OBJECTIVE：The purpose of this study was to examine the problems of tracking patients by single facility for diseases that may be provided by specialists and in collaboration with regional healthcare providers during drug treatment and the applicability of an administrative claims database in Japan as a possible solution to these problems. METHODS：This retrospective cohort study utilized data from the DeSC database (from June 2018 to August 2022). First, we reported the number of facilities visited by patients with chronic thromboembolic pulmonary hypertension (CTEPH) on drug therapy, the frequency of visits at each facility, and new prescriptions of pulmonary vasodilators to identify possible transfers and concurrent consultations during drug therapy. We then reported the number of new diseases with possible adverse events at the facility where antithrombotic prescriptions were initiated and at other facilities among CTEPH patients who visited multiple facilities. RESULTS：We extracted 106 patients of CTEPH patients that were prescribed anticoagulants (77 patients in the multi-facility group and 29 patients in the single-facility group). The mean frequency of visits was 10.1 months/year (standard deviation 2.5) in the single-facility group and 10.4 months/year (standard deviation 2.1) in the multi-facility group, respectively. Whereas, the frequency of visits to only the facility that antithrombotic prescriptions were initiated in the multi-facility group was about half, at 6.5 months/year (standard deviation 4.0). For pulmonary vasodilators, out of the 18 patients (19 events) in the multi-facility group who had the initiation of prescription for pulmonary vasodilators at a facility other than where antithrombotic prescriptions were initiated, 13 of the patients (14 events) did not have the same prescription confirmed at the facility where antithrombotic prescriptions were initiated. These results indicate that CTEPH is a reasonable disease for patients to visit multiple facilities during drug treatment. In the multi-facility group, the newly diagnosed diseases confirmed at facilities other than the one where antithrombotic prescriptions were initiated and not confirmed at the facility where the antithrombotic prescriptions were initiated were：18/19 events of bleeding, 0/1 event of interstitial pulmonary diseases, 17/19 events of upper gastrointestinal motility disorders, 1/1 event of thyroid dysfunction, and 0/0 event of retinal disorders. CONCLUSION：This study showed that there may be safety information that cannot be picked up solely by the facility where the drug prescription was initiated due to multiple facility visits associated with diverse treatments. In cases where specialists may collaborate with community health care providers to treat a target disease during drug treatment, the generation of safety information through a patient-traceable an administrative claims database should be considered for the implementation of appropriate pharmacovigilance activities.

OBJECTIVE：The purpose of this study was to examine the problems of tracking patients by single facility for diseases that may be provided by specialists and in collaboration with regional healthcare providers during drug treatment and the applicability of an administrative claims database in Japan as a possible solution to these problems. METHODS：This retrospective cohort study utilized data from the DeSC database (from June 2018 to August 2022). First, we reported the number of facilities visited by patients with chronic thromboembolic pulmonary hypertension (CTEPH) on drug therapy, the frequency of visits at each facility, and new prescriptions of pulmonary vasodilators to identify possible transfers and concurrent consultations during drug therapy. We then reported the number of new diseases with possible adverse events at the facility where antithrombotic prescriptions were initiated and at other facilities among CTEPH patients who visited multiple facilities. RESULTS：We extracted 106 patients of CTEPH patients that were prescribed anticoagulants (77 patients in the multi-facility group and 29 patients in the single-facility group). The mean frequency of visits was 10.1 months/year (standard deviation 2.5) in the single-facility group and 10.4 months/year (standard deviation 2.1) in the multi-facility group, respectively. Whereas, the frequency of visits to only the facility that antithrombotic prescriptions were initiated in the multi-facility group was about half, at 6.5 months/year (standard deviation 4.0). For pulmonary vasodilators, out of the 18 patients (19 events) in the multi-facility group who had the initiation of prescription for pulmonary vasodilators at a facility other than where antithrombotic prescriptions were initiated, 13 of the patients (14 events) did not have the same prescription confirmed at the facility where antithrombotic prescriptions were initiated. These results indicate that CTEPH is a reasonable disease for patients to visit multiple facilities during drug treatment. In the multi-facility group, the newly diagnosed diseases confirmed at facilities other than the one where antithrombotic prescriptions were initiated and not confirmed at the facility where the antithrombotic prescriptions were initiated were：18/19 events of bleeding, 0/1 event of interstitial pulmonary diseases, 17/19 events of upper gastrointestinal motility disorders, 1/1 event of thyroid dysfunction, and 0/0 event of retinal disorders. CONCLUSION：This study showed that there may be safety information that cannot be picked up solely by the facility where the drug prescription was initiated due to multiple facility visits associated with diverse treatments. In cases where specialists may collaborate with community health care providers to treat a target disease during drug treatment, the generation of safety information through a patient-traceable an administrative claims database should be considered for the implementation of appropriate pharmacovigilance activities.

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.

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.

Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.

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.