The Pharmacists Act is a law that defines the duties and qualifications of pharmacists in general. On the road to its establishment, there was a passionate desire and effort from our forefathers to “contribute to the improvement of pharmaceutical services by allowing pharmacists to fully demonstrate their abilities" that continued from the promulgation of the “medical system." The law was partially revised with respect to the Assurance of Quality, Efficacy and Safety of Pharmaceuticals, Medical Devices, etc., promulgated in December Reiwa (Act No. 63 of Reiwa). Based on this revision, we reaffirm the current situation and needs of pharmacists and accept that pharmacists need to be closely involved in the healthcare machinery.

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Elderly diabetic patients at home tend to have multiple chronic diseases, and are prone to problems such as polypharmacy, duplication and interaction of medications, and remaining medications due to visits to other departments. In addition, they are prone to decline in ADL, onset of dementia, dysphagia, and frailty, making it difficult for them to manage their medication at home. The amendment of the Pharmacists Act clearly states that the role of pharmacists is to follow up after dispensing medication. From the viewpoint of preventing the risk of side effects such as hypoglycemia, follow-up after the introduction or change of diabetic SU drugs or insulin is particularly important, and continuous pharmacological management for home care is required. This paper introduces the key points of medication follow-up for elderly diabetic patients at home, points to keep in mind such as remaining medication management, and how to provide information for patient support.

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Cooperation between pharmacies and hospitals necessary to continue drug treatment safely and securely. In order to realize the comprehensive community care system promoted by the government, cooperation between hospitals and local medical institutions is indispensable. This is because if there is no information about drug therapy at the time of admission or discharge, or if it is "wrong" or "old", adverse events may occur in the patient. Therefore, in order to provide patients with "safe and secure drug therapy", seamless drug–drug cooperation between hospitals and pharmacies is necessary. There are two means of drug–drug collaboration practiced at Shion Hospital: "joint guidance at discharge" and "drug management summary for pharmacy pharmacists". Among the joint guidance at discharge and the drug management summary, the five hospitals with abundant medical resources are "central parenteral nutrition management", "enteric nutrition management", "pressure ulcer management", "blood glucose control", and "medication management". Information sharing is important because there are differences between facilities and homes with limited medical resources. In particular, two types of information are objective work such as "administration of medication that adherence can be observed" and interpersonal work such as "proper use of medicines". It is important to continue to follow after giving the medicine.

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During the COVID-19 outbreak, an open survey was conducted via the Internet to clarify the problems faced by pharmacists engaged in home care and pharmacy practice. Anyone could respond to the survey, but the call was made mainly to those involved in the Japanese Association of Home Care Pharmacies. The survey asked participants to describe their perception of the COVID-19 outbreak, mainly related to home care and pharmacy practice. As a result, 231 participants responded, of which 222 (96.1%) were pharmacists. Among these pharmacists, 182 (78.8%) were engaged in pharmacy practice, including home care. Some commented that they did not have a standard guide to prevent infection during patient home visits. This caused a decrease in the number of home visits, and they could not bring students to the patients’ homes for practical training. These situations were associated with a decrease in the frequency of prescriptions for home care patients, and some pharmacists experienced patients refusing home care visits. In addition, there was a lack of masks and personal protective equipment. The increase in the burden on pharmacists was caused by a need for disinfection in the pharmacies and the increased number of patients’ home visits for delivery of drugs by telephone order. They also cited financial management problems of pharmacies. In addition, problems with their own family-related issues were cited. In this study, we described many important remarks concerning pharmacy practices and home health care during the COVID-19 outbreak that are concealed by official notifications and reports.

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Recently, home pharmacists have been required to promote multiprofessional cooperation for home medical care. However, the above-mentioned practice among home pharmacists has been less reported. We experienced a case of treatment-resistant hypertension in an elderly female patient, which was intervened by home pharmacists cooperating with a home doctor and a nurse as part of home medical care. Consequently, this resulted in an improvement of blood pressure and a reduction of antihypertensive agents. Since hypertension, complicated by depression, was suspected based on the information shared with the home doctor and nurse, we suggested a prescription of escitalopram. Escitalopram treatment resulted in the improvement of blood pressure and reduction of antihypertensive agents. Furthermore, the Quick Inventory of Depressive Symptomatology score was decreased after escitalopram treatment. In this case, the practice by home pharmacists is considered useful improving the quality of home medical care.

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