Polypharmacy listed in the prescription review process in the Guidelines for “the Proper Use of Drugs by the Elderly”, issued by the Ministry of Health, Labor and Welfare, has factors such as number of drugs, poor adherence and a large number of prescription medical institutions and so on. Since hospitalization is often short in acute care hospitals, it is necessary to evaluate the patient’s background and these factors in a short period to optimize prescriptions, so we analyzed the association with factors such as polypharmacy factors of the prescription optimization requiring reduction of the drug to extract the factors of concern. According to the comparative analysis results of the reduced-dose group of 76 patients and the non-reduced-drug group of 136 patients, there was no significant difference in “late elderly” and “oral administration of five or more drugs” and so on, but there were significant differences in “duplicate drugs” (p=0.012), “complicated regimens” (p=0.016), and “poor adherence” (p=0.005). This study suggested that intervening in the prescribing of patients with factors that are highly relevant to the need for drug reduction contributes to improving the work efficiency of pharmacists in acute care hospitals.

Objective: The act of adding a color line to a packaged paper, such as a red line after breakfast, has its own color scheme at each pharmacy/hospital. When patients must change doctors or pharmacists for reasons such as moving or a natural disaster, they may wind up taking the wrong medication because of the coloring pattern being different from before. We therefore conducted a survey concerning the coloring pattern for pouches of one-dose packages. Method: We conducted a survey via an online questionnaire for pharmacists from May 16 to 22, 2018. This survey was approved by the Ethics Review Board at Nagasaki Pharmaceutical Association (Chorinyaku 29-7). Results: Among 77 responses, 54.5% (n=42) set coloring rules according to the dosage. The most frequently used colors were red for after breakfast, yellow for after lunch, blue for after dinner and black for before going to bed. The questionnaire showed that 66.2% (n=51) favored unifying the coloring pattern, while 15.6% (n=12) were against such efforts. Discussion: Incidents have occurred due to a lack of a unified coloring pattern, and the number in favor of unifying the pattern was greater than that against. We thus concluded that unifying the coloring pattern is desirable.

The medication errors may be caused by excess caregiving workload due to shortage of caregivers. To improve safety of elderly pharmacotherapy, the medication support workload was investigated and simulated by changing medication timing. The medication support workload was investigated from the number of medication and caregiver at breakfast, lunch, evening meal and bedtime in an elderly facility. We simulated the workload associated with changing medication timing. There was 51 residents who received medication support in the elderly facility. The total number of daily medications was 191, 48, 120 and 33 at breakfast, lunch, evening meal and bedtime, respectively. The mean number of medication supporter was 2, 3, 3.2 and 3 at breakfast, lunch, evening meal and bedtime, respectively. Fifty four formulations administered once daily at breakfast have not been specified medication timing on package inserts. If these 54 formulations are administered at lunch time, the number of medication will be changed from 191 to 117 at breakfast and 48 to 122 at lunch. The medication support workload of a caregiver will be changed from 95.5 to 59.0 medications (25 to 20 residents) and 16.0 to 40.3 medications (8.7 to 12 residents) at breakfast and lunch, respectively.

The medication support workload of a caregiver was highest at breakfast time in a day. Changing the medication timing of once daily formulation from breakfast to lunch time can level the medication support workload of a caregiver in a day.

We analyzed the anthropometric parameters affecting the onset of diabetes in the general population with hemoglobin (Hb) A1c as an index, and examined the relationship between gender differences and the measured parameters. In this study, body mass index (BMI), systolic blood pressure, diastolic blood pressure, visceral fat area, body fat percentage, muscle mass, bone density, young adult average value of bone density, HbA1c, and lipid levels were analyzed by sex. A multiple linear regression analysis using HbA1c as an objective variable on 255 subjects (94 men and 161 women) showed a significant positive correlation for age and BMI in both sexes. Moreover, diastolic blood pressure and LDL-cholesterol (LDL) levels were significantly negatively correlated in women. Furthermore, with HbA1c as the objective variable, a regression analysis was performed in which the interaction age or BMI and the other parameters was added to the model in both sexes. In men, the interaction between age and body fat percentage or visceral fat area was observed, and in women, the interaction between age and LDL levels was observed. A simple slope analysis of the interaction between men and visceral fat area and body fat percentage showed a positive correlation in both the elderly and younger groups, and an interaction between women and LDL showed a negative correlation in the elderly groups. These results indicate that age and BMI were involved in HbA1c elevation in both sexes.

Background: Crohn’s disease (CD) is an idiopathic inflammatory disease that causes discontinuous chronic granulomatous inflammation and other symptoms in the entire gastrointestinal tract. It is treated mainly internally; however, systemic side effects of drugs such as steroids can become an issue and interfere with continued treatment. Budesonide sustained-release products that have low systemic bioavailability exhibit high therapeutic efficacy and low side effects. There is little evidence that budesonide has been used in Japan. Objective: The purpose of this study was to identify and characterize concomitant medications and laboratory tests in patients using budesonide extended-release products. Methods: Fifty-one patients diagnosed with CD and prescribed with budesonide sustained-release products were identified in the JMDC Claims Database between November 2016 and June 30, 2017, and were selected for the study. Results and Discussion: Patients using budesonide extended-release formulations consumed lower amounts of 5-ASA and PSL compared to those who did not use budesonide before consuming 5-ASA and PSL. Data indicated that changes in treatment were made due to the ineffectiveness of other drugs. Also, among patients with a risk of HBV reactivation (N=41), the frequency of relevant antibody testing was low (N=17), thereby indicating a possible lack of appropriate testing for treatment selection.

In order to ensure patient safety, pharmacists need to encourage patients to take all their prescriptions to one pharmacy. Implementation of the Family Pharmacist System, which is an institutionalization of this approach, is a step in this direction and patient behavior has been investigated ever since the system was adopted. However, till date, no study has investigated behavioral changes through follow up of the same patient. Therefore, in this internet-based study, we obtained patients’ responses to 12 questions including those concerning the centralization of prescriptions and presentation of medication diaries to investigate the behavioral changes in the individual patients before and after the adoption of the Family Pharmacist System. Responses from a total of 2,291 patients were analyzed. Among all the patients, the biggest behavioral change was observed regarding the centralization of prescriptions, which increased from 27.3% to 35.4%. The next biggest change concerned the presentation of medication diaries, which increased from 74.2% to 77.0% after adoption of the Family Pharmacist System. Responses to other questions indicated an increase of less than 1.6%. These results suggest that awareness regarding the Family Pharmacist System may improve the rates of centralization of prescriptions and presentation of medication diaries.

To provide safe pharmacotherapy, pharmacists are required to interview patients to obtain relevant information. However, some ordinary citizens resent being interviewed by community pharmacists; thus, it is necessary to increase patient understanding of the process. In this study, we focused on pharmacy inquiries based on patient interviews and attempted to evaluate the current situation and contribution to patient safety. We used inquiry data from a community pharmacy nearby Hokkaido University Hospital. Pharmacy inquiries based on “patient interviews” accounted for 33.3% of the all pharmacy inquiries, showed a high permission proportion (98.5%), and contributed greatly to patient safety with respect to “usage and dosage.” Further, it was confirmed that pharmacy inquiries based on the information that “the explanation from the doctor and the actual prescription are inconsistent” indicated a contribution to patient safety. Our findings provide a preliminary evidence for a large-scale survey on the usefulness of pharmacy inquiries based on “patient interviews”.

In hemodialysis outpatients, it is important to control serum phosphorus levels in the target range by meal management and hyperphosphatemia drugs. However, information is limited about the patients’ backgrounds involving  in the poor control of serum phosphorus levels. In this study, we performed a survey about the effects of patient age, gender, and diabetes mellitus on the control of serum phosphorus levels in hemodialysis outpatients at Sapporo Minami Ichijo Hospital. We also investigated the prescription and the cost of hyperphosphatemia drugs in the patients with poorly-controlled serum phosphorus levels. There was a tendency that serum phosphorus levels became greater than the target level in male patients with lower age and in patients with diabetes mellitus. Moreover, the concomitant use of expensive hyperphosphatemia drugs was more remarkable in the patients with poorly-controlled serum phosphorus levels than in well-controlled patients. This leaded to the significant increase in the cost of hyperphosphatemia drugs. A likely reason for inappropriate serum phosphorus levels in these hemodialysis outpatients was poor medication adherence in taking hyperphosphatemia drugs. Accordingly, the improvement of medication adherence through more active intervention by pharmacists is essential for controlling serum phosphorus levels appropriately and for reducing drug costs in hemodialysis outpatients.

Summary: A survey was conducted to reveal the changes in awareness regarding infection prevention before and after COVID-19 infection. Hand washing habits were followed by 97.6% of respondents before the spread of COVID-19 and increased by 0.7% to 98.3% after (Hand washing with water + Hand washing with soap; 13.0% + 85.3%). The habit of hand disinfection among respondents markedly increased from 52.7% before the spread of the virus to 81.0% after (p<0.01). And most respondents could not answer correctly regarding infection prevention for ‘parts of hand disinfected’ or ‘parts of hand washed’ or ‘duration of hand washing’, etc. In terms of education/training on infection prevention, particularly, hand washing and hand disinfection, in Japan, 71.3% ‘did not receive education/training’ on ‘hand washing’ and 82.3% ‘did not receive education/ training’ on ‘hand disinfection’. A total of 47.7% of the respondents wanted to receive education/training regarding the methods and effects of infection prevention from healthcare professionals. Of these, only 21.7% wanted to receive education/training from pharmacists. Pharmacist should show own roles by voluntarily utilizing own knowledge such as public health and contributing to the community and might need to provide patients or citizen with infection prevention education at community pharmacies and drugstores.

To investigate citizens’ awareness regarding medical cosmetic therapy and the related needs of pharmacists, a web-based survey of 200 individuals was conducted. Only 16% of respondents knew about medical cosmetic therapy. However, 31.5% of respondents said they wished to apply medical cosmetic therapy if they became ill. A total 26.5% of respondents stated that they wanted a pharmacist to be involved with respect to cosmetic ingredients, effects, and allergies. The needs of pharmacists for medical cosmetic therapy are currently low. However, if the role of pharmacists in home medical care and community-based health care were to increase in the future, there is a considerable opportunity for these professional to become involved in medical cosmetic therapy as another role in improving quality of life of their patients.