Objective: The government has been promoting further contribution to home care by pharmacists since almost all homebound patients are prescribed more than one medicine. However, little information is available on the adverse drug reactions (ADRs) in home care setting. This study was conducted to describe the ADRs reported by pharmacists in home care and examine factors related to their reports.

Design: Questionnaire survey

Methods: We requested patient-visiting pharmacists at community pharmacies throughout Japan to answer questions about their patients. Main questions included patient characteristics, number of drugs taken, presence of ADRs and details, and pharmacists' workload related to home-visiting.

Results: Data on 5,447 patients were collected from 1,890 pharmacies. The percentage of patients in whom the visiting pharmacists found ADRs was 14.4%. ADRs reported in 10 or more cases covered 12 categories, accounting for 85.2% of all ADRs. The top five categories were: dizziness, grogginess, or lightheadedness; gastrointestinal disturbances; clinical test value abnormality; altered mentation; and cutaneous symptoms. In seven of the 12 ADR categories, central nervous system drugs such as sleeping pills, antianxiety drugs, and psychoneurosis drugs were in the top three suspected drugs. Additionally, patients' gender, residential situation, and the number of drugs taken were implied as factors related to ADRs.

Conclusion：Our study indicated that, while the percentage of ADR occurrences in home-visiting service in Japan was at the same level as outpatients in other countries, drugs for the central nervous system accounted for a higher percentage of suspected drugs. Further, occurrence of ADRs was associated with the use of more than 6 concomitant drugs. These results suggest that physicians and pharmacists need to collaborate in decreasing the number and dose of central nervous system drugs.

Aim:To examine any relations of workload and outcomes of pharmacists’ home visiting service for medication management and guidance. Survey Target:Managing pharmacists and home-visiting pharmacists from community pharmacies of the Osaka Pharmaceutical Association’s Yao and Toyonaka branches as of March, 2012. Methods:Survey forms regarding drug management and guidance at patients’ homes were mailed, requesting mail or online response. Workload indexes were visit frequency and work time on site. The relation of workload and its outcomes was examined using univariate analysis regarding three items:change in unused medication amount;detection of side effects during visits;change in prescription. SPSS ver. 20 for Windows was used for statistical analysis. Results:90 of 201 pharmacies responded (collection rate 44.8%), and 110 home patients’ data were analyzed. 5-to-15-minute actual work time scored highest (57.4%), followed by less than 5 minutes and 15 to 30 minutes, both at 21.3%. Visit frequency of twice a month scored highest (70.4%), followed by once a week (19.4%), once a month (7.4%), and once in more than one month (2.8%). 5-minute or longer patient visits had a tendency of higher percentage of patients whose unused medication decreased after visits started than less-than-5-minute visits (P=0.072). “Once a week” visits had a tendency of higher percentage of pharmacists detecting side effects than less frequent visits (P=0.061) and changing in prescription (P=0.085). Conclusion:The results above implied the relationship between workload and outcomes incurred by pharmacists’ home visits for medication safety management and guidance.

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.

BACKGROUND: In Japan, there have been few reports about drug compliance, which is an important determinant of effectiveness, in the management of bronchial asthma patients. To clarify drug compliance and its relationship with various aspects of asthma management, a questionnaire survey was performed on asthmatic patients and their pharmacists.
METHODS: This survey was carried out, from October to November in 2001. The subjects were limited to the regular inhaled corticosteroid (ICS) users, and were restricted to patients whose medication had not been changed for at least 6 months before the survey. The questionnaires inquired about asthma status, various factors that have been reported to be associated with drug compliance and asthma management. Patients' pharmacists were asked about prescribed medications and drug compliance based on the pharmaceutical records.
RESULTS: Completed questionnaires were received from 610 patients. ICS compliance was not lower than that of anti-allergic drug but lower than that of oral sustained-released theophylline (OSRT) . Multiple regression analysis revealed a significant correlation between ICS and OSRT compliance.
CONCLUSION: These results might suggest that OSRT could improve patient's compliance to drug therapy through its bronchodilatory effect, thus resulting in better compliance to ICS. If this were the case, OSRT would play an important role in asthma management.

Osteoclasts are bone-specific multinucleated cells generated by the differentiation of monocyte/macrophage lineage precursors. Regulation of osteoclast differentiation is considered an effective therapeutic approach to the treatment of bone-lytic diseases. Periodontitis is an inflammatory disease characterized by extensive bone resorption. In this study, we investigated the effects of sodium fluoride (NaF) on osteoclastogenesis induced by Porphyromonas gingivalis, an important colonizer of the oral cavity that has been implicated in periodontitis. NaF strongly inhibited the P. gingivalis-induced alveolar bone loss. That effect was accompanied by decreased levels of cathepsin K, interleukin (IL)-1β, matrix metalloproteinase 9 (MMP9), and tartrate-resistant acid phosphatase, which were up-regulated during P. gingivalis-induced osteoclastogenesis. Consistent with the in vivo anti-osteoclastogenic effect, NaF inhibited osteoclast formation caused by the differentiation factor RANKL (receptor activator of nuclear factor κB ligand) and macrophage colony-stimulating factor (M-CSF). The RANKL-stimulated induction of the transcription factor nuclear factor of activated T cells (NFAT) c1 was also abrogated by NaF. Taken together, our data demonstrate that NaF inhibits RANKL-induced osteoclastogenesis by reducing the induction of NFATc1, ultimately leading to the suppressed expression of cathepsin K and MMP9. The in vivo effect of NaF on the inhibition of P. gingivalis-induced osteoclastogenesis strengthens the potential usefulness of NaF for treating periodontal diseases.
Acid Phosphatase ; drug effects ; Alveolar Bone Loss ; microbiology ; prevention & control ; Animals ; Anti-Bacterial Agents ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Bacteroidaceae Infections ; microbiology ; prevention & control ; Bone Density Conservation Agents ; therapeutic use ; Cathepsin K ; drug effects ; Interleukin-1beta ; drug effects ; Interleukin-6 ; analysis ; Interleukin-8 ; drug effects ; Isoenzymes ; drug effects ; Macrophage Colony-Stimulating Factor ; drug effects ; Male ; Matrix Metalloproteinase 9 ; drug effects ; Osteoclasts ; drug effects ; Periodontitis ; microbiology ; prevention & control ; Porphyromonas gingivalis ; drug effects ; RANK Ligand ; drug effects ; Rats ; Rats, Sprague-Dawley ; Sodium Fluoride ; therapeutic use ; Tartrate-Resistant Acid Phosphatase ; Transcription Factors ; drug effects ; X-Ray Microtomography ; methods