Multicentre prospective observational study on community pharmacist interventions to reduce inappropriate medications

The status of community pharmacists' involvement in inappropriate prescription practices among outpatients who visit community pharmacies has not been reported in Japan. Therefore, this study described community pharmacists' interventions aimed at the discontinuation of inappropriate drugs or the reduction of drug doses. We conducted a multicentre prospective observational study of pharmacists' interventions on inappropriate prescriptions for outpatients during a 1-month period in September 2018. A total of 28 pharmacists from 28 community pharmacies in Japan participated in this study. We analysed cases in which pharmacists discontinued drugs or changed the doses due to drugs being inappropriate, adverse effects, duplication of pharmacological effects and drug-drug interactions. Community pharmacists provided interventions for 736 patients at an average of 26.2 patients per day during the study period. The pharmacists recommended that doctors discontinue inappropriate drugs or reduce the doses of regular drugs for 103 patients (13.9%). Among the 107 pharmacist recommendations to decrease inappropriate prescriptions, 83 (77.6%) were accepted, including 62 cases of discontinuation (57.9%) and 21 of drug dose reduction (19.6%). A total of 122 drugs were discontinued according to pharmacists' recommendations. In addition, pharmacists' intervention improved sleepiness, sedation and cognitive function. This study shows the active involvement of community pharmacists in polypharmacy by discontinuing inappropriate drugs or reducing the dose of regular drugs, which may contribute to the improvement of adverse effects among outpatients.