[An Attempt to Build the Practice Model of Pharmacist in Home Care Medicine for Children].

Although the need for homecare medicine for children is increasing in Japan, few studies have focused on the role of pharmacists in this area. The purpose of the present study was to clarify the practice process of pharmacists in pediatric homecare medicine and develop a practice model. Three pharmacists with experience in homecare medicine for children participated in semi-structured interviews. The data were analyzed using the modified-grounded theory approach (M-GTA). The analysis generated 8 categories and 21 concepts. The practice of pharmacists in homecare medicine for children is the pharmacotherapy management process, and it aims at "enabling the transition from hospital to home for children and continuity of their homelife with family" in collaboration with other professions. Above all, the two concepts of "optimization of prescription and device selection to enable the hospital-to-home transition" and "optimization of prescription and device selection for ensuring patient safety" form the core of clinical decision making in the pharmacotherapy management process. By integrating these two optimization concepts, the transfer of patients to home can be undertaken smoothly, leading to safer pharmacotherapy in the lives of patients and their families. Furthermore, pharmacists considered clinical decision making from two perspectives: "the child's growth-based approach" and "homelife-based approach." The foundation of these practice processes comprised "professional responsibilities" and "consideration of families' feelings."

[Survey on Visiting Nurses' Awareness of the Roles of Pharmacists in Pediatric in-Home Care].

In recent years, there has been an urgent need to build a pediatric in-home care system with multiple occupations. This study aims to clarify the role of pharmacists in this system by investigating what visiting nurses' expectation from them. A self-administered questionnaire survey was conducted, targeting nurses enrolled in 10 home-visit nursing facilities. Responses were received from 51 nurses at six facilities, and the questionnaire collection rate was 42.5%. The primary role of the pharmacists that nurses regarded was the management of prescribed oral medications such as "mixing powders, single-dose packages at each time" and "sorting and summarizing each time medicine packages are taken." Other roles included providing information based on the drug's physicochemical properties such as "the tube gets clogged easily when the medicine is administered" and "do not crush the medicine when administering it." The findings of this study are novel because they revealed that pharmacists need to perform pharmaceutical assessments on the influences of changes in children's physical condition and the presence or absence of effects of drugs, and share information in real time. They also need to participate in a conference at discharge. For the first time, this study revealed the roles of pharmacists expected by nurses in pediatric in-home care. However, further knowledge or training are required, especially in terms of the relationship between the symptoms in children and the medicine administered, for pharmacists to effectively practice their roles.

Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report.

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and facility information were obtained from 2638 pharmacies that participated in a survey. DPM was calculated based on the dispensing volume and number of prescriptions, which are routinely collected data that are simple to use. Use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased from January 2019 to January 2021. In particular, the antimicrobial use was higher in otorhinolaryngology departments than in other departments, despite a decrease in the antimicrobial use. In the linear multiple regression analysis, otorhinolaryngology department was independently associated with the third-generation cephalosporin, quinolone, and macrolide prescription in all periods. This study reveals for the first-time trends in antimicrobial use through a new indicator using the volume of drugs dispensed in pharmacies throughout Japan. Antimicrobial use differed by the medical department, suggesting the need to target interventions according to the department type.

[The Effect of Clinical Research by Community Pharmacists on the Medical Field -The Perspective of Scientists in the Community Can Improve a Patient's Circumstances].

Our pharmacy, with a sterile dispensary, is a support center for home-care dispensing; we are actively participating in a regional collaboration in combination with medical treatment, nursing, and social care. We have supported about 1000 home care patients so far: most of these have been elderly people living at home, but roughly two dozen were pediatric patients. Although the primary diseases of the children varied, they shared in common both a high dependence on medicine, and great difficulty in moving them. With our pediatric patients, a caregiver had to be in constant attendance because the child's medical care was intermittent. In addition, at the pharmacy, due to the volume of medication for these pediatric patients, caregivers have had to wait a long time for prescription fulfillment, and often receive so much medicine they need a cart to carry it home. Through providing pharmacist-led home guidance on medicines, we are able to offer some support in the pharmacotherapy of children with extreme symptoms who remain under the supervision of a doctor from an advanced medical institution, even after returning home. Through my experience visiting both elderly people and children under home care, I have keenly realized the importance of a community pharmacist's research in improving pediatric formulation and home medical care systems. We must aim to reduce the burden of medication management for both patients and caregivers, and to improve a patient's "comprehensive quality of life, including (his or her) family".

[Support for Children with Difficulties in Living at Home: The Role of Community Pharmacies in Pediatric Home-care Systems].

Our pharmacy is a support center for home-care dispensing with a sterile dispensary, actively participating in a regional collaboration among medical treatment, nursing, and social care. We have supported hundreds of home-care patients, most of whom were elderly people living at home but a dozen or so were pediatric patients. Although the primary diseases of the children varied, what they had in common was a high degree of medical dependence and it was difficult to move them. At the same time, a caregiver had to be in constant attendance because medical care was intermittent. At the pharmacy, they faced long waiting times and received so many medications that they needed platform carts to carry them. By providing pharmacist-led home guidance on medications, we supported the pharmacotherapy of children with extreme symptoms who remained under the supervision of a physician from an advanced medical institution even after returning home. Through my experience of visiting both elderly people and children, it is clear that the home medical care system for the elderly, which assumes that the patients' physicians will visit their homes, is badly suited to pediatric patients who must visit advanced medical institutions for examinations.

[Current State of Process of Dispensing Prescription for Pediatric Patients Who Need Home Visiting for Intervention for Pharmaceutical Management].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, there are concerns that many pharmacies are not actively involved in, because the dispensing fee does not match their prescriptions, which are very complicated and contain some high-risk medicines. We analyzed the burden of dispensing prescribed medicines so that we can quantitatively discuss from prescription contents. The essence of the burden of a pharmacy regarding home medical care for children is to cover the transportation of heavy pharmaceuticals and the combination of multiple medication including high-risk medicines and lack of pediatric drug formulations with the efforts of the on-site pharmacist. It became clear that the pharmacist's objective work supports pediatric pharmacotherapy.

[Mindset for Pharmacists as an Expert of Pharmacotherapy-Case of Home-Care Rheumatoid Arthritis Patients with Multiple Diseases].

The number of older adult patients with rheumatoid arthritis(RA)is increasing. As older adult patients tend to have multiple diseases requiringmedications, they are likely to experience side effects from the decline in their physiological functioning. In addition, suppression of disease activity leads to a decline in ADL in the case of patients livingalone, even leadingto difficulties in livingat home. In the 3-years clinical course on older adult RA patients livingalone with multiple diseases, we show the mindset that community pharmacists must have for three events(namely, hypoalbuminemia, chronic heart failure, and dehydration)in which inflammation influences medicinal or side effects.

[Role of Pharmacists in the Care of Pediatric Patients Needing Home Visiting Intervention for Pharmaceutical Management and Their Life Depending on Medical Care].

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, currently, few medical personnel of both medical institutions and pharmacies are aware of home visiting intervention for pharmaceutical management. Home visiting intervention should be utilized more for severely impaired children who are highly dependent on medical care to effectively reduce the nursing care burden of the family and to secure pharmaceutical supply path.

[Case Study - A Successful Cooperation of Clinic Pharmacist and Pharmacies in Home Palliative Care with PCA Pump].

To make a good end at home and provide good palliative care for patients with cancer are urgent issues in Setagaya ward, as shown by certain statistics. Medical opioids are greatly needed for palliative care; as patient controlled analgesia(PCA) develops, it can lead to decisions by patients and their families to receive end-of-life care at home because the patient can choose to receive the same advanced palliative care received at the hospital. With in-home palliative care, given the rapid change in the medical condition of the patient and the sentiment of the family, the role of pharmacists is to quickly and reliably supply the pharmaceuticals and medical equipment that doctors need. The following are important in order to enable this; 1 ) a pharmacy stocked with medicalopioids in accordance with needs, 2 ) a pharmacy with a system that can provide support quickly, 3 ) the presence of people who understand the area of resources, and 4 ) a constant face-to-face relationship. The "Sakura-HOPPS(Sakurashinmachi Homecare Pharmacists PartnershipS)"is a group intended to provide exchange and cooperation of pharmacists beyond the framework of organizationalaffil iation, and authors hope to encourage the participation of increasingly more pharmacists to develop a close-cooperation system of acute care hospitals and community medical/home care.

[A Way of Medication Support for Elderly People Who are Solitary and Have Declined Cognitiveability].

Home-based medical care has been promoted in recent times because of a decline in the birthrate and increased elderly population, and there is wide individual variation in the elderly patients' recuperating environment and/or symptoms. In our experience, when solitude and dementia overlap, patient-management becomes challenging. In the management of such patients, we have identified the importance of a pharmacist as part of the home-based medical care team. The pharmacist plays an important role in providing optimal solutions in terms of environmental adjustment for medication/medication support plan, according to the physical ability and cognitive ability of the patient, under a limited care plan. The statistical data from the national database indicates that there will be an increase in the number of elderly people who are "solitary" and have "declined cognitive ability", and this could be a challenge which could be tackled with home-based medical care system.