prescriptions and reduction of medical costs via the provision of information and improvement of adherence through follow-up.7) Despite the concern that our study was only conducted for 1 week, changes in the survey period could lead to drug-associated variations due to differences in inquiries and follow-up, as well as differences in sADRs. In fact, the drugs subjected to follow-up may have been influenced by the coronavirus epidemic.7) To ensure universality, future long-term or similar surveys are necessary.
In conclusion, this study revealed that the prescription inquiries, home care services, and medication follow-up conducted by community pharmacists contribute significantly to preventing sADRs and enhancing the safety of pharmacotherapy. Additionally, these efforts led to an annual healthcare cost reduction of approximately ¥42 billion. Future research should analyze cost reduction effects from prescription modifications and other interventions in home care and follow-up cases to provide a more comprehensive assessment of their economic effect.
Acknowledgements
We thank all the members of the Japan Pharmacist Association for their cooperation in conducting this study. We thank the pharmacists who participated in this study.
This study was commissioned by the Japan Pharmaceutical Association and was conducted at the Shikamura Laboratory of the Faculty of Pharmaceutical Sciences, Tokyo University of Science, as part of the Japanese National Pharmacy Collaboration Survey in 2023.
Funding
The Japan Pharmaceutical Association funded this study.
Conflicts of Interest
The authors declare no conflict of interest.
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