A Survey on Medicine Adoption and Appropriate Use in Hospitals in 2020 / 医薬品情報学

Objective: This study conducted a survey of the status of medicine adoption and appropriate use in hospitals. We compared the findings with 2015 survey results to evaluate the changes over time. We also evaluated the impact of changes in the current health care environment, including local community collaboration and the COVID-19 pandemic.Methods: The survey included 500 randomly selected hospitals with more than 200 beds, over 50% of which are general ward beds, as well as 175 hospitals that were randomly selected from the respondents of the 2015 survey. The survey questionnaire included the number of medicines, availability of medication lists, adoption decisions, and impacts of local collaboration efforts and the COVID-19 pandemic on drug adoption and appropriate use.Results: A total of 260 responses were collected from 675 hospitals (39% response rate). Of the 260 respondents, 90 were regional medical care support hospitals, 23 were special functioning hospitals, 143 were general hospitals other than those specified, and 4 were other hospital types. The average number of adopted medicines was 644 for oral medicines, 234 for topical medicines, and 228 for injectable medicines. Ninety-five percent of the hospitals used package inserts or interview forms when adopting medicines, but 15% used original articles. About 36% of the hospitals used standardized methods (hospital formulary management or protocol-based pharmacotherapy management), indicating a lack of pharmacists with pharmaceutical evaluation skills. As for local community collaboration regarding adopted medicines, the most common example was providing information to community pharmacists’ associations, and the most common method was sending information by e-mail, regardless of the hospital type. Regional collaboration meetings were few. The COVID-19 pandemic changed the method of obtaining drug information from pharmaceutical companies.Conclusion: For hospital pharmacists, the selection of adopted medicines is one of the tasks of pharmaceutical management. There are urgent needs for the use of standardized methods and the training of pharmacists involved in the selection of adopted medicines. The establishment of a system to provide appropriate use of medicine to patients by standardizing the method of medicine adoption and information sharing is desirable.

Validation of Epidemiological Methods for Studying the Infection Risk in Rheumatoid Arthritis with Methotrexate Combined Biologicals using Propensity Scores / 薬剤疫学

Objective：In epidemiological studies, changes in patient conditions caused by treatment would be chronologically repeated. Thus, the manner of representing this change can create time-dependent bias which researchers should address. In this study, we aimed to validate the estimators obtained using various epidemiological methods based on the infection risk between the administration of methotrexate (MTX) alone and MTX combined biologicals.Design：Cohort studyMethods：We extracted data regarding 3769 rheumatoid arthritis (RA) patients, consisting of 2805 patients with MTX alone and 964 patients with MTX combined biologicals from the claims data from JMDC Inc.. We represented each time course using the time axis of the elapsed time, the prescription number, and the administration time to make the corresponding data set. Subsequently, we performed time-conditional propensity score (PS) matching for matched points in each time axis. We also performed Inverse Probability Weighting Estimator (IPW) and Augmented Inverse Probability Weighting Estimator (AIPW) analyses.Results：The Odds Ratios (OR) estimated by each method using the time axis of the elapsed time, the prescription number, and the administration time were 1.48 (95％CI 0.71-3.11), 1.60 (95％CI 0.72-3.55), and 1.04 (95％CI 0.58-1.86), respectively. We performed PS weighting, of each Average Treatment Effect obtained from IPW, and the AIPW were estimated to be 0.31％ (95％CI −0.91-1.53) and 0.29％ (95％CI −0.91-1.49), respectively, and the average treatment effect on the treated was estimated to be 0.10％ (95％CI −1.11-1.32). We support the findings of a previous study which showed that the combination of biologicals was not statistically associated with increased infection risk.Conclusion：This study suggests that estimators from different perspectives might be obtained by using some epidemiological methods. Therefore, our results could contribute to the establishment of an improved methodology.

Validation of Epidemiological Methods for Studying the Infection Risk in Rheumatoid Arthritis with Methotrexate Combined Biologicals using Propensity Scores / 薬剤疫学

Objective：In epidemiological studies, changes in patient conditions caused by treatment would be chronologically repeated. Thus, the manner of representing this change can create time-dependent bias which researchers should address. In this study, we aimed to validate the estimators obtained using various epidemiological methods based on the infection risk between the administration of methotrexate (MTX) alone and MTX combined biologicals.Design：Cohort studyMethods：We extracted data regarding 3769 rheumatoid arthritis (RA) patients, consisting of 2805 patients with MTX alone and 964 patients with MTX combined biologicals from the claims data from JMDC Inc.. We represented each time course using the time axis of the elapsed time, the prescription number, and the administration time to make the corresponding data set. Subsequently, we performed time-conditional propensity score (PS) matching for matched points in each time axis. We also performed Inverse Probability Weighting Estimator (IPW) and Augmented Inverse Probability Weighting Estimator (AIPW) analyses.Results：The Odds Ratios (OR) estimated by each method using the time axis of the elapsed time, the prescription number, and the administration time were 1.48 (95％CI 0.71-3.11), 1.60 (95％CI 0.72-3.55), and 1.04 (95％CI 0.58-1.86), respectively. We performed PS weighting, of each Average Treatment Effect obtained from IPW, and the AIPW were estimated to be 0.31％ (95％CI −0.91-1.53) and 0.29％ (95％CI −0.91-1.49), respectively, and the average treatment effect on the treated was estimated to be 0.10％ (95％CI −1.11-1.32). We support the findings of a previous study which showed that the combination of biologicals was not statistically associated with increased infection risk.Conclusion：This study suggests that estimators from different perspectives might be obtained by using some epidemiological methods. Therefore, our results could contribute to the establishment of an improved methodology.

A Questionnaire Survey on Economic Evaluation of Pharmaceutical Care in Schools of Pharmacy / 社会薬学

In Japan, the model core curriculum for pharmacy education was revised in 2013 and a topic related to pharmacoeconomics was added. A questionnaire survey was conducted to clarify the current situation of teaching this topic in schools of pharmacy. In an annual meeting of social pharmacy education in October 2017, a purpose this survey was explained and asked someone who had taught this topic in each school to answer questions. A total of 61 schools responded by mails or e-mails among 74 schools across Japan (82.4% response rate). About 68% of schools, the topic was taught as a part of required subjects. Main keywords related to analytical methods such as cost-effectiveness, ICER, and QALY were covered at 90% and over of all schools. However, utilization for healthcare decision making process was rarely discussed with case analysis (21.6%). Only limited schools answered that they included keywords of HTA and guideline. More than 90% of schools showed that preparation of syllabus and slides for the lecture was helpful. The survey indicated that contents taught in each school differed across schools and an appropriate educational tool would be required to standardize way of teaching under the core curriculum requirements.

Task Force Report on the Validation of Diagnosis Codes and Other Outcome Definitions in the Japanese Receipt Data / 薬剤疫学

Although the recent revision of the ministerial ordinance on Good Post-marketing Study Practice (GPSP) included the utilization of medical information databases for post-marketing surveillance, there has been limited research on the validity of diagnosis codes and other outcome definitions in Japanese databases such as administrative claims (“receipt”) database. This task force proposed how to conduct good validations studies, based on the narrative review on around 100 published papers around the world. The established check list consists of ： (ⅰ) understanding the type of the database (e.g. administrative claims data, electronic health records, disease registry) ； (ii) understanding the setting of the validation study (e.g. “population-based” or not) ； (iii) defining the study outcome ； (iv) determining the way of linkage between databases ； (v) defining the gold standard ； (vi) selecting the sampling method (e.g. using the information of all patients in the database or a hospital, random sampling from all patients, random sampling from patients satisfying the outcome definition, random sampling from patients satisfying and not satisfying the outcome definition, “all possible cases” method) and sample size ； (vii) calculating the measures of validity (e.g. sensitivity, specificity, positive predictive value, negative predictive value) ； and (viii) discussing how to use the result for future studies. In current Japan, where the linkage between databases is logistically and legally difficult, most validation studies would to be conducted on a hospital basis. In such a situation, detailed description of hospital and patient characteristics is important to discuss the generalizability of the validation study result to the entire database. This report is expected to encourage and help to conduct appropriate validation studies.

The Relation between a Class on Preventing Drug Abuse and Students’ Conversations after the Class / 社会薬学

Introduction: Education for preventing drug abuse for younger generations is important in both local schools and families. However, owing to their sensitive nature, drug abuse issues are difficult to discuss outside school. This study explored the association between a class that provided guest lectures on preventing drug abuse and students’ conversations on drug abuse issues with their family and/or friends on that topic. Methods: We held a 30-minute class as visiting lecturers, speaking with students in grades 4-6 at an elementary school in Tokyo. We also conducted a cross-sectional questionnaire before and after the class. The questionnaire focused on whether the students spoke with anyone on the topic, with whom they spoke, and what were the topics of such discussions. Results: Answers were obtained from 127 students. Before the class, 30 students (24%) reported having engaged in some form of conversation on the topic. After the class within five days, 56 students (44%) reported having such conversations (P<0.05). The greatest number of students spoke with their mothers after the class, and mainly about the class itself. Discussion: The class therefore may have encouraged their conversations outside school on drug issues. Conducting education in elementary schools on preventing drug abuse is likely to create communication opportunities with family members on this topic.

Experience of the “Anti-Tobacco, Alcohol and Drug Abuse Education” in Primary School / 社会薬学

Introduction: A new role for community pharmacists is to perform educational activities related to tobacco, alcohol, and drug abuse. It is important to consider schoolchildren and provide classes targeted to this age group. However, it is difficult for community pharmacists to provide these classes for students because they have few chances to gauge what students understand. Therefore, we explored a better way for community pharmacists to deliver their classes. Methods: We provided a “drug safety” class, which encouraged 9-12-year-old students at primary school to resist tobacco, alcohol, and drug abuse. To prepare for the class, we held several discussions with the primary school teachers. We incorporated their advice and comments into our slides and skit for the class. Their points and our process of preparation for the class are shown. Results: Three important points were identified in our discussions with the teachers. I. We should consider delivering an interactive class for the children, so they could participate in a skit and quizzes, instead of a one-sided talk from the teacher. II. We should use pictures and examples that are visually simple for children. III. We should take parents who smoke and drink into consideration. Discussion: There is an increase in opportunities for community pharmacists to contribute to classes about tobacco, alcohol, and drug abuse at schools because of the importance of encouraging children to resist tobacco, alcohol, and drug abuse. It is important for pharmacists to consult with teachers to recognize the needs of students in their classes. The community pharmacists could then ensure their classes met the school and schoolteachers’ needs by using their experience in educational activities.

New Directions for the Brown Bag Program, Identified from the UK’s Experience of Advanced Pharmacist Services / 医薬品情報学

<b>Objective: </b>The Brown Bag program is a drug use review service conducted by community pharmacists.  To improve this program for promoting appropriate drug use, we studied the Medicine Use Review (MUR) program introduced in the UK in 2005, which is similar to the Brown Bag program.<br><b>Methods: </b>First, we obtained data through an internet-based search on MUR, which included data on the skills and accreditation required by pharmacists for conducting this program, the conditions required in pharmacies, the target patient groups, and financial reimbursement of pharmacists/pharmacies for these services.  Subsequently, we visited professional pharmaceutical organizations, a university, and a pharmacy in the UK to conduct interviews involving a predetermined questionnaire, with a total of 6 interviewees.<br><b>Results: </b>The MUR is a medication review program provided free of cost to patients mainly with chronic conditions.  It aims to identify potential safety concerns and improve medication adherence.  In addition to knowledge regarding pharmacotherapy, pharmacists require advanced communication skills for evaluating the use of medications and for providing appropriate consultations in face-to-face sessions. Providing an environment that protects patient privacy is also important.  After the MUR was introduced, the number of services has increased every year and good practices in this regard have increased.<br><b>Conclusion: </b>Information regarding patient selection, check sheet items (e.g., drug names, mode of drug use, reasons for use, and side effects), and feedback procedures was obtained from the MUR program.  The Brown Bag program should be improved to apply this activity to promote appropriate medication use and enhance risk communication service.