(Written by Tonya Dauterman, UF Assistant Professor of Pharmacy Practice and Chair of Experiential Education, for Ohio Pharmacists Association Magazine. Story originally published September, 2017)
The adventure began in summer 2016 for five students and two faculty members from the University of Findlay’s (UF) College of Pharmacy. Visiting Kyushu University of Health and Welfare (KUHW) in Nobeoka, Japan was a true intercultural experience with the goal of comparing common pharmacy practices in the inpatient, outpatient and academic settings between Japan and the United States. Student representation included one member of each class from P2-P6.With a timeline of three weeks, including travel, a lot of preparation needed to happen prior to boarding the plane for Japan. Learning objectives validated by faculty and the Assistant Dean for International Engagement were shared with the participants. Three hospitals and community pharmacies were observed. The participants were immersed into the curriculum at KUHW and were instructed to journal daily, noting all similarities and differences stated in the course objectives. Discussions were held daily. Students took pictures to document findings, which were validated with Japanese pharmacy faculty.
The group noted descriptive differences in all practice areas. U.S. pharmacists have collaborative practice agreements allowing more diverse practice opportunities. Japanese pharmacists have similar traditional roles in community, long-term care and oncology collaboration and receive a bachelor’s degree after five years of college with clinical rotations during their fourth year. Japan lacks the use of technicians, thus pharmacists serve both technical and clinical roles in most practice settings. This has a negative impact on Japanese pharmacists’ salaries in comparison to the U.S. Additionally, cultural differences direct patient preferences to herbal and self-care treatments. Drug expenditures in Japan are affected by the lack of trust in the generic market.
Participants met the learning objectives, noting pharmacists are well respected with unique roles in both countries. Cultural differences influence pharmacy practices and academics in each country and students understood differences that could benefit both populations.
The group noted descriptive differences in all practice areas. U.S. pharmacists have collaborative practice agreements allowing more diverse practice opportunities. Japanese pharmacists have similar traditional roles in community, long-term care and oncology collaboration and receive a bachelor’s degree after five years of college with clinical rotations during their fourth year. Japan lacks the use of technicians, thus pharmacists serve both technical and clinical roles in most practice settings. This has a negative impact on Japanese pharmacists’ salaries in comparison to the U.S. Additionally, cultural differences direct patient preferences to herbal and self-care treatments. Drug expenditures in Japan are affected by the lack of trust in the generic market.
Participants met the learning objectives, noting pharmacists are well respected with unique roles in both countries. Cultural differences influence pharmacy practices and academics in each country and students understood differences that could benefit both populations.
Background
Pharmacy is an ever-changing worldwide profession. Even though pharmacy has a universal presence, the practice of pharmacy has an abundance of variations that greatly depend on where the practicing pharmacist is located. These practice modifications can range from the types of medications used to treat patients to what role the pharmacist plays in the patient care continuum. An example of these geological variations can be found throughout the United States where every state has slight differences on how pharmacy should be practiced despite being part of the same country.
Due to these variations, it is important that colleges of pharmacy present opportunities for students to learn about and participate in global health. In doing so, pharmacy students will be able to gain new perspectives about their respective countries’ development and growth of the pharmacy profession and be able to discuss practice tendencies with the rest of the world. U.S. pharmacy professionals can learn from other countries to better their practice as well. The University of Findlay’s College of Pharmacy provided this opportunity for students to visit a pharmacy school in Japan to learn more about the country’s pharmacy practice tendencies.
Inpatient
Just like in the U.S., Japanese hospitals vary in their size and treatment capabilities. There are smaller community hospitals that serve rural, less populated areas that are only capable of addressing conditions that have lower acuity. Patients who have higher acuity needs are transferred to larger, more advanced hospitals. These larger institutions appeared to have advanced funding, with equipment such as automatic dispensing machines as well as other technologies.
Despite Japanese hospitals being very similar to those found in the U.S., there were also several notable differences. The first was the physical location of the inpatient pharmacy. In Japan, the inpatient pharmacy was located on the main floor near the main entrance/exit. The amount of security in or around the pharmacy area, when compared to U.S. inpatient pharmacies, was observed to be significantly lacking. However, in this setting, crime didn’t seem to be a concern for the Japanese.
On the medical floors, there were noticeable differences in ensuring drug security. In the U.S., it is not uncommon to see a Pyxis-like machine on every floor to secure medications until they need to be dispensed to the patient. In Japan, there were storage bins/drawers that held a patient’s medications, but the devices appeared to be insecure and could be accessed by anyone behind the nurses’ station. Japanese hospitals also do not have any outpatient pharmacies available for patients to fill their prescriptions upon discharge. Patients are given a prescription that they themselves need to fax to their pharmacy of choice in order to fill the prescription. When the patient arrives at the pharmacy to pick up the prescription, the patient must give the original prescription to the pharmacist to receive the filled prescription.
Another notable difference found in Japanese hospitals was that pharmacists are placed on
each hospital floor. These floor pharmacists are responsible for verifying the medications, identifying interaction potentials, administering medications to patients, and answering questions for the medical staff on that floor. The administration of medications by the pharmacist was considered by the observers to be a unique responsibility due to this task typically being done by someone on the nursing staff in the U.S.
Outpatient
Of the many differences that were noted during the study abroad experience, there were several variances that were observed during the outpatient site visits. The biggest differences noted by the faculty and students were the type and formulation of medications that were used for patient treatment. When a patient needs to take a prescription medication in Japan, the formulation that most patients prefer is powdered form over formulations such as tablets, capsules, or liquids. When patients have to take a medication in either tablet or capsule form, they do not receive these medications in an amber vial like they do in the U.S. Instead, Japanese outpatient pharmacies use multi-dose packets that contain all the medications that a patient needs to take for that specific time or day. Another major variance that was observed by the students was that patients in Japan preferred to use herbal products before they would use an OTC medication or visit a doctor to get a prescription medication.
Counseling in the outpatient setting is also practiced differently in Japan than it is in the U.S. Japanese pharmacists do not always counsel patients in a private area, and the counseling process usually involves family members, as well as the patient. This style of counseling is almost the complete opposite of how it is done in the U.S. In the U.S., a patient’s privacy is of the utmost importance, so counseling patients in a private area is mandatory. Due to this emphasis on privacy, the patient and the pharmacist are usually the only people involved in the counseling process, unless the patient is a minor or requests the presence of a family member during the counseling session.
Academia
The pharmacy programs found at KUHW and the U.S., specifically the University of Findlay, are quite comparable but do have some notable differences. Both universities utilize the 0 to 6 format
for their pharmacy degrees, meaning that it only takes a total of six years to complete the pharmacy program with a degree. However, a major variance between the two programs is that students from the U.S. graduate with a PharmD degree while KUHW students graduate with a bachelor’s degree, despite spending the same amount of time in college and covering similar material.
for their pharmacy degrees, meaning that it only takes a total of six years to complete the pharmacy program with a degree. However, a major variance between the two programs is that students from the U.S. graduate with a PharmD degree while KUHW students graduate with a bachelor’s degree, despite spending the same amount of time in college and covering similar material.
The curricula between the two universities are also very similar when compared side by side. Students from each university take similar courses throughout their academic careers, but the year these courses are offered vary. For example, Japanese students take law during their first and sixth years and are introduced into the pharmaceutical sciences earlier than UF students. UF students cover law in their fifth year and do not start learning about the pharmaceutical sciences until their third year. Another notable difference is that Japanese students spend their fifth year off campus gaining practical experience, and spend their sixth year back on campus performing research and studying for their licensing exams. UF students are required to have a research project completed by the end of their fifth year and spend their sixth year gaining practical experience and studying for their licensing exams.
Conclusion
To make a more pronounced impact on the way that pharmacy is practiced, it is crucial that we attempt to more thoroughly understand the differences in pharmacy practice between Japan and the 
United States. This trip served to identify commonalities and differences between the two countries in terms of academia, inpatient, and outpatient pharmacy practices. The data obtained are useful to lay the foundation of basic information needed for further research on this topic. Future studies are recommended to build upon this foundation of knowledge and to further define the differences in pharmacy education and practice between the two countries. Areas of particular interest for future studies include health insurance systems, pharmacy law, and academic clinical rotation content.
United States. This trip served to identify commonalities and differences between the two countries in terms of academia, inpatient, and outpatient pharmacy practices. The data obtained are useful to lay the foundation of basic information needed for further research on this topic. Future studies are recommended to build upon this foundation of knowledge and to further define the differences in pharmacy education and practice between the two countries. Areas of particular interest for future studies include health insurance systems, pharmacy law, and academic clinical rotation content.
References
1. Marumatsu N and Liang J. Hospital length of stay in the United States and Japan: a case study of myo- cardial infarction patients. International Journal of Health Services [Internet]. 1999 [cited 2017 Jan 20]; 29(1):189-209. Available from: https://www.ncbi.nlm. nih.gov/pubmed/10079404
2. Belli DK. Can Japan serve as a model for U.S. health and long-term care systems? [Internet]. San Francisco (CA): American Society of Aging; 2013 May 9 [cited 2017 Jan 20]. Available from: http://www. asaging.org/blog/can-japan-serve-model-us-health- and-long-term-care-systems
3. Yamada K and Nabeshima K. Pharmacist-managed clinics for patient education and counseling in Japan: current status and future perspectives. Journal of Pharmaceutical Health Care and Sciences [Inter-
net]. 2015 Jan 28 [cited 2017 Jan 19]; 1(2) [about 12 screens]. Available from: https://jphcs.biomedcentral. com/articles/10.1186/s40780-014-0001-4
4. Aungst T. Lessons from visiting a Japanese phar- macy. Pharmacy Times [Internet]. 2015 Nov 11 [cited 2017 Jan 19]; [about 3 screens]. Available from: http:// www.pharmacytimes.com/contributor/timothy-aungst- pharmd/2015/11/lessons-from-visiting-a-japanese- pharmacy
5. Yamamura S, Yamamoto N, Oide S, and Kitazawa S. Current state of community pharmacy in Japan: practice, research, and future opportunities or chal- lenges. Annals of Pharmacotherapy [Internet]. 2006 Nov 1 [cited 2017 Jan 23]; 40(11): [about 4 screens]. Available from: http://journals.sagepub.com/doi/ abs/10.1345/aph.1H221
6. Cisneros RM, Jawaid SP, Kendall DA, et al. Inter- national practice experiences in pharmacy education. American Journal of Pharmaceutical Education [In- ternet]. 2013 [cited 2017 Jan 23]; 77(9):1-6. Available from: http://www.ajpe.org/doi/pdf/10.5688/ajpe779188
