We developed a home pharmaceutical management evaluation criteria list to evaluate pharmacy services in home care, and analyzed the relationship between home care services and the level of burden on pharmacists. The list consisted of 4 domains (37 sub-domains): dispensing (5), home visits (3), interprofessional collaboration (4), and patient management (25). Using this list, we assessed 224 patients receiving home care and using a pharmacy in Aichi Prefecture based on their medication records. Among dispensing-related subscales, “number of prescribed drugs”, “special treatment materials”, “duration of dispensing”, “opioid medications”, and “sterile dispensing” were correlated with the level of burden on pharmacists. Additionally, “availability of service after midnight/on holidays” and “actual workload” as home visits-related subscales, and “pre-discharge conferences”, “inquiries from other professionals”, and “sending reports” as interprofessional collaboration-related subscales increased the level of burden on pharmacists. As for patient management, “care grade” and “cognitive function” representing physical conditions did not increase the level of burden on pharmacists, whereas “malignant tumors” and “nutritional status” did.
In recent years, supplements have been sold widely in drug stores and online, but caution needs to be exercised with regard to their interactions with pharmaceutical agents. We provided advice and information on interactions between pharmaceutical agents and supplements to health insurance pharmacy customers who wanted them, using the Natural Medicines Database (NMDB). We then conducted a questionnaire survey between May 15 and June 15, 2020 of 125 people who received consultations based on the NMDB. Interactions that required special attention were discovered in 10 people (8%), and appropriate guidance was given. The questionnaire survey revealed that 48.3% of all respondents used supplements, while 65.3% said that they wanted to check for interactions. This suggests a certain need for pharmacy customers to check interactions between pharmaceutical agents and supplements, and that providing accurate information using the NMDB or other databases may lead to functional improvements at pharmacies.
Here, we report a case in which a home – visit pharmacist observed the adverse effects of drugs in a patient with lifestyle – related diseases and heart failure. In April 2018, we evaluated the relationship between side effects of drugs that require particularly careful administration and chief complaints in a 85-year-old female patient. The results indicated the presence of insomnia, knee pain, early morning hypertension, loss of appetite, bradycardia, and edema of the lower limbs. The blood digoxin concentration was in the toxic range, systolic blood pressure (SBP) was 160–200 mmHg, and the heart rate (HR) was 40–50 bpm. We suggested discontinuation to the physician, who accepted the proposal. In May 2018, SBP decreased to 120–130 mmHg, HR was to 60–70 bpm, and the appetite returned to normal. In August 2018, tachycardia (110 bpm) occurred and therefore verapamil was administered additionally. The pharmacist provided information regarding the state of breath sounds, lower limb edema, body weight, blood pressure, and HR. to the physician. As a result, tachycardia disappeared and loxoprofen was discontinued. Since evaluation of potential side effects is difficult for non-medical caregivers, it is important for pharmacists to intervene and provide information to physicians.
The pharmacists have examined how to improve defecation control of the elderly patients who are more than 65 years old and are not able to control their defecation well in cooperation with the doctors and the staff members of the long term care bed since April, 2018. We made use of an algorithm for choosing a therapeutic agent for constipation of this hospital for the 13 elderly patients who are not able to control their defecation well. As a result, the order of choosing a therapeutic agent for constipation became easy to understand. Now we can suggest to the doctors when to change therapeutic agent for constipation and how much should they administer based on the number of days of defecation in a week and the evaluation of bristol stool form scale. And we combined linaclotide or elobixibat with Japanese herbal medicine, and administered it as the therapeutic agent for constipation. As a result, both the average number of days of defecation in a week and the center numerical value of bristol stool form scale in a week have improved more than administering magnesium oxide or irritative purgative.
The same result was obtained in the case of 11 patients who were administered for more than 24 weeks. We could show that it was useful for pharmacists to participate in defecation control of the elderly patients positively in cooperation with many kinds of professions in order to choose a suitable therapeutic agent for constipation and to improve defecation control.