The Japanese Association of Home Care Pharmacies conducts an annual academic conference, a place of learning, where people from various medical professions gather and share information. From the perspective of the Executive Committee Chairman, in charge of the 12th Annual Meeting of the Japanese Association of Home Care Pharmacies, I considered the theme of the conference the most important aspect and decided to change “regional medical care in front of me” to “home pharmacy in the era of comprehensive community care”. Furthermore, to conduct a meaningful academic conference, good content and a certain number of participants are necessary; this academic conference was planned with the cooperation of the executive committee members. Next, we conducted a notification activity with an aim to provide awareness of selection and concentration. The process included various activities related to the direction of the 12th Academic Conference and the management of the Executive Committee. The content of this program could be used as a reference by those responsible for the management of academic conferences as the participants at the 12th Annual Meeting reaffirmed their motive of taking a step in their respective regions. I sincerely hope that this conference has provided an opportunity to further improve community medicine.

The home medical care can reach last moments with their families for patients of the end period at the home, but they feel fear to death and future uneasiness, and a psychiatric symptom including insomnia, depression and delirium may appear. Their families feel pain physically and mentally for 24-hour nursing and care. It is important for pharmacists to communicate with patients and their families because individual patients feel differently psychosocial pain. In order to care for the patient's psychosocial pain, it is necessary to perform the treatment such as pharmacotherapy for psychiatric symptoms. Pharmacists must check the patients and their families for psychiatric symptoms and give medication instructions so that the prescribed medication is not painful for the patients. In hospitals, psychiatric liaison teams composed of various occupations such as psychiatrists, nurses, and pharmacists are configured to alleviate the psychosocial pain of patients and their families. In order to prevent patients and their families from burdening home medical care, not only relief of physical pain in palliative care but also psychosocial pain are important to be relieving through multidisciplinary cooperation in the regional comprehensive care system in the community. Pharmacists need to be trusted by patients and their families to palliated mental pain.

Under the situation that structuring Community-based integrated care systems is urgent task, the responsibility of pharmacist working at pharmacy is broad, deep and important.In order to adopt coming changes in the medical environment, it is essential to maximize their professional ability. To achieve that, it is important to keep pharmacists’ mental and physical health not just coming from mechanization and introduction of ICT, but also coming from new medical resources /role called “Co-pharmaceutical staff”(CPS). The professional ability of pharmacist will be maximized by constructing the procedure documents and training program for CPS operation along with 0402 Notice, and by promoting the CPS’s health professional mind. As pharmacist at pharmacy to support patient’s drug treatment, it is mandatory to do continuous pharmaceutical management and support patients and also it is mandatory to make the best efforts to share the dosing information with doctors.The CPS system will be much more important and that situation make pharmacists maximize their professional ability and make them engage in rewarding work.

This study analyzed characteristics of prescription audits for home medical care patients, focusing on the Pharmaceutical Intervention Records (PIR) project conducted in collaboration with the Gifu Pharmaceutical Association and the Gifu Pharmaceutical University. The pharmacists registered audit data for 1,546 prescriptions into the PIR database in 2018. For the analysis, we divided the 1,546 prescriptions into a subject group (those with prescriptions for home medical care patients) and a control group (comprising other prescriptions). In the subject group, the proportion of elderly people, women, and patients who were prescribed six or more drugs was significantly higher than that of those in the control group. In addition, as a characteristic of prescription audits for the subject group, the audit information sources included consultation with doctors and nurses, the state of patients and patient homes, check of unused medicine, and test results. In addition, the reasons for pharmaceutical inquiries were renal dysfunction and serious side effects, and the type of prescription change was change of drug form. These proportions were significantly higher than in the control group. For these reasons, it was suggested that pharmacists use practical communication and trust relationships with patients and patients’ families as well as interprofessional collaboration to collect information. Moreover, the result suggest that they should inspect prescriptions according to patients’ vital signs and state of taking medicine.

As part of the Japanese Government’s 2018 revision of medication-dispensing fees, a new “medication adjustment subsidy” was established to evaluate pharmacists’ execution of the polypharmacy reduction policy. We calculated the subsidy received by the authors’ pharmacy for 123 of its patients and analyzed patients’ characteristics, reasons for discontinuation of medications, what these medications were taken for, and pharmacists’ years of experience. A Cost-effectiveness was performed for the additional income. The number of drugs per capita decreased from 9.0 to 6.0. We found that 274 (87.3%) medications were discontinued based on a pharmacist’s recommendation. Most of these were gastrointestinal medications and antipyretic analgesics being taken together. Although the number of medications consumed by these patients peaked between ages 80 and 84 at 10.7, there was no major age-related difference in the number of discontinued medications. Of these, 190 (69.3%) were being taken for no reason. The subsidy for the patients was received in 133 payments, amounting to ¥166,250. During the 28-day calculation period, the cost of patients’ prescriptions decreased by ¥461,680. No significant relationship was found between pharmacists’ experience and the results. The study suggests creating an environment wherein pharmacists collaborate with physicians and other healthcare providers for each patient based on a routine that involves following-up with patients after they begin taking a medication, assessing from a pharmacological perspective, and providing feedback to the patient’s physician to reduce the problem of polypharmacy by reducing the number of medications patients take and help lower medical costs.

Analyzed the contents of pharmacological interventions of visiting medicine management guidance work done by Toyooka hospital pharmacists, analyzed contents of visiting medicine management guidance work and examined its usefulness. During the period from April 2011 to March, we investigated the content of request for home guidance, content of prescription proposal, effect, and adverse event for 65 patients who conducted home guidance at our hospital. In the intervention request, 43 cases (66.1%) requested relief of symptoms due to cancer were the most frequent cases, and cases supporting end-of-life cancer patients at home with cancer were the most frequent cases. We also checked cases that corresponded with hospital specialists and teams. The total number of prescription proposals was 429, and 340 cases (79.3%) of them were reflected in the prescription. The breakdown of pharmacological intervention was that 117 cases (27.3%) supported the prescription design of medical narcotics, followed by 92 cases (21.4%) of symptomatic medicines other than opioid drugs, supporting home palliative care Most cases involved intervention to do. In 32 cases (49.2%) had Relaxation of physical symptoms improved by intervention by pharmacists. The home guidance conducted by a hospital pharmacist was suggested to be able to do a rapid and stepped pharmacological assessment through smooth collaboration with the hospital team and improve QOL.

In this study, we developed a multi-disciplinary home medical training program for pharmacy students. The purpose of this program is to train pharmacists to be active in the field of home medical care. The training was conducted at a clinic that provided medical care and had a long-term care facility. The training period was two weeks, and the training method was on the job training, where the pharmacy students accompanied the patients and medical staff, who had different occupations, throughout the facility. Ten pharmacy students participated in the training, and all of the trainees were experienced at accompanying doctors, nurses, and pharmacists. At the patient facility, all of the trainees were able to attend and learn from the healthcare provided by medical staff with different occupations, such as physical therapists, public health nurses, helpers, and occupational therapists. The training locations were various facilities related to home medical care, such as the patient homes, home-related facilities, and home-visit nursing stations. The training provided to the pharmacists was through accompanying doctors, nurses, pharmacists, and physical therapists during end-of-life care, pre-discharge conferences, and case conferences. In the report written by the trainees after the training, life, trust, multi-professional roles, the roles of other occupations, the exercise of expertise, information sharing, and death were extracted as keywords for home medical care. The degree of satisfaction and understanding of the trainees for the training was high, and this program was evaluated as effective and useful.

The super-aging of Japan’s population has led to a rapid increase in the number of older persons with dementia. There are difficulties in managing the medication of dementia patients, and many patients are unable to adhere to their medication regimens without appropriate support due to low cognitive function. This report describes three cases where the Mini–mental State Examination (MMSE) was utilized to aid home medication support by pharmacists and contribute to the improvement of medication adherence. Patient 1 had an MMSE score of 26; through self-management with the medication calendar and oral reminders from a helper, the patient experienced an increase of 7% in medication adherence. Patient 2 had an MMSE score of 21; this patient used the medication calendar, phone-based reminders from family members, received medication deliveries and oral reminders from a helper, which led to an increase of 4.8% in medication adherence. Patient 3 had an MMSE score of 23; setting drugs on the medication calendar with helper's cooperation, the patient experienced an increase of 2.3% in medication adherence. These cases suggest that the MMSE has potential applications in the pharmacist-led optimization of home medication support for dementia patients.