著者
恩田 光子 今井 博久 春日 美香 安田 実央 下村 真美子 岡本 夏実 高田 百合菜 七海 陽子 田中 有香 荒川 行生
出版者
Japanese Society of Drug Informatics
雑誌
医薬品情報学 (ISSN:13451464)
巻号頁・発行日
vol.17, no.1, pp.21-33, 2015 (Released:2015-06-28)
参考文献数
37

Objective: To examine the effect of pharmacists’ visits to homebound patients on the elimination of unused drugs.Method: We conducted a survey with pharmacies throughout Japan that provided home-visit service, asking them questions regarding their work with up to five patients (the survey period was from January 15 through the end of February, 2013).  Main survey questions were: (1) whether they managed unused drugs since the start of their home-visit, and (2) how they managed the unused drugs.  For (2), we conducted case studies by asking the pharmacists to choose the case that impressed them most and describe the unused drugs involved, actions taken, and the results.Results: Data on 5,447 patients were collected from 1,890 pharmacies throughout Japan (collection rate: 56.9%).  Pharmacists managed unused drugs from 2,484 patients (45.6%). 1,746 patients (3,590 cases) were qualified for analysis.  In 2,332 cases (65.0%), pharmacist intervention eliminated the incidences of unused drugs.  In 782 cases (21.8%), unused drugs were discarded, while the number of drug administration days was adjusted in 2,623 cases (73.1%).  In 21 cases (0.6%), drugs were both discarded and had the number of days adjusted.  There were others for 164 cases (4.5%).  The total price of the eliminated unused drugs was approximately 6,920,000 yen (4,000 yen/person).  Illnesses that benefited most from the elimination of unused drugs were chronic respiratory failure (16,306 yen/person), and Parkinson’s disease (4,803 yen/person).Conclusion: We confirmed the economic effect of eliminating unused drugs by pharmacists’ home visits.
著者
恩田 光子 今井 博久 正野 貴子 高田 百合菜 藤井 真吾 七海 陽子 荒川 行生
出版者
一般社団法人 日本薬剤疫学会
雑誌
薬剤疫学 (ISSN:13420445)
巻号頁・発行日
vol.21, no.1, pp.1-11, 2016-08-31 (Released:2016-09-27)
参考文献数
25
被引用文献数
1

ほとんどの在宅療養患者には,複数の薬剤が処方されており,政府は薬剤師による在宅ケアへのさらなる参画を推進している.しかしながら,副作用(副作用の疑い)(Adverse Drug Reactions: 以下 ADRs)の発生に関する情報はほとんど存在しない.本研究の目的は,在宅療養患者における薬物治療に伴う ADRs の発生状況,ADRs との関連要因について明らかにすることである.調査対象は全国の保険薬局とし,当該薬局において訪問サービスを実施している薬剤師に対して,訪問対象患者に関する調査票への記入を依頼した.主な調査項目は,患者属性,内服薬の品目数,ADRs の有無とその具体的内容,訪問サービスに係る薬剤師の業務量とした.1,890薬局から5,447人分の患者データを収集した結果,薬剤師が訪問時に ADRs を発見した患者割合は14.4%であった.10件以上報告された ADRs は12症状分類で全体の85.2%を占め,上位5症状分類は,めまい・ふらつき・立ちくらみ等,消化器障害,臨床検査値異常,意識障害,皮膚症状であった.被疑薬は,上位12症状分類のうち7症状分類において,催眠鎮静剤・抗不安剤,精神神経用剤,その他の中枢神経系用薬のいずれかが被疑薬の上位3項目に含まれていた.また,ADRs との関連要因として,患者の性別,居住形態,内服薬の品目数等が抽出された.日本の在宅医療における ADRs の割合は,諸外国と比較し大差はないが,被疑薬に占める中枢神経系用薬の割合が高いことが示唆された.また,ADRs の発生と多剤併用の関連も実証されたことから,医師と薬剤師の協働による中枢神経系用薬の減薬に取り組む必要がある.
著者
恩田 光子 今井 博久 七海 陽子 平野 章光 藤井 真吾 荒川 行生
出版者
公益社団法人 日本薬学会
雑誌
YAKUGAKU ZASSHI (ISSN:00316903)
巻号頁・発行日
vol.135, no.3, pp.519-527, 2015 (Released:2015-03-01)
参考文献数
18
被引用文献数
2 1

A nationwide survey was conducted to verify relations between the workload of home-visiting service by community pharmacists and outcomes. Data were collected on 5447 patients from 1890 pharmacies. Most (61.9%) pharmacists visited patients' homes twice monthly, spending there a net average of 20.6 work minutes. At the time of the survey, 29.8% of the patients had improvement of adherence compared with at start of home visits; 65.5% had no change, and 1.4% had gotten worse. Similarly, 41.6% had decreased unused medications, 54.4% had no change, and 2.3% had increased. Home-visiting pharmacists found adverse drug events (ADEs) caused by drug administration in 14.4% of their patients. They dealt with 44.2% of these cases by discontinuing administration of the responsible drug, 24.5% by reducing the dosage, and 18.3% by changing drugs, with a total of 88.1% having been improved. Prescription changes intended to correct problems occurred in 37.1% of the patients. In patients whom the pharmacists visited more often, a higher percent had ADEs, had their prescription changed to correct problems, and had improved adherence and unused medications. The average actual work time was longer in patients whose outcomes improved than in those whose outcomes did not. A higher involvement in homecare by pharmacists was found to improve outcomes of drug treatment.
著者
七海 陽子 恩田 光子 坪田 賢一 田中 理恵 向井 裕亮 的場 俊哉 田中 有香 荒川 行生
出版者
公益社団法人 日本薬学会
雑誌
YAKUGAKU ZASSHI (ISSN:00316903)
巻号頁・発行日
vol.135, no.9, pp.1057-1067, 2015 (Released:2015-09-01)
参考文献数
24
被引用文献数
4

In Japan the prevalence of dementia has increased considerably, and pharmacists are involved in addressing these patients' medication-related problems. Here, we determined whether pharmacists' comprehensive assessment of medication profiles could reduce the burden of dementia patients' medication-related problems. In this historical cohort study 120 community pharmacies were randomly selected, and participating pharmacists completed questionnaires concerning comprehensive assessment of patient medication profiles, using a “start” questionnaire for patients prescribed medication prior to or during the study period and a “follow-up” questionnaire for patients who subsequently visited pharmacies for prescriptions. Numbers and details of problems and solutions implemented by pharmacists and identified in the start and follow-up questionnaires were compared. Changes in start and follow-up scores were also compared between patients whose problems were identified by pharmacists (identified group) and those whose problems were not (non-identified group). Data were collected for 349 patients issued medication by 60 pharmacies. The most common medication-related problems identified in the start survey were key person's understanding of donepezil (60 cases) and other dementia treatments (60 cases), and adherence to treatment (53 cases). Solutions implemented by pharmacists included gathering information regarding drug administration and dementia awareness from the key person and providing pharmaceutical counseling and instruction. Subsequently, problems related to understanding of dementia treatment, understanding donepezil, and adherence were resolved by 70.0%, 65.0%, and 58.5%, respectively. Pharmacists' comprehensive assessment of medication profiles could effectively solve dementia patients' medication-related problems.