Open-label, Multicenter, Randomized, Parallel-Group Comparative Study on the Utility of Telephone Follow-Up in Community Pharmacies for Detecting Triple Whammy in Patients with Multiple Drug Combinations

Polypharmacy has become a major problem owing to the increasing complexity of diseases and drug therapies caused by the rapid development of a hyper-aged society in Japan. Among these, it has been reported that the concomitant use of renin angiotensin system inhibitors, diuretics, and NSAIDs increases the risk of acute kidney injury; this has been called for attention as “triple whammy.” Confirmation of concomitant medications in the community pharmacy is a crucial issue. In this study, with the objective of optimizing methods for detecting “triple whammy,” we investigated the impact of telephone follow-up on the detection ratio compared with the conventional method of verification at the pharmacy counter during the subsequent visit. Pharmacies in Shiga Prefecture that agreed to participate in this study were randomly assigned to two groups, and the results of the concomitant medication checks corresponding to each group were analyzed. The percentage of confirmed concomitant medications was significantly higher in the telephone follow-up group (97.6％) compared with 63.5％ in the conventional counter-confirmation group (P < 0.01), and the percentage of confirmed NSAIDs (ie, triple whammy detection) was also significantly higher in the telephone follow-up group (P < 0.01). The efficiency of the confirmation of concomitant medication was significantly improved, resulting in an increase in the detection rate of triple whammy, suggesting that telephone follow-up is an effective method for follow-up during the medication period in community pharmacies. This study protocol has been registered with the UMIN Clinical Trials Registry (UMIN‑CTR, University Hospital Medical Information Network: UMIN000047550).