Pharmacist Intervention Involving Physical Assessment in Reviewing Prescriptions for Antihypertensive Medication

介護老人保健施設（以下，老健）に入所中の降圧薬服用者を対象に，薬剤費削減を目的として，薬剤師が処方変更に介入した．処方変更後の安全性評価のために，薬剤師自らがphysical assessment を行った．Angiotensin II type 1 Receptor Blockers（ARB）はAngiotensin-Converting Enzyme Inhibitors（ACEI）の後発品への変更を，ARB 以外の降圧薬については後発品に変更することを医師に提案した．変更案が受け入れられ，処方が変更された．ARB 以外の降圧薬を服用していた対象者では後発品の変更により変更前後の血圧に有意差は認められなかった．一方，ARB では，ACEI への変更によって，140/90 mmHg未満に収めることは可能であったものの，3 分の2 の対象者で血圧は上昇した．喉の違和感，掻痒性の発疹を訴える対象者が2 名いたが，2 週間後には消失した．薬剤費は14 名分30 日間で約4 万円削減された．本研究で，老健での新たな薬剤師業務を提案することができた．To reduce drug costs for persons admitted to welfare facilities for the elderly requiring long-term care (WFEC) who have been taking antihypertensive drugs, pharmacists helped doctors change the prescription. Pharmacists performed physical assessment of patients as a part of drug safety management. The pharmacists proposed to the doctors that incoming patients switch 1) from Angiotensin II type 1 Receptor Blockers (ARB) to the generic angiotensin-converting enzyme inhibitors (ACEI) and 2) from brand name antihypertensive drugs other than ARB (AHD) to generic drugs. The doctors agreed with the pharmacists, and the prescriptions were changed. For patients who had taken AHD, no significant differences were observed in blood pressure by switching to the generic drug. Alternatively, although it was possible to maintain BP up to less than 140/90 mmHg by switching from ARB to ACEI, two thirds of patients had increased blood pressure. One patient experienced an uncomfortable feeling in the throat and another developed an itchy rash, but these symptoms disappeared within two weeks. For 14 patients over 30 days, drug costs were reduced approximately 40,000 yen. In this study, an additional role for pharmacists at WFEC was proposed