Implementation Challenges for online medication counseling in Japan

Conceivable Difficulties based on the current Medication Instruction

The advantage of online medication counseling is that you can receive medication counseling from a pharmacist through your smartphone or computer and even complete the consultation and receive the medication at home. However, while the number of users of online medical services is increasing, the spread of online medication guidance seems to be still lagging. The reasons for this are the following issues.

Transportation costs and quality maintenance
Online medication counseling differs from online medical care in that it involves the physical delivery of medications to patients. Unlike face-to-face consultations, where medicines are handed over to the patient at the pharmacy, online medication counseling consists of the cost of having the medications delivered to the patient's home, either by a delivery company or by pharmacy staff. In addition, there is the issue of maintaining the quality of the medicines. We need to store medication in a cool place; otherwise, high temperatures may deteriorate. Especially in summer, it is necessary to use a temperature-controlled delivery service because of the high temperature inside the truck during delivery. In my experience, there have been cases where ointments and creams packed in containers have burst due to high temperatures. It is essential to consider temperature control and packaging when delivering medicines to avoid such incidents.

Lack of patient information
Online medication counseling may make it difficult to read the patient's complex facial expressions or check test values or medication record handbooks compared to face-to-face medication counselling. In addition, there is a lack of patient information needed by pharmacists and the risk of drug information not being conveyed to patients. For example, inhalants used to treat asthma, COPD, and influenza has different usage methods for each device, and there are individual differences in the power of inhalation. Therefore, it is necessary to provide explanations that suit the patient's needs. In the case of face-to-face inhalation instruction, it is possible to use a demonstration device and practice the technique. Still, it is necessary to consider alternative measures for online medication instruction.

Moves toward the spread of online medication guidance
From April 10, 2020, the Ministry of Health, Labour and Welfare of Japan eased online medication counseling regulation for a limited time against constraints from new coronavirus infections. This deregulation enabled the provision of online medication counseling to first-time patients and to provide medication counseling only through voice communication by telephone. In addition, the "Regulatory Reform Implementation Plan," approved by the Cabinet on June 18, 2021, specified the continuation of deregulation of online medication guidance and the consideration of medical fees. These deregulations are further promoting the spread of online medication guidance.

In today's ageing society, more and more patients find it difficult to go to pharmacies due to their declining physical abilities. Despite the challenges mentioned above, I hope that the widespread use of online medication guidance will make it easier for all people to receive medical services.

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【References】

• Ministry of Health, Labour and Welfare, Pharmaceutical Safety and Environmental Health Bureau,　「オンライン医療の推進について」, 07-Apr-2020, https://www8.cao.go.jp/kisei-kaikaku/kisei/meeting/wg/iryou/20200407/200407iryou04.pdf
• NTT DATA INSTITUTE OF MANAGEMENT CONSULTING, Inc.　「オンライン診療の普及促進に向けたモデル構築にかかる調査研究　報告書」　The Ministry of Internal Affairs and Communications, Mar-2020, https://www.soumu.go.jp/main_content/000688633.pdf
• Ministry of Health, Labour and Welfare, Pharmaceutical Safety and Environmental Health Bureau,　「オンライン診療・服薬指導に関する検討状況について」　2021,　https://www8.cao.go.jp/kisei-kaikaku/kisei/meeting/wg/iryou/20210910/210910iryou01.pdf
• The Medical Profession Division, Health Policy Bureau, & Pharmaceutical Safety and General Affairs Division, Environmental Health Bureau, Ministry of Health, Labour and Welfare,　「新型コロナウイルス感染症の拡大に際しての電話や情報通信機器を用いた診療等の時限的・特例的な取扱いについて」　10-Apr-2020,　https://www.mhlw.go.jp/content/12404000/000620865.pdf
• Etsuko Negishi, others　「病―診―薬連携，わかしお医療ネットワークのオンライン服薬指導システムの構築とその運用」　The Pharmaceutical Society of Japan, 09-Dec-2002,　https://www.jstage.jst.go.jp/article/yakushi/123/3/123_3_191/_pdf/-char/ja

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