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5.5.3. Strategies used and lessons learnt

Training programme for pharmacy students and pharmacists

To educate pharmacists towards appropriate clinical competencies, a six-year programme for pharmacist education was started in 2006. At the time of introducing the six-year course, we began developing a model/core curriculum for pharmacy students to gain a minimal level of clinical skills. Both hospital pharmacists and community pharmacists now work collaboratively with pharmacy schools.

Reform of the pharmaceutical supply system

Relaxation of regulations is a global trend, and Japan is no exception. The Japanese government introduced registered salespersons who can sell second-and third-class OTC drugs. It is probably true that pharmacists can provide better safety in self-medication through OTC drugs.

Although first-class OTC drugs are sold only by pharmacists, the number of community pharmacies with no OTC drugs is increasing because they are focused on dispensing prescriptions. The Japanese Pharmaceutical Association, however, advocates that all drugs used for self-medication be supplied to purchasers through pharmacists, with counselling for effective and safe use.

Home health care programme for elderly people in the community

In 2000, a long-term care insurance system was introduced to respond to society s major concern about aging [10]. Pharmacists involvement includes providing medicines management for long-term care. This role should expand, and there is a need for more community-based pharmaceutical care. The number of pharmacies contributing to long-term care is increasing, including providing new roles (eg home parenteral nutrition or domiciliary medicines adherence counselling). However, many pharmacists do not have the necessary clinical skills to evaluate patient conditions. The community workforce is in need of targeted skills and practitioner development infrastructure.

5.5.4. Outcomes

Training programme for pharmacy students and pharmacists

There is no outcomes evidence for the effect of the new six-year programme at this stage. The outcomes will be evaluated by the Japan Accreditation Board for Pharmaceutical Education [11]. New challenges are:

a. Controlling the appropriate capacity (entry) in pharmacy schools and accrediting/credentialing the clinical competencies of novices;

b. Improving the core curriculum for training of pharmacy students in pharmacy schools; and

c. Reorganizing clinical practice experiences at pharmacies and hospitals. The Japan Pharmaceutical Association (JPA) has established a new education system (the Japan Pharmaceutical Association Lifelong Learning Support System - JPALS) in order to support CPD from March 2012 [12]. The JPALS is expected to play an important role in this area.

Reform of pharmaceutical supply system

The number of community pharmacies with no OTC drugs is increasing, and the rate of compliance in the supply of first-class OTC drugs is low (31.5%). Many pharmacists did not have enough experience in dealing with OTC drugs in the past because they focused on dispensing of prescriptions. The challenges are:

a. Enhancement of the supply system for OTC medicines and

b. Establishing a national training programme and guidelines for the safe supply of OTC medicines.

Home health care programme for elderly people in the community

The number of pharmacies and pharmacists involved in the long-term care system are increasing. Pharmacists will be expected to play an important role in this community health care programme. However, other health care professionals still do not accept the role of pharmacists in these settings. More effort is needed to improve workforce capabilities to achieve confidence by other health professionals and to produce better patient outcomes.

In conclusion, the total numbers of pharmacists and pharmacies are not currently an issue. However, because of the imbalance of work environments (community pharmacy, hospital pharmacy, or drug store), a shortage of pharmacists in some fields is reported. This may result in some areas having poor access to appropriate pharmaceutical services. This maldistribution of pharmacies and pharmacists needs to be addressed. Education and development programmes for pharmacy students and pharmacists are in development. The next step is to increase the public and professional awareness about the importance of pharmacists in Japan s health care system by the profession itself.

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References

1. Nippon Communications Foundation. Japan s 2012 Budget. 2012 [cited 15 May 2012]. Available from: http://nippon.com/en/features/h00007/

2. Ministry of Health, Labour and Welfare in Japan. Service guide (English). 2011 [cited 15 May 2012]. Available from: http://www.mhlw.go.jp/english/ org/pamphlet/dl/pamphlet-about_mhlw.pdf

3. Ministry of Health, Labour and Welfare in Japan. The survey of the numbers of doctors, dentists, and pharmacists in 2010. 2011 [cited 15 May 2012]. Available from: http://www.mhlw.go.jp/toukei/saikin/hw/ishi/10/dl/kekka_3.pdf

4. Japan Pharmaceutical Association (JPA). Annual Report of JPA 2010-2011. Tokyo: JPA. 2011 [cited 15 May 2012]. Available from: http://www.nichiyaku. or.jp/e/data/annual_report2010e.pdf

5. School Health and Safety Act. http://law.e-gov.go.jp/htmldata/S33 S33HO056.html [cited 7 July 2012]

6. Ministry of Health, Labour and Welfare in Japan. 2012 [cited 15 May 2012]. The Results of 97th National Examination for Pharmacist. Available from: http://www.mhlw.go.jp/stf/houdou/2r98520000016lphatt/ 2r98520000016lqy.pdf

7. Ministry of Health, Labour and Welfare in Japan. Part 2 Chapter 2 Section 10 Promotion of Measures for Safety and Security of People - White Papers & Reports Annual Health, Labour and Welfare Report 2009- 2010. 2009 [cited 15 May 2012]. Available from: http://www.mhlw.go.jp/english/wp/ wphw4/ dl/honbun/2_2_10.pdf

8. Ministry of Health, Labour and Welfare in Japan. The condition of examination of registered sales person and the number of registered sales person in FY 2010. 2011 [cited 15 May 2012]. Available from: http://www.mhlw.go.jp/bunya/iyakuhin/ippanyou/pdf/shiken_2011.pdf

9. Ministry of Health, Labour and Welfare in Japan. The report of survey of the state of the supply system of the over-the-counter medicines. 2012 [cited 15 May 2012]. Available from: http://www.mhlw.go.jp/stf/ houdou/2r985200000205gu.html

10. Ministry of Health, Labour and Welfare in Japan.Long-term Care Insurance in Japan. 2002 [cited 15 May2012]. Available from: http://www.mhlw.go.jp/english/topics/elderly/care/index.html

11. Japan Accreditation Board for Pharmaceutical Education. Outline of JABPE. 2008 [cited 15 May 2012]. Available from: http://www.jabpe.or.jp/ english/index.html

12. Japan Pharmaceutical Association. Japan Pharmaceutical Association Lifelong Learning Support System. 2012 [cited 15 May 2012]. Available from: http://www.nichiyaku.or.jp/action/wpcontent/ uploads/2012/02/jpals_flyer.pdf

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