Objective: To clarify the barriers pharmacists face in handling patients with adverse drug events at community pharmacies and to propose solutions.
Design: Cross-sectional study.
Methods: One hundred-twenty-one pharmacists, who worked and experienced to work at community pharmacies (76.0%), hospitals (22.3%), or elsewhere, participated in this study.  All of them were divided into 12 groups and asked to note the barriers, and abstract and structure them through discussion in each group according to the KJ-method.  On the other hand, workers at community pharmacies including people with experience were also asked to fill out a prepared questionnaire on barriers.
Results: Six groups structured the barriers from the perspective of professional flow as pharmacists and the other groups structured them from the perspective of a medical care team.  The barriers emerging from both structures were (a) difficulty in identifying adverse drug reaction and assessing its grade at community pharmacies, (b) lack of standardized protocols for informing physicians from community pharmacies, (c) not being informed about a physician’s assessment of suspicious adverse drug reactions, and (d) difficulty in explaining adverse events to patients and their families.  Those barriers were reported by a high percentage of respondents to the questionnaire.
Conclusion: The barriers are all crucial in order to avoid health damage caused by medication at community pharmacies and should be urgently solved.

Benzodiazepine receptor agonists (BZs) are medications to be used with caution, not only for long-time users, but also for first-time users. This study aimed to compare the use of BZs or central nervous system (CNS) agents in first-time BZs users (FU) and continuing BZs users (CU). Using a large health insurance claims database in Japan, BZs users aged ≥40 years in 2013 who were opioid non-users without hospitalization were classified into FU or CU, by use of BZs in the first half-year. BZs or CNS agent use at the index date (the first date BZs were dispensed in the latter year) was investigated as follows: (1) proportion of patients with prescriptions of BZs for use as needed (BZs-AN), (2) daily number of BZs or CNS agents, and (3) daily standardized dose of BZs or CNS agents. More individuals in the FU group (3,162/16,576; 19%) than in the CU group (7,627/46,088; 17%) received BZs-AN (p＜0.001); 87% of the FU group vs 62% of the CU group used single BZs (p＜0.001), and 53% vs 24% used less than 5 mg/day of equivalent diazepam (p＜0.001). A similar trend was found for CNS agents. Numbers or doses of BZs or CNS agents decreased with increasing age in both groups. However, some first-time users aged 70-74years started with ≥2 types of BZs or ≥10 mg/day of equivalent diazepam. Overall, BZs for outpatients without opioids were started carefully, but a prescription review was necessary for some patients, requiring more effort from healthcare providers.

Objective : Recently, a directive that all pharmacies should have a family pharmacist by 2025 was announced. However, this directive has not been clearly communicated to patients. The purpose of this study was to examine the effect of patient information handouts on the number of patients who use the new family pharmacist system, using the evaluation index of family pharmacies (Key Performance Indicator [KPI]). Methods : We created and distributed patient handouts about family pharmacists. The number of new family pharmacists, the number of consultations, and the consultation content from June-August 2021 (pre-distribution period) and September-November 2021 (distribution period) were examined to compare the KPI group and non-KPI group. A cutoff score of the KPI index was used to determine compliant vs. non-compliant. Results : The median (interquartile range) number of new patients in the KPI group (7 pharmacies) increased from 0 (0.0, 1.5) in the pre-distribution period to 4 (2.5, 10.5) in the distribution period (P＝0.019). In the non-KPI group (4 pharmacies) it was 0 (0.0, 0.0) both before and after distribution. The number of consultations about unused prescribed medications and health increased (P＝0.031 and 0.047, respectively) in the KPI group during the distribution period, with no change in the non-KPI group. Conclusion : The use of handouts led to an increase in users of the family pharmacist system in the KPI group. The use of handouts at KPI pharmacies will help patients understand the pharmacist profession and the benefits of the family pharmacist system.