【背景・目的】2016年に新設された「かかりつけ薬剤師」は, 薬剤師が特定の患者と契約を結ぶことで残薬解消や多剤・重複投薬防止といった効果が期待される制度だが, 患者側の認知度の低さや, 薬剤師側の契約内容への懸念から依然広く活用されるには至っていない。そこで利用者・薬剤師双方を対象にその理由を探ることが本研究の目的であった。
【方法】薬局利用者50名に対する質問紙調査および「かかりつけ薬剤師」経験を有する薬剤師11名への面接調査を実施した。
【結果・考察】薬局利用者対象の調査では「制度自体の存在を知らない」という回答が約半数を占めた。また「必要なサービスならば受けたい」という回答が多かった。一方, 薬剤師対象の調査では「患者から受診先選定に関し助言を求められた時」や「一包化や処方変更の提案をした時」に最もやりがいを感じ, 「契約を結んだ患者の家族背景や生活習慣に関してより細やかに気を配るようになった。またそのような情報を患者から引き出すコミュニケーション能力が必要になった」「特定診療所の門前薬局だが, 契約を結んだ患者が多様な医療機関から処方箋を持参するようになったため, 幅広い診療科への対応と薬学的知識が必要になった」「かかりつけ薬剤師として時間外の電話対応を求められたのは多くて月1回程度であり, これに特別なコミュニケーション能力は要しない」といった回答が得られた。
【結論】「かかりつけ薬剤師」制度がより活用されるためには, 制度自体の認知度を高めると共に, 提供するサービスの充実が不可欠であることが分かった。また薬剤師対象の調査からは, 「かかりつけ薬剤師」は受診勧奨や処方変更などを通して十分に職能を発揮できた時最もやりがいを感じていることが分かった。さらに時間外の電話対応や特定患者の集中のような懸念された問題はないものの, コミュニケーション能力や薬学的知識の一層の向上が求められることが分かった。
Background : The primary care pharmacist system launched in 2016 encourages patients to designate community pharmacists of their choice as their "primary care pharmacists" who provide the patients with thorough pharmaceutical care. To date, however, the system has not been widely recognized or utilized. Thus, in order to facilitate proper use of the system, we have proposed a 2-year research project to design primary care pharmacist communication training programs where pharmacists learn about roles expected of primary care pharmacists as well as acquire skills necessary to fulfill those roles.
Methods : In the initial phase of the project, we surveyed patients as well as interviewed pharmacists who had worked as primary care pharmacists since 2016. The 11-item questionnaire was designed and administered to 50 patients who visited pharmacies in Tokyo. The 10-item guide was developed and used during a semi-structured interview with 11 pharmacists in Kanagawa prefecture.
Results : The patient survey revealed that nearly 50% of the respondents were unaware of the system but expressed interest in paying for the service "if I or my family need such service." In addition, the pharmacist interview indicated that many of the primary care pharmacists found the experience highly rewarding, especially when they were able to suggest prescription change or medical consultation to their patients. Doing so, the pharmacists pointed out, requires a wider array of pharmaceutical knowledge as well as communication skills to discreetly ask about the patient's lifestyle or family history. Contrary to their concerns, their patients rarely called them at night or on weekend. Even when they did, responding to those calls required no specific skills.
Discussion & Conclusion : The types and quality of the service provided by primary care pharmacists to their patients are crucial to the system's success. In addition, the system should receive much wider media attention for it to succeed. Having "primary care pharmacist" contracts with patients turned out to be less time-consuming and more rewarding to the pharmacists than they had previously anticipated, but requires communication skills and /or pharmaceutical knowledge specific to their role as the primary care pharmacist.