Drug price standards have two characteristics. On the one hand, it is a list of drugs that can beapplied in medical insurance, and on the other it is a price list of these drugs. In Japan, the total amount of national medical expenditure continues to grow, and the ratio of drugs is about 22%. Consequently, when discussing health insurance and financial resources, the issue of drug prices arises. The 2016-2017 discussion on the “Basic Policy for Fundamental Reform of the Drug Pricing System” states that from the perspective of achieving both “sustainability of universal health insurance” and “promotion of innovation” and realizing “reducing public burden” and “improving the quality of medical care” for public benefit, we will work toward fundamental reform of the drug pricing system. This will be achieved with emphasis on the Plan-do-check-act cycle. In the future, while referring to the drug pricing systems of overseas countries, we must consider drug pricing systems that ensure a drug provision system that aligns with the Japan's medical insurance system.

While working as a hospital pharmacist, I always felt that pharmacists lacked various skills to understand vital signs and images of clinical findings that were often seen during ward conferences. Therefore, I believe that pharmacists should be able to provide technical guidance in understanding vital signs, which is a common language for medical personnels. After becoming a faculty member, in 2006, Professor Norito Takamura and I applied for and were accepted into the training program on promoting the highly-qualified medical personnel to meet the social needs such as community medicine (Medical Personnel GP) supported by the Ministry of Education, Culture, Sports, Science, and Technology, Japan. Along with professor from the university, I focused on building training systems for pharmacists to enable them in understanding the vital signs. These training systems aimed to teach basic physical assessment skills that can help pharmacists in contributing to pharmacotherapy and studying the protein binding displacement techniques between serum proteins and drugs. In this paper, we would like to present the current status of the clinical pharmacy simulation training at our university. For instance, we describe our efforts in conducting bedside training for pharmacy students, physical assessment workshop for pharmacists, training sessions on advanced objective structured clinical examination (Advanced OSCE) with patient simulator, and creating e-learning materials, etc.

We conducted a questionnaire survey on issues in interprofessional education (IPE) expected to develop human resources who will be responsible for interprofessional work (IPW) in cancer medical care and palliative care, and aggregated and analyzed the issues based on the response results. Responses were obtained from a total of 349 people, including 101 university faculty members, 139 medical professionals, 14 certified care workers, 20 welfare professionals, 48 administrative personnel, and 27 care managers. Certified care workers had significantly higher self-assessment scores for “role” and “team play” as members of a multidisciplinary collaborative team. Dentists had low self-evaluation scores for both “role” and “team play”. With regard to professional human resource development, necessary traits that were expected from individuals for IPW were: “educational ability” for university faculty, “field ability” for medical/care work/welfare professionals, “coordination ability” for administrative personnel, and “collaborative ability” for information and communication technology fields. IPE is expected to develop human resources who will be responsible for IPW, and respondents most often requested that programs should “increase opportunities for participatory learning outside the university”, with university, government, medical, long-term care, and welfare professionals.

This paper investigates Japanese community pharmacists' opinions on the opening of outsourcing of medication dispensing services and the resultant strengthening of clinical, patient-centered work, which is being considered by the Japanese government and the Ministry of Health, Labour and Welfare (MHLW). In our nationwide internet-based awareness survey, we collected information on basic attributes of the pharmacists and their workplaces, including the size and location of the pharmacy where they work, gender, age, clinical experience, employment status, and daily patient contact time. We then presented them with material from the MHLW Working Group, discussing the potential opening of outsourcing of medication dispensing. We asked the pharmacists their opinions on the pros and cons of opening of outsourcing, their concerns, how they could utilize the time created by opening of outsourcing, and their awareness of potential clinical services such as in-home visits to provide pharmaceutical care. We analyzed a sample of 1,069 responses obtained from pharmacists working at chain pharmacies and independent pharmacies. Regarding the acceptance of opening of outsourcing, 524 (49.0%) respondents “agreed” or “somewhat agreed” with this initiative, far exceeding the 175 responses (16.4%) that “disagreed” or “somewhat disagreed.” This suggests that there is a high possibility that opening of outsourcing will lead to the strengthening of clinical pharmacy services, as intended by the Japanese government and the MHLW, although 370 (34.6%) respondents said the potential effect of the change was “unknown,” highlighting the unclear content of the government policy and the insufficient understanding of pharmacists of its potential implications.

A male in his 80s presented to our clinic. The physician instructed us to discontinue warfarin and change to direct oral anticoagulant (Direct oral anticoagulant ; DOAC) for prolongation to PT-INR 3.5. As 1% lanoconazole cream had been prescribed 14 days prior to patient presentation, it was suspected that the drug enhanced the action of warfarin by inhibition of CYP2C9. We informed the physician that the case of PT-INR prolongation might be due to the combination of warfarin and imidazole antifungal topical drugs. The physician announced that warfarin will be resumed after confirming the discontinuation of the use of 1% lanoconazole cream and warfarin withdrawal at the next physician's house call date. Later, when we provided information to the physician regarding the appropriate period of withdrawal of warfarin, the physician instructed us to resume the use of warfarin on the same day. Since then, PT-INR has remained in the appropriate range, and it was confirmed that extension has not been approved. In this case, it is thought that it is possible to provide appropriate drug treatment by conducting home visits under the instruction of a physician and providing necessary information on drug use.

Recently, the necessity and demand for home medical care have increased. Moreover, patients and their family members often prefer that terminal patients die at home. Here, the case of a female patient with suspected chemical coping during terminal care at home is described. She suffered from mental distress due to anxiety and insomnia; therefore, she frequently consumed oxycodone hydrochloride at night. To avoid serious adverse reactions, discussions and correspondence were conducted through multi-disciplinary cooperative information sharing and pharmaceutical interventions. “Chemical coping” was deemed to be the stage before the development of abuse and dependence. In most cases, chemical coping is overlooked because it is rarely reported. When receiving home medical care, patients who feel anxious may develop chemical coping, as medical staff are not always available, unlike in hospital environments. Therefore, throughout terminal care at home, it is crucial to provide the patient and their family with professional guidance and cooperation to avoid the risk of the patient developing chemical coping behaviors.

With the difficulties of 2025 just around the corner, multidisciplinary collaboration is required for the next generation. In addition to common oral diseases, such as dental caries and periodontal disease, oral candidiasis is an endogenous infection of the oral cavity caused by commensal microorganisms. Oral care, the basis of home dental care, can be addressed by multidisciplinary intervention; information exchange is necessary for the early detection of these oral diseases. Dysphagia is a major problem for those with underlying disease, especially the ability to suspect drug-induced dysphagia. For this situation, dentists, with the approval of the attending physician, should intervene collaboratively with other professionals and disseminate diverse oral health information. While it is challenging to replicate the same high-level of dental care at home as in an outpatient setting, dentists rely heavily on medication registers to acquire patient information. The pharmacist must provide accurate information about oral medications and Bisphosphonate (BP) formulations administered as injection. Also, oral problems should not be an obstacle to the patient's advance care planning (ACP). A policy for dental intervention should be determined at the initial stage of considering ACP, and problems should be identified and resolved from a multidisciplinary perspective.