Despite the demand for pharmacists' active participation in home medical care and cooperation with other professionals, their role in home medical care is not properly understood by other professionals. This study qualitatively analyzed the opinions of other professionals about their perceived need to cooperate with pharmacists.

A semi-structured interview was conducted involving 4 visiting nurses and 2 certified care workers providing home medical care services in Aichi Prefecture, and the obtained data were qualitatively analyzed using a grounded theory approach.

As medication management of patients at home was difficult due to not only patients' physical factors, but also emotional and social factors, as well as living, environmental, and institutional factors, the ability to care for such patients is essential. Home medication management was performed mainly by care workers, nurses, and pharmacists; however, a difference in the attitude of sharing information with pharmacists was observed between care workers and nurses. Thus, pharmacists must consider emotional barriers, such as concerns and hesitations towards pharmaceutical knowledge among other professionals, as well as emotional conflicts over the overlap of professional domains in the management of medications. Also, since home medical care is provided in the patient's personal domain, excessive emphasis is often placed on the patient's and family's intentions. It is, therefore, important that pharmacists acquire the ability to endure emotional difficulties and dissonance caused by the patient's rejection of professional involvement, and learn and develop an attitude to accept the feelings of patients and their families.

Recent reports have indicated that proton pump inhibitor (PPI) use affects serum magnesium levels, however few studies have investigated the relationship between PPI use and magnesium levels in peritoneal dialysis patients. This study aimed to clarify the association between PPI use and serum magnesium levels in peritoneal dialysis patients. We retrospectively reviewed the records of 27 patients who had received peritoneal dialysis in stable condition at the Aichi Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kainan Hospital between August 2017 and July 2018. We defined hypomagnesemia as a value < 2.0 mg/dL, and they were divided into hypomagnesemia (n = 19) and non-hypomagnesemia (n = 8) groups according to the serum magnesium level. A comparison of the patient backgrounds in the two groups revealed significant differences in the serum magnesium levels and administration of PPI. Multiple logistic regression analysis showed that the administration of PPI (odds ratio: 8.50, 95％ confidence interval: 1.13-63.87, P = 0.038) was significantly related to hypomagnesemia. Therefore, the administration of PPI is a risk factor for the development of hypomagnesemia in peritoneal dialysis patients and should be used with caution, such as by monitoring serum magnesium for administration.

Prescription queries are essential for appropriate pharmacotherapy even though they impose additional work upon healthcare providers and increase the waiting time for out-patients. We developed a 10-item institutional decision support protocol that enables pharmacists in our hospital to change out-patient prescriptions when prescription queries were provided from community pharmacies. All prescription queries from community pharmacies were managed by pharmacists in our hospital. If the prescription queries fit the protocol, hospital pharmacists would assess the prescriptions based on drug information and other available information from the electronic medical record system. These pharmacists then replied that the prescriptions could be changed and provided information to physicians about the revised prescriptions. To evaluate the protocol, we analyzed the records of prescription queries from community pharmacies regarding out-patient prescriptions both before and after 4 weeks developing the protocol. After protocol development, 17.9％ (88/492) of prescription queries were changed by hospital pharmacists based on the protocol. The ratio of prescription queries requiring more than 10 minutes to complete was markedly reduced from 13.5％ (10/74) to 0％ (0/71). The majority (76.6％, 85/111) of community pharmacies that provided prescription queries were located 6 km or more from our hospital. These results suggest that our institutional decision support protocol was useful in reducing the workload for pharmacists and physicians, as well as decreasing waiting times for out-patients, without disturbing the effectiveness and safety of pharmacotherapy. In addition, this protocol-based pharmacotherapy management was applicable to prescription queries from community pharmacies located over a wide area.

STROMECTOL^® Tablets (ivermectin), an oral scabicide, is often administered to patients as a simple suspension via a feeding tube. However, other studies have reported that this method reduces the dose of ivermectin by 10-50％ compared to that associated with oral administration. There are several devices used for administration via a feeding tube. This study proposes appropriate devices for such administration. First, we compared the recovery ratio of ivermectin by different 6 devices (a syringe, an oral dispenser, a small cup, kendakun, a suspension bottle and a quick bag). Among them, the results showed that the recovery ratio of the oral dispenser, suspension bottle, and quick bag was 100％ after flush operation. Next, we conducted a questionnaire survey of 10 students to evaluate the usefulness of the six devices. The result showed that the suspension bottle or quick bag was easiest to use but the suspension bottle required attention regarding back flow. In addition, the cost of the suspension bottle was the lowest, the dispenser was the highest. The usefulness test is limited because it is targeted at students. When administering STROMECTOL^® Tablets via a tube, the entire volume could be administered without any loss by flushing using a suspension bottle or a quick bag and setting the angle of administration directly underneath.

The family pharmacist system was established in 2016. Although community pharmacists are required to comprehensively manage patients' medication, they sometimes find it difficult to understand each patient's information in detail. From June 2016, we started providing pharmaceutical summaries about each patient to community pharmacies, which included information about the following items: newly started and discontinued drugs, any adverse effects and drug allergies, any warnings about the patient's medication, and the patient's medication history during their hospitalization. Each summary was taken to the relevant community pharmacy by the patient after discharge. In this study, we conducted a survey of community pharmacies in December 2016. We sent a questionnaire about pharmaceutical summaries to community pharmacies, and the response rate was 63.3％ (57/90). As a result, 100％ of pharmacies that did not receive a summary answered, “The summaries will act as references for pharmaceutical management”, and 96％ of pharmacies that did receive summaries answered, “The summaries have helped with pharmaceutical management”. Forty-eight percent of pharmacies that did not receive a summary answered, “The summaries will provide community pharmacists with the chance to become family pharmacists”. However, only 27％ of pharmacies that did receive summaries answered, “The summaries provided community pharmacists with the chance to become family pharmacists”. This suggests that the summaries helped community pharmacists to understand patients' information. Although such pharmaceutical summaries have the potential to facilitate the development of the family pharmacist system, we have to provide them more efficiently.

To clarify the knowledge and awareness of hemorrhoids per se and the therapeutic behavior in consumers, we conducted a survey with 60,000 consumers in Japan. The survey items included demographic characteristics (age and sex), knowledge and awareness of hemorrhoids per se and the therapeutic behavior, such as ambulant treatment and over-the-counter (OTC) medicine usage.

The survey result showed that the proportion of consumers having subjective hemorrhoidal symptoms is 10.0％, which consists of anal fissure (41.2％), external hemorrhoids (33.1％), internal hemorrhoids (26.8％), anal fistula (4.0％), and don't-know (18.8％) and that 25.5％ has prior experience with hemorrhoids. Importantly, 19.8％ possessing hemorrhoid-related symptoms in the population had no awareness of hemorrhoids. Of note, 72.6％ of consumers with subjective hemorrhoidal symptoms utilized neither the ambulant treatment nor OTC medicine, because many of them had shame, anxiety, and inadequate knowledge of hemorrhoids and the applicable therapy. In fact, there were few consumers who understood the existence and characteristic symptoms of three types of hemorrhoids. These findings indicate the need to engage in educational activities on hemorrhoids and applicable therapeutic drugs by offering accurate information from the perspective of pharmaceutical companies.

Low-dose estrogen-progestin (LEP) has been shown to reduce the severity of dysmenorrhea symptoms. Its use has been approved for dysmenorrhea management in Japan. The majority of patients undergoing LEP treatment are young. Therefore, side effect management is extremely important. We aimed to determine the status of actual adverse reactions to LEP using national public databases.

Data from the Japanese Adverse Drug Event Report (JADER: April 2004-September 2016) database and the Information on the Decision on Payment/non-payment of Adverse Reaction Relief Benefits (April 2004-September 2016) were downloaded from the website of the Pharmaceuticals and Medical Devices Agency.

The number of reports on LEP-related adverse events in the JADER was 1,449 (920 cases [63.5％] of thromboembolism, 85 cases [5.9％] of bleeding, 48 cases [3.2％] of liver function disorder, and 43 cases [3.0％] of malignant tumors). The reporting odds ratio (95％ confidence interval) of LEP associated with thromboembolism was 52.9 (46.7-59.8). The incidence of thromboembolic events increased with an increase in age. The proportion of severe cases did not differ between individuals aged 30 years and those aged ≧40 years. Thromboembolism occurred within 90 days in many cases. There were 136 requests for the involvement of the relief system, among which 125 (91.9％) received payment.

This study clarified the occurrence of LEP-related adverse events and relief system usage. As the number of adverse events reported exceeded the number of relief systems available, it is conceivable that this system is not completely utilized.