In Nagasaki Prefecture, a questionnaire survey was conducted to investigate the status of“ Family Pharmacy” in terms of medication management. On the specified day, information about the pharmacy and its patients was collected. Information on 16,238 patients was provided by 325 pharmacies out of 720 by responding to the survey. Based on the patient's medication histories, over 20％ of the patients that visited a pharmacy had prescriptions from more than one medical institution. This percentage increased with age. The percentage of patients who take maintenance medication for multiple chronic stages such as: hypertension, diabetes, hyperlipidemia, and dementia, was 6.8％ for the forties age group and 16.3％ for the fifties age group. It reached about 25％ for 60 and older. This survey showed that the number of patients who visited pharmacies with multiple disease states that required medication management, including drug interactions, increased corresponding with age. More effective medication management is required for the elderly aged 75 and older that have a decline in their physical function. We need to further study the role and evaluation of the “Family Pharmacy” from the benefit of medication management for patients with multiple chronic diseases.
This study investigated the correlation between antihypertensive medication and the effect of post-operative rehabilitation in elderly hypertensive patients. We performed a retrospective analysis of 158 elderly hypertensive patients receiving antihypertensive medication after surgery for femoral neck fracture in Takaoka City Hospital from April 2012 to March 2015. We divided the patients into three groups: 51 patients with systolic blood pressure (SBP) more than 121 mmHg at the end of rehabilitation in our hospital, 84 patients with SBP between 101 mmHg and 120 mmHg, and 23 patients (hypotensive group) with SBP lower than 100 mmHg. The better rehabilitation effect after surgery for femoral neck fracture was observed in the group of SBP more than 121 mmHg compared to the hypotensive group. In the hypotensive group, significant increase in the rate of hyponatraemia was observed, and the rate of taking-diuretics and blood-transfusion was highest. There was no significant difference in age, bodyweight and serum albumin level. These results suggest that avoiding excessive hypotension and hyponatraemia is important in elderly hypertensive patients taking diuretics in order to attain better rehabilitation effects after surgery for femoral neck fracture.
We investigated the preventive effect of extract containing metabolic products of Bacillus subtilis natto (NFE extract) on essential hypertension. The spontaneously hypertensive rat (SHR rat) and stroke-prone SHR rat (SHR-SP rat) were used in this study, and the NFE extract was administered by free drinking for 6-14 weeks of age (6, 7 weeks of age, 25 mL/day/rat; 8-14 weeks of age, 30 mL/day/rat). The administration of NFE extract did not affect the food intake and body weight in the WKY, SHR and SHR-SP rats. Significant changes in systolic (SBP) and diastolic (DBP) blood pressure levels between WKY rats administered with and without NFE extract were not observed for rats 6-14 weeks of age. On the other hand, the SBP and DBP in SHR and SHR-SP rats increased with aging, and the administration of NFE extract significantly attenuated the increased SBP, DBP in SHR and SHR-SP rats. In conclusion, the administration of NFE extract prevents increased blood pressure in SHR and SHR-SP rats. These findings provide significant information that can be used to design further studies aimed at elucidating the precise mechanism for decrease of blood pressure by NFE extract.
Information on the efficacy and safety of new medicine is limited because clinical trials are performed in a limited population. Thus, we evaluated Phase III trials and the pharmaceutical and medical device agency's review reports and risk management plans at Yokohama General Hospital. Moreover, pharmacists evaluated the patient applications for new medicine. We support appropriate pharmacotherapy to evaluate adopted medicines through these activities. Moreover, following the adoption of medicines at our hospital, we form criteria for prescribing high-risk medicines and support appropriate pharmacotherapy. In this study, we evaluated and supported the risk factors of sodium glucose cotransporter 2 (SGLT2)-inhibitors as dehydration (particularly in elderly patients for concomitant diuretic use), urinary tract infection, and genital infection for appropriate use. Furthermore, we developed criteria for prescribing SGLT2-inhibitors, at patient limited and evaluating adopted medicines. We established the endpoints of support by pharmacists as the rate of patient inclusion criteria and pharmacists' intervention for patient inclusion criteria. As a result, the rates of patient inclusion criteria were 43.3％ (8/17) and 53.3％ (8/15) patient limited and evaluating adopted medicines, respectively. After the pharmacists' intervention, SGLT2-inhibitor was not prescribed to one patient with a history of cerebral infarction and congestive heart failure. Furthermore, as a result of consultations and careful administration for fifteen patients by physicians and pharmacists, severe adverse events were not reported in these patients. We suggest that it was effective to support appropriate pharmacotherapy evaluation of adopted medicines and drug information and form criteria for appropriate use at our hospital.
Limited sharing of information occurs between hospitals and community pharmacies regarding outpatients receiving oral chemotherapy. We therefore developed the sharing system of patient information between hospital and community pharmacies using the monitoring sheet of tegafur/gimeracil/oteracil potassium (S-1). After October 2013, community pharmacies monitored adverse events in patients receiving S-1 using the monitoring sheet, and subsequently provided this information to our hospital by fax. A medical clerk entered the information into the electronic medical records, thus providing feedback to hospital physicians. In this study, we retrospectively investigated adverse events in outpatients who had received S-1 between September 2012 and October 2014. In total, sixty-seven patients were included in the study. The proportion of patients who experienced adverse events in the control group and the monitoring sheet group was 69.0％ and 76.0％, respectively. The proportion of patients who developed lacrimation in the control group and the monitoring sheet group was 11.9％ and 36.0％, respectively, which was statistically significant (P = 0.03). On the other hand, the proportion of patients who managed any adverse events in the control group and the monitoring sheet group was 45.2％ and 68.0％, respectively. The proportion of patients who managed lacrimation in the control group and the monitoring sheet group was 11.9％ and 32.0％, respectively, which was not statistically significant (P = 0.06). These results suggest that this sharing system contributed to the identification of adverse events induced by S-1, resulting in appropriate management for patients who developed these adverse events by hospital physicians and community pharmacists.
Although medical care is shifting from facility-completed to community-completed type, currently there is only a small number of pharmacists' participating in home medical care. This is due to problems in the participation system including; information inadequacy of the pharmacies available for home visit service (information discrepancy between submitted information and actual availability), inadequate recognition of pharmacists' roles and operations on home medical care, visible relationship building, etc. Therefore, we have established the promotion committee of home medical care and have taken various measures. At the committee, we have created a map of pharmacies supporting home medical care (with information of availability for home visit service and available area / time), construction and operation of a system for searching pharmacies with narcotics' inventory from drug names, preparation of information and documents necessary for participation, creation and distribution of a brochure for public relations of the home visiting pharmaceutical service, and improvement of the multidisciplinary cooperation through training sessions, etc. based on the results of a home medical care survey conducted in all the insurance pharmacies in the area. As a result, we have gained the recognition and understanding of the pharmacists' roles, etc. having led to an increase in the number of medical institutions available for home visit service and pharmacies participating in home medical care accordingly. We could establish a system by which pharmacists support home medical care by addressing various problems affecting pharmacists.
The World café is effective in classes and training courses as a new method for knowledge sharing in pharmaceutical education. However, the relationship between the usefulness and satisfaction of participants has not been adequately studied using a statistical model. We performed a clinical case study on the World café, and analyzed the results of the questionnaire. We found that a participant who experiences increased speaking opportunities thinks the World café is valuable, and such recognition improves their satisfaction rating of the World café.