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.

Keywords: Additive interaction; Administrative claims data; Community pharmacy; Pharmacist; Retrospective cohort study.

Fig. 1

Flow diagram of identifying the eligible cohort

Fig. 2

Adjusted absolute risk difference curves for the prevention of therapeutic duplication or drug interaction. Abbreviations. aARD: adjusted absolute risk difference; AUC: area under the absolute risk difference curve. Scoring system I was developed using two multiple logistic regression models and scoring system II was developed using a single multiple logistic regression model. The plots depict q in the x-axis and the corresponding aARDs in the y-axis based on these scoring systems. The higher the AUC is, the better the scoring system performs