Identification of individuals benefiting from the kakaritsuke-yakuzaishi (family pharmacist) system in Japan: a retrospective cohort study using an employment-based health insurance claims database

Abstract

Background The kakaritsuke-yakuzaishi system (henceforth, the family pharmacist system) which provides more health services than those by general pharmaceutical practice, was implemented in Japan in April 2016. To distribute medical resources and medical care expenditures appropriately, identifying the possible major beneficiaries of this system is essential. By analyzing administrative claims data through this retrospective cohort study, we identified modifiers of the potential benefits of the system. Further, we integrated the identified modifiers into a scoring system that indicates the possible benefitting subpopulations. Methods We obtained data about individuals under 75 years old routinely using community pharmacies in Japan from the JMDC database. We classified the individuals as users or non-users. We used claims related to “choufukutouyaku-sougosayoutou-boushi-kasan (additional therapeutic duplication and drug interaction [TDDI] prevention fees)” filed between April 2018 and March 2020, which indicate that individuals’ prescriptions were modified to adjust leftover drugs or to avoid TDDI as indicators of potential benefit. We estimated adjusted absolute risk differences and 95% confidence intervals for product terms using multiple generalized linear regression models. We included the factors whose 95% confidence interval lower limits did not reach 0 in the multiple logistic regression models for developing a scoring system. Results The eligible cohort included 162,340 individuals (1,214 users and 161,126 non-users). The leftover drugs adjustment significantly increased for individuals prescribed antidepressants. However, as only one modifier was identified, we did not develop a scoring system for the leftover drugs adjustment. For TDDI prevention, the following factors were included in the scoring system: being female, being prescribed ≥ 6 drug types, using ≥ 2 medical institutions, and being prescribed proton pump inhibitors, antibiotics, probiotics, or traditional Japanese herbal medicines. The developed scoring system for TDDI prevention scored “female” and “traditional Japanese herbal medicines prescription” factors higher than other factors. Conclusions Individuals who are female or prescribed traditional Japanese herbal medicines, or antidepressants may benefit significantly from the family pharmacist system.

Telephone follow‐up contributes to improving adherence and treatment duration in patients with hepatocellular carcinoma treated with lenvatinib

“…The family pharmacist system aims to facilitate centralized and consistent pharmaceutical care and enable the delivery of more effective and comprehensive pharmaceutical services by developing patient–pharmacist contracts. Therefore, individuals often visit pharmacies near their home 23 …”

“…In Japan, the separation between prescribing and dispensing is facilitated by developing a system through which physicians receive higher fees for fulfilling prescriptions to community pharmacies, compared with the fees they receive for dispensing drugs themselves. 23 The family pharmacist system aims to facilitate centralized and consistent pharmaceutical care and enable the delivery of more effective and comprehensive pharmaceutical services by developing patient-pharmacist contracts. Therefore, individuals often visit pharmacies near their home.…”

“…Therefore, individuals often visit pharmacies near their home. 23 Family pharmacist intervention: Family pharmacist telephone follow-up (FP-telephone) group. The telephone follow-up was performed continuously between hospital visits by the family pharmacist until the end of LEN treatment (Fig.…”

Evolution and Innovation of Social Insurance Policies for New Forms of Employment

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Association between having a primary care physician and health behavioral intention in Japan: results from a nationwide survey

“…However, little is known about the impact of KI on patients’ health behaviors. A study on Kakaritsuke-Yakuzaihi , the pharmacist version of KI, reported its beneficial effects were limited to a specific patient population [ 10 ]. Regarding KIs, one study reported that having a KI was positively associated with visiting large-scale hospitals [ 11 ]; however, it reflected the need for a practitioner referral for the initial hospital visit.…”