Original Article

Comparison of Community PharmacyPractice in Japan and US State of Illinois

Ken-yuh Hasumoto1, Roger K. Thomas2, Masayuki Yokoi1,3,and Kunizo Arai4

AbstractIn 2006, a new 6-year educational system of pharmaceutical sciences was initiated to turn out strong clinical pharmacists in Japan.However, this new attempt is estimated not to fully satisfy the demand of clinical sites and the needs of the society in Japan. Theobjective of this study is to assess the performance of pharmaceutical services of community pharmacists in Illinois, United States,and Japan with the aim of comparing these services and barriers to pharmacy service delivery. The study designed as a cross-sectional, web-based study among US and Japan pharmacists. The survey asks several questions about demographic data, technical-related information and pharmaceutical services offered to patients, and pharmacy service performance. Almost 50 (92.6%)community pharmacists in United States reported that they dispensed more than 100 prescriptions in 1 day during the study period.In contrast, in Japan, community pharmacists (55.2%) dispensed 10 to 50 prescriptions during the same period. Half of the phar-macists in Japan either strongly agreed or agreed that they lack sufficient interpersonal and management skills. And many pharmacistsagreed that lack of appropriate knowledge and insufficient training before graduation are major barriers to optimizedpharmacy services in Japan. These findings can be used to promote discussion between Japanese pharmacists and stakeholders aboutpharmacy education programs in Japan and the future role of the community pharmacists in patient care in Japan.

Keywordsbarriers, community pharmacy, pharmacy practice, Japan, USA

Introduction

Most nations in Europe, the Middle East, and North America

have adopted the system of the separation of dispensing and

prescribing medicines between pharmacists in community

pharmacies and doctors in medical institutions (hereafter

referred to as the separation system) for several hundred years.

Although the separation system is thought to be the most effec-

tive way to maximize pharmacists’ and doctors’ expert abilities

in such nations, in Japan to this day the necessity of the separa-

tion system has continued to be criticized and argued with.1

Pharmacists, in cooperation with prescribing physicians, will

explain effects, side effects, directions for use, and so on, of

drugs to patients (patient compliance instruction) so that

patients improve their understanding of drugs and have the

expectation to take dispensed drugs as directed, leading to

improved efficacy and safety of drug therapies. As for the legal

rule of dispensing medicines, there are several distinctive dif-

ferences between United States and Japan. First, the separation

system is adopted optionally in Japan. Therefore, 70% of pre-

scription medicine in Japan is dispensed by community phar-

macists according to prescriptions, and the other 30% by

prescribing doctors in person without issuing prescriptions.2

Contrastively, doctors in United States are forbidden to dis-

pense or sell drugs to patients in person. This definitive

occupational division between doctors and pharmacists

enhances pharmacists’ ability to audit prescriptions, for exam-

ple, checking duplication of prescribed medications, managing

history of allergies, or monitoring harmful effects from admi-

nistered medicines. Additionally, pharmacists in United States

have legally extensive discretion about dispensation, which

Japanese pharmacists do not; for example, refilling of prescrip-

tions, administration of vaccinations, review of medications,

plans for at-home medical care, and so forth.3 Furthermore,

United States has pharmacy technicians who performed dispen-

sing roles, while Japan does not. Most Japanese pharmacists

1 College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu Shiga,

Japan2 Department of Languages, Literatures, and Cultures, Illinois State University,

Normal, IL, USA3 Pascal Pharmacy, Kusatsu, Shiga, Japan4 Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and

Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa,

Japan

Corresponding Author:

Kunizo Arai, Faculty of Pharmaceutical Sciences, Institute of Medical,

Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi,

Kanazawa, Ishikawa 1192, Japan.

Email: arai@p.kanazawa-u.ac.jp

Journal of Pharmacy Practice1-7ª The Author(s) 2018Reprints and permission:sagepub.com/journalsPermissions.navDOI: 10.1177/0897190018786614journals.sagepub.com/home/jpp

think that a separation of medical practice and drug dispensing

is preferable to the Japanese system. They contend that this

system allows for the pharmacist to have a better picture of the

patients’ entire medication profiles. This contention holds true

in United States.

As for the educational system of pharmacists in Japan, the

6-year period in universities has been compulsory to qualify for

the national examination for pharmacists since 2006. It is mod-

eled on institutions in United States. Despite concepts of

responsibility and confidence being purported as the foundation

of pharmacy education and practice in “Model Core Curricu-

lum for Pharmaceutical Education,”4 pharmacists do not feel

confident in their clinical decision-making capabilities.5,6 Most

Japanese pharmacists feel that their training inadequately pre-

pares them for their careers and think that a pharmacist should

maintain high standards of knowledge and skill throughout

their lifetime.

Although there are many differences between United States

and Japan in the health insurance system, pharmaceutical ser-

vices, and social environment, the difference in the pharma-

cists’ perceptions of their education and work environment

between the 2 nations is a very interesting subject to consider

in the effort to make pharmacy education programs in Japan

more effective. In this study, we investigated the community

pharmacy practices by questionnaires in United States and

Japan. We discussed the system of an efficient education sys-

tem in Japan.

Methods

We investigate through questionnaires the difference between

the provision of pharmaceutical services of community phar-

macists in Illinois, United States, and Ishikawa and Fukui pre-

fectures, Japan. A cross-sectional online survey was distributed

to community pharmacists in Japan and United States.

Plan of Investigation

Data were collected through an anonymous online question-

naire administered on the Google Documents platform in Japan

and Select Survey NET in United States. The questionnaire

(Table 1) was made up according to the aims of the study and

approved by Illinois State and Kanazawa University Human

Research Ethics Committee in United States and Japan, respec-

tively. The original questionnaire (in Japanese) was translated

from Japanese to English by one of the authors (R.K.T). Infor-

mation about the study, including the link to the online ques-

tionnaire, was sent by addressed e-mail to 515 community

pharmacies in Ishikawa and Fukui Prefecture in Japan, the

mailing list of the Ishikawa and Fukui Pharmaceutical Associ-

ation, while, in United States, with the cooperation of the Illi-

nois Pharmacists Association, which has approved

collaboration with this study, the office sent e-mail to 696

pharmacists in Central Illinois for participating in the study.

Data were collected during the period from November 1, 2016,

to December 31, 2016, in Japan and from September 1, 2016, to

November 30, 2016, in United States.

Form of Questionnaire and Method of Data Analysis

The questionnaire was developed by Rayes et al based on

previous similar studies.7 In our research, 3 pharmacists from

different disciplines also assessed the survey for content cov-

erage and clarity. The survey was carried out in the form of a

questionnaire comprising 7 sections to elucidate social demo-

graphic data, practical issues related to daily pharmacy prac-

tice (Q1: Number of prescriptions dispensed in one day, Q2:

Medicines prescribed in pharmacy, Q3: Enhanced pharmacy

services offered, Q4: Reference books and computer usage in

daily pharmacy practice, Q5: Dispensing computer usage),

and barriers to pharmacy service delivery. Multiple-choice

questions were employed on pharmacy practice issues, while

questions related to barriers require participants to choose out

of 5 options for an answer: “strongly disagree,” “disagree,”

“unsure,” “agree,” and “strongly agree.” We referenced sev-

eral preceding literatures in drawing up the 5 selective scale

method.

We calculated the odds of affirmation and denial to each

query, Japanese and American, respectively. Mann-Whitney U

test was used to compare differences as appropriate. We suc-

cessively calculated their ratio, processed the result statisti-

cally, and turned out the 95% confidence interval (CI). All

significant differences were judged by the significant level of

5%. All statistical analyses were performed by the software

Excel Statistics Bell Curve 2016 (Society Information Service

Inc, Japan). We calculated the ratio of odds and 95% CI using

the software. Each item of data dealt with 3 significant figures.

The number of object community pharmacists dealt with an

integral number naturally.

Results

Age and the Experiential Period Group of ObjectPharmacists

American pharmacists participating in the survey were younger

than Japanese pharmacists. Approximately three-quarters

(72.6%) of participants were 20 to 30 years old in United States.

In Japan, 65.5% of participants were 41 to 60 years old. The

years of work experience of community pharmacists in United

States were less than that of pharmacists in Japan (Table 2).

A significant difference in pharmacists’ demographic infor-

mation and drug dispensing rate was found between pharma-

cists according to age, work experience, and number of

prescriptions dispensed in 1 day (Mann-Whitney U test; P

value <.05).

The Contents of Pharmacists’ Daily Mission

In Illinois, United States, approximately 58 (93.5%) respon-

dents dispensed more than 100 prescriptions a day during this

2 Journal of Pharmacy Practice XX(X)

Table 1. Survey Questions.

Age (years) c 20 to 30 c 30 to 40 c40 to 50 c 50 to 60 c 60þ

Work experience (years)

as a pharmacist

c 0 to 5 c 5 to 10 c 10 to 20 c 20þ

Q1: Number of prescriptions dispensed in one day

c 0 to 10 c 10 to 50 c 50 to 100 c 100þ

Q2: Medicines prescribed in pharmacy (check all that apply)

cVitamins cNSAIDs cAntibiotics c Eye drops cNicotine repl. Therapy cBlood press. Agents

cAnti-allergies agents cNasal decongestants cCough remedies cOral hypoglycemic agentscCholesterol lowering agents cAnticancer agents cAntiretroviral drug c Sterile products cNarcotics

Q3: Enhanced pharmacy services offered (check all that apply)

cRefill a prescription cVaccination/injection cMedication review cHome health care cDiet plans

cTherapeutic drug monitoring cHerbal medicines cHyperlipidemia management servicescHypertension management services cNutritional supplement cOsteoporosis management services

cPediatric care c Skin care c Smoking cessation cWeight reduction consultant cWound care cOther ()

Q4: Reference books and computer usage in daily pharmacy practice

cUnited States Pharmacopeia (USP) c PDR cMeyler’s Side Effects of Drugs cThe Merck Index

cAmerican Drug Index cPharm. data base cWeb-based info. cOther ( )

Q5: Dispensing computer usage

cNot available cBarcode reader cRegular internet use cRegular e-mail use cOther ( )

Q6: Barriers to pharmacy service delivery

� Pharmacists lack sufficient time to offer services.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� There is a shortage of pharmacists and/or pharmacy employees.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Customers do not sufficiently appreciate the work of pharmacists.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists lack appropriate knowledge.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacy technicians have insufficient confidence in pharmacists.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� The salary level for pharmacists is inappropriate.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists lack authority and prevention against medical malpractice by physicians.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists are underestimated by other health-care professionals.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists are under pressure to generate sales.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� There is a lack of financial rewards for enhanced pharmacy services.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists receive insufficient training before graduation.

c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

� Pharmacists lack sufficient interpersonal and management skills.c Strongly disagree cDisagree cUnsure cAgree c Strongly agree

Hasumoto et al 3

study period, while in Japan, 32 (55.2%) respondents dispensed

10 to 50 in a day (Table 2).

Table 3 shows the comparison of enhanced pharmacy ser-

vices offered in Japan and United States. There are marked

difference in the services in the 2 nations. As the vaccina-

tion/injection and the refilling of prescriptions are not legally

authorized in Japan at present, these were not offered as

enhanced pharmacy services in Japan. On the other hand, there

was much less opportunity in United States than in Japan to

offer diet plans and home health care.

Barriers to Pharmacy Service Performance

We evaluated the difference in the provision of pharmaceutical

services of community pharmacists between United States and

Japan (Table 4). Factors detecting statistically significant dif-

ference were 6. Japanese respondents approved the following 4

factors more than their American counterparts with statistically

significant differences: (i)-1. Pharmacists’ lack of appropriate

knowledge. (i)-2. Pharmacists’ lack of sufficient interpersonal

and management skills. (i)-3. Pharmacists’ insufficient training

before graduation. (i)-4. Shortage of pharmacists and other

employees in the pharmacy. On the other side, they strongly

disagreed or disagreed (hereafter referred to as “disapproved”)

more with the following 2 factors more than their American

counterparts with statistically significant difference: (ii)-1.

Lack of financial rewards for enhanced pharmacy services.

(ii)-2. Existence of pressure to generate sales.

In the survey of Japan, the community pharmacists who

were educated in the 6-year system in the education of phar-

maceutical sciences were identified. The resemblance between

the group which has graduated in the 6-year system and the

4-year system group on barriers to pharmacy practice was

revealed (Table 5). And there is no difference in the

pharmaceutical services provided by the 6-year and 4-year pro-

gram pharmacists (Table 6).

Discussion

The authors investigated the barriers to pharmacy practice in

Japan and United States in this study. This study indicated that

the community pharmacists in United States replied that they

received efficient pharmacy training before graduation and

have appropriate knowledge and skills as pharmacists. In con-

trast to United States, the community pharmacists in Japan

recognized that they received inefficient pharmacy training

before graduation and lacked appropriate knowledge and skills

as pharmacists.

The education of pharmaceutical sciences in United States is

a model for the 6-year system in the education of pharmaceu-

tical sciences in Japan. The 6-year system was initiated in 2006

in Japan. Therefore, most respondents over their 20s were not

graduated from the 6-year system of education. Since 86.2% of

Japanese respondents are older than 30 years in this study, this

result mainly reflects the perspectives of graduates from the

4-year system of education. Contrastively, only 27.4% of

United States respondents are over 30 years, and the work

experience years of all respondents are under 10 years of age.

Therefore, this result had to be considered to reflect the

opinions of pharmacists in their 20s with little experience.

Although the Japanese pharmacists felt a shortage of phar-

macists and other employees in the pharmacy more than the

American respondents, the pharmacists in United States dis-

pensed a much greater number of prescriptions in a day than the

Japanese. Moreover, their ratio of approving the shortage is

much less than that of the Japanese (Table 4). It is possible

that the cause may be considered to be Japanese pharmacists’

lack of knowledge and skill, as Japanese pharmacists’ lack of

Table 2. Pharmacists’ Demographic Information and Drug DispensingRate.

VariableIL, United States(n ¼ 62), n (%)

Japan (n ¼ 58),n (%) P Value

Age, years

20-30 45 (72.6) 7 (12.1) .000131-40 13 (21.0) 16 (27.6)

41-50 3 (4.8) 22 (37.9)

51-60 1 (1.6) 7 (12.1)61þ 0 5 (8.6)

Work experience, years0-5 50 (80.6) 9 (15.5) .0001

6-10 12 (19.4) 11 (19.0)11-20 0 20 (34.5)

21þ 0 18 (31.0)Number of prescriptions dispensed in 1 day

0-10 0 2 (3.4) .000111-50 0 32 (55.2)

51-100 4 (6.5) 17 (29.3)101þ 58 (93.5) 7 (12.1)

Mann-Whitney U test.

Table 3. Enhanced Pharmacy Services Offered in the United Statesand Japan.

Pharmacy ServicesUnited States,

n (%)Japan,n (%) P Value

Refill a prescription 53 (85.0) 0 .0001

Vaccination/injection 57 (91.9) 0 .0001Medication review 48 (77.4) 21 (36.2) .0001

Smoking cessation 26 (41.9) 8 (13.8) .0001

Therapeutic drug monitoring 21 (33.9) 1 (1.7) .0001Hypertension management services 18 (29.0) 27 (46.6) .065

Herbal medicines 13 (21.0) 6 (10.3) .066Hyperlipidemia management services 11 (17.7) 4 (6.9) .63

Nutritional supplement 7 (11.3) 28 (48.3) .0001Weight reduction consultant 6 (9.7) 2 (3.4) .159

Osteoporosis management services 5 (8.1) 7 (12.1) .523Pediatric care 5 (8.1) 7 (12.1) .523

Skin care 5 (8.1) 18 (31.0) .02Wound care 2 (3.2) 12 (20.7) .04

Home health care 1 (1.6) 39 (67.2) .0001Diet plans 1 (1.6) 35 (60.3) .0001

Mann-Whitney U test.

4 Journal of Pharmacy Practice XX(X)

appropriate knowledge and insufficient training before gradua-

tion were detected statistically positive significant in this study.

It is thought to be a very important factor for efficiency that

United States has the system of pharmacy technicians, and they

assist in physical dispensing. This system is good for support-

ing the pharmacists to act to the best of their ability; hence, it is

considered worthy of investigation to adapt the system for

Japanese pharmacies. And the differences in services, such

refilling of prescriptions and vaccination which American

pharmacists are given more strong authority from the doctor,

may affect the results of the survey.

It is reasonable for pharmacists to feel the lack of appropri-

ate knowledge, as the service of community pharmacists is

lately advancing and deepening, and the recent progress is so

rapid. Aside from such backgrounds, Japanese approval odds

were statistically positive, significant compared to the results

from Illinois, United States. This means that Japanese pharma-

cists have less chance to obtain appropriate knowledge than

pharmacists in United States. It suggested the better method

of lifelong education for community pharmacists is provided in

the United States. In addition to the chance to learn at school or

through self-study, it also suggests that lifelong education for

community pharmacists is insufficient in Japan.

This insufficient Japanese education system is also suggested

by the result of “Pharmacists’ insufficient training before

graduation” and the “Pharmacists’ lack of sufficient interperso-

nal and management skills.” These indicated that the Japanese

system of community pharmacy also lacks arrangement of leg-

islation, as mentioned. In the present circumstances, Japanese

patients select community pharmacies not with regard to the

ability of pharmacists but with regard to the distance from the

medical institution. The customers do not have sufficient appre-

ciation of the pharmacists’ work. Japanese pharmacists have no

driving force for advancing pharmacists’ specialties. It is neces-

sary to clear the specialty of Japanese community pharmacists

legally and by disclosure of information.

A question of “Under-estimation of pharmacists by other

healthcare professionals” is approved by 44.8% of Japanese

pharmacists and 63.9% by United States. This is a common

problem for community pharmacists. Their service has been

advancing recently and is of deep concern for medical care and

cure. However, it is not sufficiently understood by other health-

care professionals because of quite new experiences. This

result indicated embarrassment of pharmacists participating

in team medical treatment.

The question of “Customers’ insufficient appreciation of the

pharmacists’ work” was approved not only by Japanese popu-

lation (56.2%) but also US population (53.2%). In spite of there

being significant differences in the services in the 2 nations

(Table 3), the ratio of approval was very similar. It is

Table 4. Univariate Analysis of Variables Associated With Barriers to Pharmacy Service Delivery Between the United States and Japan.

Question

United States (n ¼ 62) Japan (n ¼ 58)Odds Ratio for

Strongly Agree orAgree Responsesin Japan (95% CI)

StronglyDisagree/

Disagree, n (%)Unsure,n (%)

StronglyAgree/

Agree, n (%)

StronglyDisagree/

Disagree, n (%)Unsure,n (%)

StronglyAgree/

Agree, n (%)

Pharmacists lack appropriate knowledge 55 (88.7) 7 (11.3) 0 11 (19.0) 23 (39.7) 24 (41.3) 120.0 (14.7-982.5)Pharmacists lack sufficient interpersonal

and management skills

35 (57.4) 16 (26.2) 10 (16.4) 12 (20.7) 16 (27.6) 30 (51.7) 8.75 (3.31-23.1)

Pharmacists receive insufficient training

before graduation

47 (77.1) 8 (13.1) 6 (9.8) 17 (29.3) 25 (43.1) 16 (27.6) 7.37 (2.48-21.93)

There is a shortage of pharmacists and/or

pharmacy employees

21 (33.9 18 (29.0) 23 (37.1) 8 (13.8) 15 (25.8) 35 (60.4) 3.99 (1.52-10.52)

Pharmacy technicians have insufficient

confidence in pharmacists

54 (88.5) 5 (8.2) 2 (3.3) 38 (65.5) 13 (22.4) 7 (12.1) 4.97 (0.98-24.27)

Customers do not sufficiently appreciate

the work of pharmacists

14 (22.6) 15 (24.2) 33 (53.2) 7 (12.2) 18 (316) 32 (56.2) 1.94 (0.69-5.43)

The salary level for pharmacists is

inappropriate

42 (67.7) 7 (11.3) 13 (21.0) 17 (30.4) 28 (50.0)) 11 (19.6) 1.87 (0.71-4.93)

Pharmacists lack authority and preventionagainst medical malpractice by

physicians

22 (36.1) 19 (31.1) 20 (32.8) 13 (22.4) 28 (48.3) 17 (29.3) 1.44 (9.56-3.69)

Pharmacists are underestimated by other

health-care professionals

13 (21.3) 9 (14.8) 39 (63.9) 10 (17.2) 22 (37.9) 26 (44.8) 0.87 (0.33-2.27)

Pharmacists lack sufficient time to offer

services

11 (17.8) 10 (16.1) 41 (66.1) 15 (25.8) 16 (27.6) 19 (46.6) 0.48 (0.91-1.21)

There is a lack of financial rewards for

enhanced pharmacy services

13 (21.3) 6 (9.8) 42 (68.9) 15 (25.9) 25 (43.1) 18 (31.0) 0.37 (0.15-0.94)

Pharmacists are under pressure to

generate sales

9 (14.5) 2 (3.2) 51 (82.3) 36 (62.1) 16 (27.6) 6 (10.3) 0.03 (0.01-0.09)

Abbreviation: CI, confidence interval.

Hasumoto et al 5

considered a common problem between United States and

Japan. As the pharmacists were generally active in highly spe-

cialized fields only indirectly affecting the patients, the func-

tion of community pharmacists is difficult to realize by the

public. Moreover, paternalism has been dominant in medical

treatment for a long time. Although this attitude appears to be

changing recently, it is anticipated to continue for the time

being. It is a common problem between the 2 nations that the

function of community pharmacists is underestimated by the

public, and it is considered important that pharmacists them-

selves act for customers’ demand and recognition.

Clinical pharmacists in United States have advanced knowl-

edge, skills, and “dependent prescription rights” on receiving

delegation of authority from the doctor. Therefore, community

pharmacists in United States give vaccinations and refill pre-

scriptions. In recent years, in Japan, the laws and system on the

insurance, the medical care, and the welfare have changed

rapidly, and the knowledge and skills for the pharmacists have

changed day after day and become complicated. It is necessary

to change the working environment around the community

pharmacists and the existence of dispensing system and the

community pharmacy.

The US curriculum followed a much more consistent policy

and placed a greater emphasis on fostering the ability to optimize

individual patient’s pharmacotherapy by making full use of

clinical reasoning.8,9 The education of pharmaceutical sciences

in United States as a developed country for pharmaceutical care

placed the practical training in the clinical site rather than knowl-

edge through classroom learning. The community pharmacists in

US practice “learning from the patient” from their undergraduate

curriculum.10 In Japan, the educational model of new core cur-

riculum of pharmaceutical sciences has come into force, which

placed significance on the patient-oriented clinical education. It

is necessary now more than ever to have knowledge of practical

and advanced drug therapy and be educated to increase the

applied skills for the 6-year system in the education of pharma-

ceutical sciences. The education associated closely with the clin-

ical site is expected to contribute greatly to the appearance of

high-quality pharmacists.

There is a statistically significant difference or not between

the 4- and 6-year program and of no effect on the services

provided. This suggests that the 6-year program has not

impacted on the service offered.

Limitation of the Study

Our study had limitations that could have influenced some of

the results. Limitations of this study revolve around study pop-

ulation. The sample of pharmacists was taken from Illinois

alone which may not be representative of all US pharmacists.

Table 5. Comparison of Pharmacists Who Had Studied Under the 4-Year Program and the 6-Year Program in Japan.

Question

Pharmacists Who Had Studied Underthe 4-Year Program (n ¼ 51)

Pharmacists Who Had Studied Underthe 6-Year Program (n ¼ 7)

PValue

StronglyDisagree Disagree Unsure Agree

StronglyAgree

StronglyDisagree Disagree Unsure Agree

StronglyAgree

Pharmacists lack appropriate knowledge 3 7 20 15 6 0 1 3 2 1 .797Pharmacists lack sufficient interpersonal

and management skills

4 5 15 20 7 0 3 2 0 2 .468

Pharmacists receive insufficient training

before graduation

4 11 23 12 1 1 1 2 2 1 .574

There is a shortage of pharmacists and/

or pharmacy employees

2 5 15 11 18 1 0 0 3 3 .468

Pharmacy technicians have insufficient

confidence in pharmacists

14 21 10 6 0 1 2 3 1 0 .290

Customers do not sufficiently appreciate

the work of pharmacists

3 4 17 22 5 0 1 1 5 0 .691

The salary level for pharmacists is

inappropriate

5 12 24 6 4 0 2 4 1 0 .944

Pharmacists lack authority andprevention against medical

malpractice by physicians

4 7 24 10 6 0 2 4 1 0 .468

Pharmacists are underestimated by

other health-care professionals

3 6 19 16 7 0 1 3 2 1 .963

Pharmacists lack sufficient time to offer

services

4 9 13 16 9 1 2 2 2 0 .220

There is a lack of financial rewards for

enhanced pharmacy services

5 8 21 10 7 1 1 4 1 0 .425

Pharmacists are under pressure to

generate sales

16 17 14 4 0 1 2 2 1 1 .170

Mann-Whitney U test.

6 Journal of Pharmacy Practice XX(X)

A significant difference in pharmacists’ demographic informa-

tion and drug dispensing rate between Illinois and Japan was

found. The overall response rate was very low (*10%). The

fact that the questionnaire was made available electronically

could have produced bias in selection, favoring professionals

who use the internet more widely and those who have e-mail.

Conclusion

We investigated the performance of pharmaceutical care in

Illinois of United States and Japan with a questionnaire-based

study and found that there are marked differences in the 2

nations. No difference is seen in the performance of pharma-

ceutical services of community pharmacists between the 6-year

and 4-year pharmacist program in Japan. And almost all the

6-year and 4-year program pharmacist agreed that lack of

appropriate knowledge and insufficient training before gradua-

tion are major barriers to performing pharmacy care services.

This suggested that the 6-year program has not impacted on the

service offered in Japan. This report is the first to compare the

performance of pharmacy practice in Japan and Illinois of

United States. Our results provide useful information about

pharmacy education programs and pharmacy services to

patients in Japan. Once the schools are improved, the work

of advocacy to increase the rights and responsibilities of phar-

macists must begin.

Authors’ Note

The present research has been planned and will be administered in

compliance with Ethical Principles Relating to Epidemiological

Research (Ekigaku kenkyu ni kansuru rinri shishin), Ministry of

Health, Labor, and Welfare/Ministry of Science and Education

(revised April 1, 2013). It also observes laws relating to guarding

personal information. This study was approved by medical ethics

committee of Kanazawa University on June 22, 2016 (approval num-

ber: 54), by Illinois State University IRB on August 3, 2016 (approval

number: 924545-2).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to

the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, author-

ship, and/or publication of this article.

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Table 6. Enhanced Pharmacy Services Offered by Pharmacists WhoHad Studied Under the 4-Year Program and the 6-Year Program inJapan.

Pharmacy Services

Pharmacists WhoHad Studied

Under the 4-YearProgram (n ¼ 51)

Pharmacists WhoHad Studied

Under the 6-YearProgram (n ¼ 7)

PValue

Refill a prescription 0 0 �Vaccination/injection 0 0 �Medication review 20 1 .301

Smoking cessation 8 0 .512Therapeutic drug

monitoring

0 1 .559

Hypertension

management services

25 2 .398

Herbal medicines 5 1 .852

Hyperlipidemiamanagement services

3 1 .726

Nutritional supplement 25 3 .797Weight reduction

consultant

2 0 .870

Osteoporosis

management services

5 2 .437

Pediatric care 6 1 .926

Skin care 17 1 .425Wound care 12 0 .323

Home health care 33 6 .385Diet plans 31 4 .889

Mann-Whitney U test.

Hasumoto et al 7