薬剤服用歴を用いた在宅医療における薬学的介入後の患者アウトカムの評価

The purpose of this study was to identify patient outcomes after pharmacist interventions in the home health care context using pharmaceutical care records accumulated during daily operations. We focused on 591 cases at Nakajima Pharmacy from April 2020 to December 2021, where dispensing fees were charged to prevent duplication of medication and unnecessary interactions of home patients (excluding those related to adjustment of ongoing medications). The study investigated the content and background of prescription changes, the follow-up rate, and patient outcomes. The most common circumstances that led to pharmacist intervention for homebound patients were symptom occurrence (uncontrolled symptom, new symptom, drug adverse event). Of the patients for whom pharmacist intervention was provided for symptoms, 72.8% received follow-up according to the pharmaceutical care records. Furthermore, 59.2% of patients with follow-up showed an improvement of their symptoms. In addition, many patients had their medications discontinued or the dosage reduced by the pharmacist despite stable symptoms. More than 90% of these patients showed no change in symptoms. Besides interventions associated with the occurrence of symptoms, many interventions related to medication adherence were found to result from the patient’s physical condition, such as poor swallowing function. The results suggest that tracking pharmacy drug histories may help pharmacists to better understand the need for follow-up implementation and the changes in patient outcomes after interventions.