New value of pharmacistsin homecare medicine in Japan

NCHS / SUC Pharmacist

YUKO OSUGA

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What can a pharmacist do in home care? For patientsBetter QOL? Improve compliance?Would patients feel comfortable with pharmacists?

For doctorsCan help to reduce the burden?

For clinicWorth having a pharmacist inside a clinic?

Any additional values??2

Types of pharmacies

Challenges of medication management in home care

• In the Super aging society, many elderly people have difficulty managing their medications.

• While the needs of home care is increasing every year, the importance of medication teaching and drug administration guidance are also increasing.

• The role of pharmacists has been unclear among the team.

• V isiting nurse or home doctor has undertaken those roles and operations.

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Palliative Dr.

Back Up

Medical care team @ SUCNurses

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Pharmacist

Psychiatrist

My work at SUC• Visit new patientsCheck the medication at first visit• Drug administration guidance• Enhance medication compliance

•Prescription proposal to the doctor based on the pharmaceutical assessment.• Creating easy-to-understand

prescriptions for outside pharmacies• Providing medical information to

outside pharmacies.

Challenges of Home Palliative care

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１． MedicationImportance of getting all possible medication history. Changing from moment to moment.Management of side effects of Chemotherapy drugs/Narcotics.

２． Narcotics arrangementNumber of pharmacies which handle narcotics is small.Complications to arrange and start continuous subcutaneous morphine infusion. Ex.)Infusion pump arrangement

３． Patients, FamilyConcerns about ‘narcotics’Concerns about his/her disease situationFear of death

Case 1

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87 y.o. Male. Living alone. small-cell lung cancer 　　 hepatic metastasis 　 Doctors visit ： 3-4times a week

Dr. Toya, Dr. Hakamada, Dr. Miyasaka were involved Nurses, care givers visit ：Daughter stayed with the patient for care.

Home visiting nurse system. 5 times a week. Drug adherence ：　 Good. Helped by daughter.

Use outside pharmacy.

The first time he took narcotic drug, he felt nauseous.

He refused to take pills for that reason.

After we listened to his feelings and gave drug information, he restarted to take pills.

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Talk with family

While doctor and nurse see the patient, pharmacist took time to talk with family.

Medication management

Write reports and share it with care givers and every medical staffs who were involved.

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Case 2

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42 y.o. Male He was diagnosed as von Willebrand disease at first, as

a result of re-examination in the Inagaki Clinic; it appeared to be a mild hemophilia case.

FactorⅧ level: 5-8% No need to do prophylaxis therapy Bleeding history: in elbow (only one time), cerebral hemo

rrhage (last October) Clotting factor: ADVATE. Hepatitis C (+), HIV (-)

He couldn’t walk after the cerebral hemorrhage ⇒ started to get home medical care

Current Japanese situation: Hemophilia treatment

•Hemophilia A Patients: 5000 / Treated in 1000 hospitals•70% of the hospitals treated less than 3 hemophilia patients.•40% of the patients are treated in hospitals who treat less than 10 hemophilia patients,•Small Clinics has a problem dealing with factors management.•There are 50,000 pharmacies in Japan but almost all the pharmacies do not deal with the drug.•The number of the patients is smaller, the clinic’s burden is heavier.•Lack of professional knowledge is also a problem in small clinics.•Need to have a system of inventory management and tight relationships with specialist.

Providing drugs and support to small clinics is the highest needs we found so far.

Advantages of pharmacist joining the team

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Can give patient-oriented drug administration guidanceCan improve complianceThe follow-up and appropriate guidance to care providers and family make it possible to build a better care environment.

Patients’ acceptance is easierVisit with physician makes it easier.

Strengthen the team careBusiness division.Can be 30-50% reduction in the work of visiting nurses and home doctor.Enhanced cooperation with local pharmacies, the possibility of medical care at home can be improved.

• There is a considerable volume of medication management in home care, it is very difficult to manage properly by MDs and nurses without pharmacists

• We could support the patients who have chronic disorders that requires long-term home care management, such as hemophilia

Future prospects