Bandoh
et al.；Drug
Numberand Cost Reduction
Pharmacist
Japanese
Journalof Community
PharmacythroughVol.6, No.2,
36-42 Participation(2018)《 Original Article 》

Drug Number and Cost Reduction through Pharmacist Participationin Medication Decision Making
Tsutomu Bandoh1*, Shunji Yamaguchi2, Youhei Ikemoto3, Masahiro Hayashi4,
Yoshimitsu Shimamori1, Yoshimi Itoh1
In Japan, there are few studies of the role of pharmacists in National Health Insurance-registeredpharmacies (hereinafter called "insurance pharmacies") in reducing the number and cost of drugs throughcollaborations with other healthcare professionals in the community healthcare setting. In this study, weinvestigated whether the participation of pharmacists in medication decision making would lead to a
reduction in the number and cost of drugs, in the case where pharmacists accompanied physicians who
made visits for medical examinations to the special elderly nursing home Seikouen in Yubari City,
Hokkaido, Japan.
The results showed that in July 2008 (the month before pharmacists participated in medication decision
making), the number of drugs prescribed per resident per month was 8.1; after pharmacist participation (theperiod from August 2008 to November 2009), the number of drugs prescribed per resident per monthdecreased significantly to 6.0–6.8. The percentage decrease (%) in the number of drugs prescribed per
resident per month also showed a significant decline relative to that in July 2008.
Drug cost per resident per day was 342.1 yen in July 2008 (before pharmacist participation), whereas it
was significantly decreased from August 2008 to November 2009 (after pharmacist participation). Similarly,
the percentage decrease (%) in drug price per resident per day declined significantly after pharmacist
participation, relative to that in July 2008.
A stratified analysis of antihypertensive drugs revealed that whereas the number of antihypertensive drugs
prescribed per resident per month was 2.2 in July 2008, the number decreased significantly to 1.7–1.8 from
August 2008 to November 2009. The cost of antihypertensive drugs prescribed per resident per day was
93.0 yen in July 2008, and a significant decrease in the cost of antihypertensive drugs was observed as wellafter pharmacist participation.
Together, these results suggest that the involvement of pharmacists in medication decision making byphysicians could potentially reduce the number and cost of drugs.
Key words; drug number, drug cost, pharmacist, community health care
Received August 27, 2018; Accepted September 25, 2018
1 Department of Pharmaceutical Community Health Care, Hokkaido University of Science,2 Ain Holdings,Inc. ,3 Drug Department, Yubari City Clinic, 4 Pharmaceutical Department, Chitose City Hospital*Corresponding author: Tsutomu Bandoh, Department of Pharmaceutical Community Health Care, Hokkaido University of
Science, 7-Jo 15-4-1 Maeda, Teine, Sapporo, Hokkaido 006-8585, Japan
Phone +81 11-676-8719
Fax +81 11-676-8666
E-mail: bandoh-t7@hus.ac.jp3636

Japanese
Journalof Community
PharmacythroughVol.6,Pharmacist
No.2, 36-42Participation(2018)
Bandohet al.；Drug
Numberand Cost Reduction

1． Introduction
2.2. Methods
Methods

1. Introduction
1-3)

In the United States, the Asheville Project is in
In the United States, the Asheville Project 1 - 3 ) is inplace, which mandates monthly interviews withplace, which mandates monthly interviews withpharmacists and in return provides patients freepharmacists and in return provides patients free
medication under agreements with participating
medication under agreements with participating
insurance companies. This project has resulted ininsurance companies. This project has resulted in
improved medication adherence and reduced
improved medication adherence and reduced
medical expenses as a whole, although no drug cost
medical expenses as a whole, although no drug cost
reduction.
reduction.
Meanwhile, in Japan, comprehensive medical
Meanwhile, in Japan, comprehensive medicalcare has been promoted with an eye to achieving notcare
promoted
with antocostachievingnotonly hasdrugbeenefficacyand safety
buteyealso
reduction

During the period between August 2008 andDuring the period between August 2008 andNovember 2009, we examined the number and cost
November 2009, we examined the number and costof drugs prescribed per resident per month and perof drugs prescribed per resident per month and per
day at the special elderly nursing home Seikouen in
day at the special elderly nursing home Seikouen in
Yubari City, Hokkaido, Japan. We expressed the cost
Yubari City, Hokkaido, Japan. We expressed theof drugs by calculating drug price. During thiscost of drugs by calculating drug price. During thisperiod, pharmacists from Yubari branch of AIN
period, pharmacists from Yubari branch of AIN
Pharmacy
physicians fromfrom Yubari
Pharmacy accompanied
accompanied physicians
Yubari
MedicalCenter inin visits
to thehome for
Medical Center
visits to
the nursing
nursing home
for
m
e
d
i
c
a
l
e
x
a
m
i
n
a
t
i
o
n
s
,
a
n
d
p
a
r
t
i
c
i
p
a
t
e
d
medical examinations, and participated iinn

only
efficacy and safety
but also
and drugcost-effectivenessin thelightcostof reduction
medicalandcost-effectiveness
in
the
light
of
medicaleconomics, in particular, pharmacoeconomics.

medication
medication decision
decision making
making forfor individual
individual residents.
residents.
All
data
are
shown
as
means
±
S.E.
and
statistical
All data are shown as means ± S.E. and statistical

economics,
particular, pharmacoeconomics.
Insuranceinpharmacies
in Japan are expected to be
Insurance
pharmacies
inare expected
to beactively involved in efforts Japanto reducesocial welfare

analysisanalysis was
was performed
performed using
using Student’sStudent’s t-test.
t-test.
Valueswere
consideredsignificant
at
P
<
. 05
Values were considered significant at P < 00.05

activelyin efforts
to reducesocial welfare
expenses.involved
Such efforts
includethe promotionof useexpenses.
Such
efforts
includethe
promotionofof generic drugs and the elimination useofversusversus thethe value
value ofof July
July2008.
2008.
As
the
present
study
used
only existing
existing unlinked
unlinked
As the present study used only

ooverprescription,f g e n e r i c d r uin
g s additiona n d t h toe eplaying
l i m i n athet i o nmainofoverprescription,
additionto playing
mainrole of dispensing in
drugs
and serving
as thethebaseforanonymized
data, itit wasanonymized data,
was deemed
deemed unnecessary
unnecessary totoconsult
withtheEthicsCommittee
ofYubariconsult with the Ethics Committee of Yubari

role
of dispensing
drugs andand serving
the baseforproviding
medications
medicalasandhygieneproviding
medications
medicalandproducts (including
homeandmedicalcare)
as hygiene
medical

Medical
Medical Center.
Center.

productshomemedical withcare)theas Medical
medicalprovision(including
facilities, inaccordance
provision
Care Act. facilities, in accordance with the Medical

3. Results
3.
Results

Care
In Act.
order to evaluate in a more objective mannerInorder
to evaluate
in a moremannerthe contributionof pharmacists
to objective
medical care,
it is

We
drugs prescribedprescribed perper
We surveyed
surveyed thethe number
number ofof drugs
resident
the month
month before
beforeresident per
per month.
month. In
In July
July 2008,
2008, thethecontributionof pharmacists
to medicalcare,asit isa
necessaryto quantify
drug cost
reductionnecessaryto quantify
drug costcontribution
reduction asofa
measure of
the economicthepharmacists participatedparticipated inin medication
medication decision
decisionthe pharmacists
making,number ofof drugs
drugs prescribedprescribed per
per resident
resident
making, thethe numberme a s u r e o f t hintervention.
e economic contribution ofpharmaceuticalpharmaceuticalintervention.
From the perspectiveof reducing social welfareper. 1 ; after
after pharmacist
pharmacist participation
participation
per month
month was
was 88.1;(the),(the period
period fromfrom AugustAugust 2008
2008 toto November
November 20092009),

From theweperspective
reducingsocial welfare
expenses,
examined ofhow
the participationof
expenses,
weexaminedhow
theparticipationofpharmacists in insurance pharmacies in medication

significant
decreases inin thethe number
number ofof drugs
drugs were
were
significant decreases
observed,
in AugustAugust andobserved, toto 6.36.3 inand September
September 2008,
2008, 6.5
6.5

pharmacists
in insurance
pharmacies
medication
decision making
wouldchange in prescribing
decision
wouldchangebehavior
behaviormaking
and thereby
reducetheprescribing
number andcost ofin. 6 in. 4 ininin October
October 2008
2008,, 66.6
in November
November 2008
2008,, 66.4
December. 3 in January 6.3
2009 , 6 . 7 inDecember 2008 , 62008,
inandreducenumberat andcost ofelderly
drugs
drugsthereby
prescribed
pertheresidenta specialprescribed
per resident at a special elderly nursing
nursing home.

February 2009 , 6 . 6 in March 2009 , 6 . 4 in April

home.

6.5 in August 2009, 6.0 in September 2009, 6.1 in2009, 6.8 in May 2009, 6.0 in June and July 2009,37
37

Bandohet al.；Drug
Numberand Cost Reduction
Pharmacist
Japanese
Journalof Community
PharmacythroughVol.6, No.2,
36-42 Participation(2018)

August 2009, 74.3% in September 2009, 75.1% inJanuary 2009, 6.7 in February 2009, 6.6 in March
October 2009 , and 6 . 3 in November 2009 (Figure
2009, 6.4 in April 2009, 6.8 in May 2009, 6.0 in1). Next, we examined the percentage decrease (%)
June and July 2009, 6.5 in August 2009, 6.0 inin the number of drugs prescribed per resident per
September 2009, 6.1 in October 2009, and 6.3 inmonth relative to that in July 2008 , i.e., before
November 2009 (Figure 1). Next, we examined thepharmacist participation in medication decision
percentage decrease (%) in the number of drugs
making. After pharmacist participation, significant
prescribed per resident per month relative to that indecreases were observed, to 77.2% in August 2008,
July 2008, i.e., before pharmacist participation in
78 . 0 % in September 2008 , 80 . 0 % in Octobermedication decision making. After pharmacist
2008 , 81 . 7 % in November 2008 , 78 . 4 % in
participation, significant decreases were observed,
December 2008, 77.9% in January 2009, 83.0% in
to 77.2% in August 2008, 78.0% in September 2008,
February 2009 , 81 . 8 % in March 2009 , 79 . 5 % in
80.0% in October 2008, 81.7% in November 2008,
April, 84 . 2 % 2008,
in May77.9%
2009 ,in74January. 4 % in2009,
June
78.4%2009
in December

October 2009, and 77.1% in November 2009
number of drugs prescribed per month for individual(Figure 2).
residents, we examined further how the drug priceAs pharmacist participation in medication
per resident per day might also be affected.
decision making led to a significant reduction in the
In July 2008, i.e., before pharmacist participation
number of drugs prescribed per month forin medication decision making, drug price perindividual residents, we examined further how theresident per day was 342 . 1 yen. After pharmacist
drug price per resident per day might also be
participation, significant decreases in the drug priceaffected.
per resident per day were observed, to 259.4 yen in
In July 2008, i.e., before pharmacist participation in
August 2008, 268.1 yen in September 2008, 277.3
medication decision making, drug price per resident
yenJanuary273.9yen.
yen inAfter
July 2009,268.3
per inday
was2009,342.1
pharmacist

2009,
77.1%
in November2). inJune and
2009,
74.3%
in July 20092009,(Figure
79.8%
As pharmacist participation in medication

167(approximately
47.0%)
were
drugs.
yen inSeptember 2009,267.5
yengenericin October
2009,
We
also
examinedthepercentage
decrease
(%)
in
and
267.1
yen
in
Novemberyen
in September
2009, 267.5
yen inparticipation,
significant
decreasesin October
the drug2009,
price
and
267
.
1
yen
in
November
2009(Figure3).
This
per resident per day were observed, to 259.4 yen
in

2009,
in July2009,2009, 81.8%
79.8% inin August
83.0%74.3%
in February
March 2009,
2009,
74
.
3
%
in
September
2009
,
75
.
1
%
in
October
79.5% in April 2009, 84.2% in May 2009, 74.4% in

studythat yenof the355 drugs2008,
used,277.3
188
Augustshowed
2008, 268.1
in September(approximately
53 . 0 %)were
proprietary
drugs
and
yen in January 2009,
273.9
yen
in July 2009,268.3

decision making led to a significant reduction in the

drug price per resident per day after pharmacist

38
38

Japanese
Journalof Community
PharmacythroughVol.6,Pharmacist
No.2, 36-42Participation(2018)
Bandohet al.；Drug
Numberand Cost Reduction
August 2009 , and 1 . 7 in September throughmonth was 2.2. However, after pharmacist
November 2009 (Figure 5).
participation, significant decreases were observed,
In July 2008 , the month before the pharmacists
to 1.8 in August 2008, 1.7 in October and November
participated in medication decision making, the2008, 1.8 in December 2008 and February andprice of antihypertensive drugs prescribed per
March 2009, 1.7 in April 2009, 1.8 in May 2009, 1.7
resident per day was 93.0 yen; however, significant
in June and July 2009, 1.8 in August 2009, and 1.7
decreases were observed after pharmacist
in September through November 2009 (Figure 5).
participation, to 66. 9 yen in June 2009, 62.8 yen in
In July 2008, the month before the pharmacists
September 2009 , and 64 . 2 yen in November 2009
participated in medication decision making, the(Figure 6).
price of antihypertensive drugs prescribed per

resident per day was 93.0 yen; however, significant
4. Discussion
decreases were observed after pharmacist
participation, to 66.9 yen in June 2009, 62.8 yen in
The Asheville Project was launched in 1996
September 2009, and 64.2 yen in November 2009
targeting city employees of Asheville, North(Figure 6).
Carolina, USA, a town with a population of roughly
80,000, to help diabetic patients better control their

4. Discussion

disease through pharmacist-directed counseling andpatient compliance instructions. The project
The Asheville Project was launched in 1996
mandates monthly interviews with pharmacists andtargeting city employees of Asheville, Northin return provides patients free medication under
Carolina, USA, a town with a population of roughly
agreements with participating insurance companies.
80,000, to help diabetic patients better control theirThis program has resulted in improved medicationdisease through pharmacist-directed counseling andadherence, and although drug cost reduction was notpatient compliance instructions. The project
achieved, medical expenses as a whole was
mandates monthly interviews with pharmacists anddecreased,accompaniedby amedication
wide rangeofin return provides
patients freeunder2009 (Figure 3). This study showed that of the 355
participation
medication
decision making,drugs used, in188(approximately
53.0%)relative
weretothat in July
, i.e.,
before pharmacist
proprietary
drugs2008
and 167(approximately
47.0%)
participation.
Significant decreases were noted after
were generic drugs.
pharmacist
participation,
to 75.8% inAugust (%)
2008,
We also examined
the percentage
decrease
in78.4%
in September
2008
81 . 7after% in pharmacist
Decemberdrug
price
per resident
per, day2008,
81.1% ininJanuary
2009, 80.1%
in July
2009,
participation
medication
decisionmaking,78. 4 % toin that
September
2009i.e.,, 78before. 1 % in
October
relativein July 2008,
pharmacist

outcomes,
includingfewer
absencesdue toagreements withparticipating
insurancecompanies.
treatment.
This program has resulted in improved medication2009,
and 78.2%
in November
2009were(Figure4).afterparticipation.
Significant
decreases
noted
T h e r e sparticipation,u l t s o f a s tot r a75.8%
t i f i e din aAugustn a l y s i2008,s ofpharmacist

Many studies
the rolewasofadherence,and overseas
although have
drugexamined
cost reduction
pharmacists
clinical practice
not achieved,in medical
expensesorasevaluateda whole theirwasantihypertensive
drugs 2008,
revealed
that in2008 ,
78.4% in September
81.7%
in July
Decemberthepharmacists
participatedin2008,month
81.1%before
in January
2009, 80.1%
in July 2009,

4 - 11 ). In acontrast,
in Japan,economicdecreased, contribution
accompanied bywide range
of
there
are
few
reportsof
drug
numberandcostoutcomes, including fewer absences due to

medication
decisionmaking,thenumberof
78.4% in September
2009,
78.1% in
October
2009,
antihypertensive
drugs prescribed
per 4).
resident per
and 78.2% in November
2009 (Figure

reduction
treatment. through participation of pharmacists ininsurance
pharmacies
who
collaborate
other
Many studies
overseashave
examined withthe roleofmonth
2 . 2 .ofHowever,after analysis
pharmacist
The wasresults
a stratifiedofparticipation,
significant
decreases
observed,antihypertensive
drugs revealed
thatwerein July
2008,

healthprofessionals
in practicethe community
healthcare
pharmacists
in clinicalor evaluatedtheirsetting,
only a handfulof studies
the
4-11)
economicand
contribution. In contrast,
in ofJapan,

to8 in August, 1 . 7 inparticipatedOctober andthe 1 .month
before 2008
pharmacistsinNovember, 1 . 8making,in December
2008 andmedication 2008
decision
the numberofparticipation
hospitalofpharmacists
in medication
there are fewof reports
drug number
and cost
12 - 14 ).
decision making

Februaryand March2009, 1 . 7 in April
2009 , 1per
.8antihypertensive
drugs
prescribed
per resident
in May 2009 , 1 . 7 in June and July 2009 , 1 . 8 in

39
39

Bandohet al.；Drug
Numberand Cost Reduction
Pharmacist
Japanese
Journalof Community
PharmacythroughVol.6, No.2,
36-42 Participation(2018)In June 2008, the attending physician at Seikouen
reduction through participation of pharmacists inwas changed from a physician at a clinic in Yubari
insurance pharmacies who collaborate with other
City to a physician at Yubari Medical Center. In
health professionals in the community healthcare
addition to outpatient treatment and home visits, thesetting, and only a handful of studies of thephysician, being newly assigned to Seikouen,
participation of hospital pharmacists in medication
increased the numberof drugs prescribed indecision making12-14).
response to the various symptoms and medical
In June 2008, the attending physician at Seikouen
conditions of the residents. As a result, the number
was changed from a physician at a clinic in Yubariof drugs prescribed per resident continued to
City to a physician at Yubari Medical Center. In
increase until July 2008 . After discussions among
addition to outpatient treatment and home visits, thethe physician, a pharmacist at an NHI-registeredphysician, being newly assigned to Seikouen,
pharmacy, a hospital pharmacist at Yubari Medical
increased the number of drugs prescribed inCenter, and a nurse at Seikouen, it was decided that
response to the various symptoms and medical
the drugs prescribed be re-evaluated and that theconditions of the residents. As a result, the number
pharmacist accompany the physician in medicationof drugs prescribed per resident continued todecision making from August 2008 . Therefore, we
increase until July 2008. After discussions among
compared the number and cost of drugs prescribed
the physician, a pharmacist at an NHI-registeredin July 2008 with those from August 2008 onwards
pharmacy, a hospital pharmacist at Yubari Medical
when pharmacist participation in medication
Center, and a nurse at Seikouen, it was decided thatdecision making was started.
the drugs prescribed be re-evaluated and that theIn the present study, we found reductions in thepharmacist accompany the physician in medication
number and cost of drugs prescribed per resident at
decision making from August 2008. Therefore, we
a special elderly nursing home in Yubari City,
compared the number and cost of drugs prescribed
Hokkaido, after participation of pharmacists inin July 2008 with those from August 2008 onwards
medication decision making. Moreover, the number
when pharmacist participation in medication

knowledge of his/her own illness and the drugs
antihypertensive drugs prescribed. During theprescribed through interviews with a pharmacist
actual visit, the physician, the pharmacist, and thewho provided instructions after receiving anurse at Seikouen determined which drugs could beprescription from a physician. Due to the efforts ofdeleted. As a result, the number of drugs prescribed
the pharmacist, the patient felt cared for anddecreased and the cost of antihypertensive drugs
medication adherence improved. Although no drug
also decreased. In the Asheville Project, medication
cost reduction was noted, medical expenses otheradherence was improved by enhancing patient's
than drug cost, such as emergency visits andknowledge of his/her own illness and the drugs
hospitalization, were reduced. Medical expenses
prescribed through interviews with a pharmacist
were successfully reduced as a whole. Meanwhile,
who provided instructions after receiving a
in the case of Yubari City, the pharmacist at an NHIprescription from a physician. Due to the efforts ofregistered pharmacy and the hospital pharmacist at
the pharmacist, the patient felt cared for andYubari Medical Center studied blood pressure data
medication adherence improved. Although no drugof the residents and the antihypertensive drugs
cost reduction was noted, medical expenses otherprescribed prior to the physician’s visit and thisthan drug cost, such as emergency visits andenabled them to decide which drugs were
hospitalization, were reduced. Medical expenses
unnecessary and could be deleted.
were successfully reduced as a whole. Meanwhile,
In the present study, pharmacists accompaniedin the case of Yubari City, the pharmacist at an NHIphysicians in visits for medical examinations andregistered pharmacy and the hospital pharmacist atparticipated in medication decision making. On the
Yubari Medical Center studied blood pressure data
other hand, in the Asheville Project, pharmacistsof the residents and the antihypertensive drugs
provided counseling and patient complianceprescribed prior to the physician’s visit and this
instructions.
Thus,tothedecidedifference
in results
mightbeenabled them
which
drugs
were

resultsof theProject. per
Prior
to thenumber andcostAshevilleof drugs prescribed
residentatphysician’svisittoSeikouen,thepharmacist
andthea special elderly nursing home in Yubari City,inthe hand,data forof drugs(drug pharmacists
prices) thanotherin thethe cost
Asheville
Project,
thedata forcounselingthe number of
We speculatethat
provided
anddrugs.
patient
compliancedue
to differencesin pharmacists’unnecessary
and could
be deleted. involvement inmedicalThis study,
findingpharmacists
suggests thataccompanied
pharmacists
In thecare.
present

andcost makingof antihypertensive
decision
was started. drugs prescribed per
resident
alsostudy,
reduced,which reductions
differed fromtheIn thewere
present
we foundin theplay
a multifaceted
physiciansin visitsrole.
for medical examinations andOverall,
there
were
fewer
significant
differences
participated in medication
decisionmaking.
On thehospitalat YubariofMedical
CenterHokkaido,pharmacist
after participation
pharmacists
instudiedthebloodpressure
dataofresidents
andthemedication decision making. Moreover, the number

thelarge variation
data might
havemight
beenbea
instructions.
Thus, theindifference
in results
contributing
factorinaspharmacists’drug prices involvement
vary markedly
due to differencesin

antihypertensive
drugs prescribed.
Duringthe actualand cost of antihypertensive
drugs
prescribedpervisit,
thephysician,thepharmacist,
and
the
nurse
at
resident were also reduced, which differed from thedependingon Thisthe drug.
medical care.
finding suggests that pharmacists
We
also
performed
stratified analysis of anti-ulcer
play a multifaceted role.

Seikouenwhich drugs
could
be deleted.
results ofdetermined
the Asheville
Project.
Prior
to theAsaresult,thenumberofdrugs
prescribed
physician’s visit to Seikouen, the pharmacist and the

drugs,
dyslipidemia
drugs,(nonsteroidal
Overall,there werefeweranalgesics
significant
differences
anti-inflammatory
drugs,etc.),
andcentralnervousin the data for the cost of drugs (drug prices)thandecreased
and the costantihypertensive
drugs
hospital pharmacist
at ofYubari
Medical Center
also
decreased.
In pressure
the Asheville
Project,
medication
studiedthe blood
data ofresidents
and thesystemsignificant
decreasea tendency
the datadrugs.
for theAnumberof drugs.
We or
speculatethatfordecreaseinthenumberofdrugs
perresident
the large variation in data might have beenpera

adherence was improved by enhancing patient's

month was observed for all of the above-mentioned

40
40Japanese
Journalof Community
PharmacythroughVol.6,Pharmacist
No.2, 36-42Participation(2018)
Bandohet al.；Drug
Numberand Cost Reduction
drugs. Moreover, a significant decrease or acontributing factor as drug prices vary markedly
tendency for decrease in drug price per resident per
depending on the drug.
day for anti-ulcer drugs and analgesics (data not
We also performed stratified analysis of antishown) was observed.
ulcer drugs, dyslipidemia drugs, analgesics
Our findings revealed that collaboration with(nonsteroidal anti-inflammatory drugs, etc.), andother healthcare professionals in the community
central nervous system drugs. A significant
healthcare setting, particularly the collaboration
decrease or a tendency for decrease in the number
between pharmacists and physicians in medicationof drugs per resident per month was observed for all
decision making, could effectively reduce theof the above-mentioned drugs. Moreover, anumber and cost of drugs. As no adverse effects
significant decrease or a tendency for decrease in
resulting from the reduction in the number of drugs
drug price per resident per day for anti-ulcer drugs
were observed, the suppression of drug cost wasand analgesics (data not shown) was observed.
likely achieved while maintaining the quality of
Our findings revealed that collaboration withmedical care.
other healthcare professionals in the community
In the future, we will conduct a quantitative
healthcare setting, particularly the collaboration
analysis of other important roles of pharmacists thatbetween pharmacists and physicians in medication
cannot be calculated in monetary terms, such asdecision making, could effectively reduce theprevention of adverse drug reactions andnumber and cost of drugs. As no adverse effects
interactions, improvement of medical care andresulting from the reduction in the number of drugs
patient QOL, and treatment outcomes of a medical
were observed, the suppression of drug cost wasteam with pharmacist participation.
likely achieved while maintaining the quality of

Medication Therapy Management Program forLong-term Clinical, Humanistic, and Economic
Hypertension and Dyslipidemia, J Am Pharm
Outcomes of a Community-based Medication
Assoc., 2008: 48: 23-31.
Therapy Management Program for Asthma, J4)	Morrison A, Wenheimer AI, Evaluation of
Am Pharm Assoc., 2006: 46: 133-147.
Studies Investigating the Effectiveness of
3. Barry AB, Benjamin HS, Susan ES, The
Pharmacists’ Clinical Services, JHP, 2001: 58:
Asheville Project: Clinical and Economic
569-577.
Outcomes of a Community-based Long-term5)	Gandhi PJ, Smith BS, Tataronis GR, Maas B,
Medication Therapy Management Program for
Impact of a Pharmacist on Drug Costs in aHypertension and Dyslipidemia, J Am Pharm
Coronary Care Unit, JHP, 2001: 58: 497-503.
Assoc., 2008: 48: 23-31.
6)	Mumick AH, Sterba KJ, Peroutka JA, Sloan
4. Morrison A, Wenheimer AI, Evaluation ofNE, Beltz EA, Sorenson MK, Cost Savings
Studies Investigating the Effectiveness ofand Avoidance from Clinical Interventions,Pharmacists’ Clinical Services, JHP, 2001: 58:
JHP, 1997: 54: 392-396.
569-577.
7)	Leape LL, Cullen DJ, Clapp MD, Burdick E,
5. Gandhi PJ, Smith BS, Tataronis GR, Maas B,
Demonaco HJ, Erickson JI, Bates DW,
Impact of a Pharmacist on Drug Costs in a
Pharmacist Participation on Physician Rounds
Coronary Care Unit, JHP, 2001: 58: 497-503.
and Adverse Drug Events in the Intensive Care
6. Mumick AH, Sterba KJ, Peroutka JA, Sloan
Unit, JAMA, 1999: 282: 267-270.
NE, Beltz EA, Sorenson MK, Cost Savings and8)	Alderman CP, Farmer C, A Brief Analysis of
Avoidance from Clinical Interventions, JHP,
Clinical Pharmacy Interventions Undertaken
1997: 54: 392-396.
in an Australian Teaching Hospital, J Qual Clin
7. Leape
LL, Cullen DJ, Clapp MD, Burdick E,

medical care.

References
In the future, we will conduct a quantitative

Pract., 2001:HJ,
21: 99-103.
Demonaco
Erickson JI, Bates DW,9)	CL, onFrankeT, Clinical
Bond
CA,
Raehl
Pharmacist Participation
PhysicianRoundsanalysis of other important roles of pharmacists that1)	Carole WC, Barry AB, Dale BC, The Ashevillecannot be calculated in monetary terms, such as
Project:ofLong-termand Economic
prevention
adverse Clinicaldrug reactions
andPharmacy
Pharmacist
Staffing,CareandandAdverseServices,
Drug Eventsin the Intensive
DrugJAMA,
Costs1999:
in United
States Hospitals,
Unit,
282: 267-270.

Outcomesof a Community
Diabetesinteractions,improvementof Pharmacy
medical careand
Care
Program,JAm
Pharm
Assoc.,
2003:
43:
patient QOL, and treatment outcomes of a medical

Pharmacother.,
1999: 19:1354-1362.
8. Alderman
CP, Farmer
C, A
Brief Analysis of
10)	
CL,
FrankeClinical
Bond
CA,
Raehl
Clinical Pharmacy Interventions T,
Undertaken

Long-term Clinical, Humanistic, andBond CA,11)	ME,T,FrankeT,
9. Bond
CA, Raehl
RaehlCL,
CL,PitterleFrankeClinical
Health Care
Professional
Staffing
Hospital
Pharmacy
Services,
Pharmacist
Staffing,andteam 173-184.
with pharmacist participation.
2)	Barry AB, Carole
WC, The Asheville Project:
References
1.

ServicesandHospital,
HospitalJ Mortality
inPharmacy
an Australian
Teaching
Qual Clin
Rates,
Pharmacother.,
1999:
19:
556-564.
Pract., 2001: 21: 99-103.

Economicof a Community-based
CaroleWC, Outcomes
Barry AB, Dale
BC, The Asheville
Medication
Therapy
Management
for
Project: Long-term Clinical andProgram
Economic

Characteristics,
HospitalStates
Mortality
Rates,Drug
Costs inandUnited
Hospitals,
Pharmacother.,1999:
1999:19:
19:1354-1362.
130-138.
Pharmacother.,

Asthma, JofAm
Pharm Assoc.,
2006 : 46: 133 Outcomesa Community
Pharmacy
Diabetes
147.Program, J Am Pharm Assoc., 2003: 43:
Carelto Y, Ando12)	
Arakawa
Nabeshima
Itatsui
10. Bond
CA, T,Raehl
CL,T, Franke
T, T,Clinical
T, R o l e oServices
f t h e C landi n i c aHospitall P h a r mMortality
acist inPharmacy3)	Barry AB, Benjamin HS, Susan ES, The
173-184.
Asheville
Project:
Clinicaland Economic
2. Barry
AB, Carole
WC,
The Asheville
Project:

PharmaceuticalCare, 1999:
Jpn J Pharm
Health Care
Rates,
Pharmacother.,
19: 556-564.
Sci., 2005: 31 : 113-120.

Outcomes of a Community-based Long-term

41
41

Bandohet al.；Drug
Numberand Cost Reduction
Pharmacist
Japanese
Journalof Community
PharmacythroughVol.6, No.2,
36-42 Participation(2018)
13)	Okazaki N, Sakata Y, Matsumoto S, Miyamori
11. Bond CA, Raehl CL, Pitterle ME, Franke T,
S, lwamoto Y, Ninomiya M, Hiraki K, A
Health Care Professional Staffing Hospital
Survey of G-CSF Chemotherapy for Cancer
Characteristics, and Hospital Mortality Rates,
and Promotion of lt’s Proper Use, J Jpn Soc
Pharmacother., 1999: 19: 130-138.
Hosp Pharm., 2013: 49: 55-58.

14)	Kitazawa F, Ueda K, Takara K, Yokoyama T,
Survey of G-CSF Chemotherapy for Cancer
Sugii H, Shimazaki C, Approach to
and Promotion of lt’s Proper Use, J Jpn Soc
Standardization of Usage of Drugs for Cancer
Hosp Pharm., 2013: 49: 55-58.
Chemotherapy, J Jpn Soc Hosp Pharm., 2011:
14. Kitazawa F, Ueda K, Takara K, Yokoyama T,
47: 1289-1293.
Sugii H, Shimazaki C, Approach to

12. lto Y, Ando T, Arakawa T, Nabeshima T, ItatsuiStandardization of Usage of Drugs for Cancer

T, Role of the Clinical Pharmacist in

Chemotherapy, J Jpn Soc Hosp Pharm., 2011:

Pharmaceutical Care, Jpn J Pharm Health Care

47: 1289-1293.

Sci., 2005: 31: 113-120.
13. Okazaki N, Sakata Y, Matsumoto S, Miyamori
S, lwamoto Y, Ninomiya M, Hiraki K, A

42
42