Polypharmacy is one of the most critical issues worldwide, especially for elderly people. Elderly people prescribed 5 or more medications have a significantly increased fall risk and those prescribed 6 or more medications have a significantly increased risk of adverse events.1–3 Furthermore, some reports have suggested that polypharmacy can be defined as not only the number of medications used but also the use of medications that are not required or cause adverse events, regardless of the number.4 Polypharmacy also regarding newly diagnosed dementia6 and cognitive decline.7 Pharmacists can play an important role for polypharmacy. For example, hospital pharmacists review inappropriate medications8–10 and community pharmacists screen inappropriate medications and consult prescribing doctors.8
In Japan, community pharmacists are required to communicate with the other healthcare professionals, such as medical doctors, nurses, and nursing care managers.11 The Ministry of Health, Labour and Welfare recommends that healthcare professionals communicate with each other. Medical service fees are charged for some kinds of that communication. In 2012, fees for avoid medications overlapping or drug interaction were established, which are calculated by the community pharmacists as they aware medications overlapping, drug interaction or unused medications and report to the prescribed doctors, thus change prescription. In 2014, fees to submit information regarding taking medications were established, which are calculated by the community pharmacists as they provide information to patients or healthcare professionals. In 2014, fees for supporting taking medications for outpatients were also established, which are calculated as the community pharmacists aware unused medications and perform one-dose packing, home pharmaceutical care or so. In 2016, fees for family pharmacists were established, which are calculated as the family pharmacist who was selected and consented by patients give the patients a drug administration guidance. Furthermore, fees to support deprescription were established in 2018, which are calculated by the community pharmacists as they submit deprescribing proposal documents to prescribing doctors in patients prescribed 6 or more oral medications for 4 weeks and as a result of the proposal withdraw 2 or more medications in 4 weeks. Although fees to submit information regarding taking medication were calculated 30,567 times during the 2018 fiscal year, fees to support deprescription calculated only 189 times.12 Fees to submit information regarding taking medication can be calculated not only send tracing reports to the prescribed doctors but also consulting via telephone, letter, face-to-face or so to, the patients or healthcare professionals. The proportion of submitting tracing reports in calculating fees to submit information regarding taking medication is not disclosed so that how many tracing reports submitted to the prescribed doctors in Japan is unclear. In addition, tracing reports can be included not only deprescription proposals but also mentioning unused medications, potential adverse event, adherence of patients, the medications which prescribed the other medical institutions, over-the-counter medications or so. For the cases of Nihon Chouzai Koiwa-Minamiguchi Pharmacy, 637 tracing reports submitted to the prescribed doctors, 149 of 637 reports included deprescribing proposals and obtained consent to submit the report from Aug 2017 to Mar 2020. Thus, fees to support deprescription were calculated only 16 times. Fees to support deprescription calculating succeeded per tracing reports included deprescribing proposal was 10.7%. It seems that deprescribing proposals via documents submitted from community pharmacists to prescribing doctors are rarely successful. What kind of factors influence for success rate of deprescribing proposals are still unknown. Thus, in this study, the factors that influence the success rate of deprescribing proposal via documents submitted by the community pharmacists to prescribing doctors were investigated. Reveal success factors for deprescribing proposals may help increase its success rate and resolve polypharmacy.