Research on the Current Status of Pharmacists’ Professional Functions in Hospitals and Factors Influencing Their Improvement and Expansion

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Hospital pharmacists are expected to ensure the safe and effective use of medicines and contribute to multidisciplinary care; however, their availability and functions remain uneven. The “Ward Pharmaceutical Care Fee I” (WardPharm-1) serves as an indicator of the implementation of advanced ward-based pharmaceutical care. This study investigated the national trends and determinants of WardPharm-1 filing, focusing on pharmacist-to-bed ratios and hospital characteristics, to identify factors enabling high-quality pharmacist services. Methods We examined national open datasets from the Ministry of Health, Labor, and Welfare for fiscal years 2021–2023, linking the “List of Registered Medical Care Providers (Medical)” and the “Hospital Bed Function Report.” Hospitals eligible for WardPharm-1 filing were identified, excluding psychiatric facilities and those not fulfilling minimum staffing standards. Per-100-bed staffing for eight healthcare professions and hospital bed counts were determined. Logistic regression and receiver operating characteristic (ROC) curve analyses determine the association between pharmacist staffing (Ph/100 beds) and WardPharm-1 filing, stratified by hospital type, Diagnosis Procedure Combination (DPC) group, and regional population density. Results Among ~5800 eligible hospitals annually, 31%–34% filed WardPharm-1. Pharmacist staffing per 100 beds demonstrated the strongest association with filing (odds ratio ≈1.2 annually), exceeding that in all other professions. Median Ph/100 beds were ~5.2 in filing hospitals and 2.6 in non-filers, with cutoff values of 3.7–4.0 pharmacists/100 beds (area under the ROC curve 0.83–0.84). WardPharm-1 filing was most frequent in general hospitals (≈50%) and DPC university or specified-function hospitals (≈90%) and least frequent in long-term care hospitals (≈3%) and depopulated regions (<25%). Sustained filers maintained Ph/100 beds around 5.2, whereas withdrawal correlated with declines to 3.4–4.3. Filing hospitals generally had twice the bed counts of non-filers. Conclusions WardPharm-1 filing strongly depends on the pharmacist-to-bed ratio. Higher-function hospitals require higher staffing density, whereas smaller or rural hospitals exhibit lower filing rates, suggesting workforce maldistribution. Strengthening ward-based pharmacist services will necessitate addressing staffing imbalances and advancing digital transformation, task shifting, and interprofessional collaboration to ensure administration of safe, efficient pharmacotherapy across Japan. Hospital pharmacists WardPharm-1 filing Pharmacist-to-bed ratio Workforce distribution Team-based care Healthcare system in Japan Background The healthcare delivery system of Japan is a critical foundation for safeguarding public health and ensuring that people can live with peace of mind [1]. Patient and community needs for healthcare have been increasing and diversifying; patient profiles continuously changing; and relationships with long-term care and daily life becoming more interwoven. Simultaneously, the environment surrounding healthcare is undergoing a rapid transformation due to population aging, advances in medical technology, tighter constraints on public finances, a shrinking labor force, and faster-than-expected progress in information and communications technology (ICT). Against this background, there exists an urgent need to establish an environment in which everyone can access healthcare without anxiety [1]. To this end, we must look ahead as far as possible and design a forward-looking, constructive pathway for functioning of healthcare delivery and healthcare professionals in the future [2]. For sustainable maintenance of Japan’s healthcare sector, it is essential to improve the productivity and added value of healthcare professionals; the expertise and insights of pharmacists are particularly critical contributors to this goal. Building on the professional knowledge developed through 6-year pharmacy education, pharmacists must assume efficient, high-productivity roles that can address workforce shortages [2]. Specifically, it is necessary to reform the work structure centered on dispensing to strengthen functions that are core to the profession—such as analyzing prescriptions, advising patients and other professionals, and developing pharmacotherapy protocols. Through these efforts, pharmacists proactively demonstrate their presence as members of multidisciplinary teams, acting as professionals in pharmaceutical services [2]. In hospitals, team-based care has advanced through ward assignment of pharmacists and a collaboration with other professions. Beyond managing patients’ own medications and medication adherence on the ward, pharmacists are expected to further enhance the effectiveness and safety of pharmacotherapy by proposing treatment plans to physicians—including monitoring therapeutic effects and adverse reactions and ordering tests as required [2]. Implementing these activities alleviates the burden on physicians and nurses [3–5] and has been widely reported to improve the quality of drug therapy and safe use of medicines across a broad range of settings such as acute care wards, subacute wards, chronic care wards, operating rooms, and oncology chemotherapy units [6–13]. Nevertheless, in the “Survey on Securing Hospital Pharmacists” conducted by the Japan Hospital Association in 2022 (2467 hospitals surveyed; 706 responses), 74.9% of responding hospitals reported lack of hospital pharmacists. Reasons cited for determining the required number of pharmacists included improving the quality of pharmaceutical services (90.5%), responding to requests from other departments such as clinical and nursing divisions (80.5%), and improving work schedules (71.1%) [14]. In the Ministry of Health, Labor, and Welfare (MHLW) project report on measures to secure pharmacists (questionnaire to 3183 hospitals; 631 valid responses), 64.8% of hospitals and 41.2% of community pharmacies recognized pharmacist shortages. Hospitals with pharmacist shortages reported impacts on routine work such as ward services (72.1%), overtime work (53.3%), and participation in team-based care (52.3%) [15]. Furthermore, the proportion of hospitals filing claims for the “Ward Pharmaceutical Care Fee I” (hereafter, WardPharm-1)—an indicator of clinical pharmacist activity—was reported as 35% in the 2022 Task Shift/Share Promotion Project report on the working conditions of hospital pharmacists (8194 hospitals surveyed; 2829 responses) [16] and 47% in a special survey on the results of the 2020 fee schedule revision (1500 hospitals surveyed; 494 responses) [17], i.e., less than half in both reports. These surveys suggest that hospital pharmacist services are not being completely implemented. An MHLW Pharmaceutical and Food Safety Bureau study group on the training and quality improvement of pharmacists predicted a future overall surplus of pharmacists and also noted maldistribution across practice settings and regions. Securing hospital pharmacists was identified as an emergent issue, and attempts to address maldistribution—tailored to local circumstances and integrated with workforce measures in regional healthcare plans—were recommended. After reports and deliberations in the Social Security Council’s Medical Care Subcommittee, pharmacist maldistribution countermeasures were incorporated into the 8th Medical Care Plan [18, 1]. Despite the high expectations for hospital pharmacists, it is difficult to state that their expected functions are being completely verified under current conditions. This study analyzes data to clarify differences between institutions where hospital pharmacists are sufficiently functional and those where they are not, with an aim to identify factors that facilitate thriving of hospital pharmacists. Methods 1. Databases We used two open datasets viz., the “List of Registered Medical Care Providers (Medical)” and the Hospital Bed Function Report. The former is an open dataset published monthly by the Regional Bureaus of Health and Welfare (Hokkaido, Tohoku, Kanto-Shinetsu, Tokai-Hokuriku, Kinki, Chugoku-Shikoku, Shikoku, and Kyushu) on the acceptance status of notifications for medical fee items at hospitals and clinics that provide insured medical services [19]. The latter is an annual open dataset (aggregated for July each year) published by the MHLW and contains information on bed functions and staffing at medical institutions with general and long-term care beds [20]. We examined the data for 2021, 2022, and 2023. To align with the Hospital Bed Function Report month, we used the July files of the “List of Registered Medical Care Providers (Medical)” for each year. The number of hospitals registered in the July “List” was 8211 (2021), 8161 (2022), and 8133 (2023), and the number of hospitals published in the Hospital Bed Function Report was 7018, 6959, and 6974, respectively. We linked the two datasets using facility codes and hospital names. Because the Bed Function Report excludes psychiatric beds, we removed hospitals with ≥80% psychiatric beds (resulting in 6875 6806 and 6837 hospitals, respectively). We further excluded hospitals that did not fulfill legally required minimum staffing levels for physicians or pharmacists—judged to undermine the credibility of notifications—resulting in 6386 6064 and 5966 hospitals, respectively. Among these, hospitals billing any of the following were considered eligible to file WardPharm-1 and comprised the analytic sample: basic hospitalization fees for general wards, long-term care wards, tuberculosis wards, psychiatric wards, advanced treatment hospitals, or specialty hospitals. The resulting number of hospitals was 5833 (71.0%), 5512 (67.5%), and 5401 (66.0%), respectively. Population data were obtained from the 2020 Population Census basic tabulations, and habitable land area for municipalities was recorded from “Statistical Observations of Municipalities 2022” [21]. 2. Analytic items As a claims-based indicator of high-quality hospital pharmacist services, we focused on WardPharm-1. Requirements to file WardPharm-1 include assigning a dedicated pharmacist to each ward and providing ≥20 h/week of ward pharmacist services. Required activities are (a) obtaining medication and injection histories and adverse event information from patients/families and identifying fundamental issues; (b) collecting and disseminating to staff the latest safety communications (e.g., emergency safety information, PMDA safety information, risk management plans, and recalls); (c) at admission, reconciling brought-in medications (names, strengths, dosage forms, etc.) and proposing a written medication plan to physicians; (d) checking for drug–drug interactions before the coadministration of two or more agents; (e) providing preadministration explanations to patients/families concerning medicines requiring special safety management; (f) performing necessary calculations (e.g., infusion rates and doses) before administration for such high-risk medicines; and (g) in addition to (a)–(f), performing the following as applicable: (1) under pre-agreed protocols, changing drug selection, dose, route, duration, or ordering tests; (2) actively proposing prescriptions to physicians regarding drug selection, dose, route, and duration; (3) proposing changes based on therapeutic drug monitoring and adverse event surveillance; and (4) performing appropriate aseptic preparation of anticancer agents [22]. It has been suggested that performing these WardPharm-1–required activities contributes to improved quality of pharmacotherapy and patient safety [23]. Therefore, we considered WardPharm-1 filing as an indicator expressing that hospital pharmacists are delivering adequate pharmaceutical care. Previous literature suggests a relationship between WardPharm-1 filing and the number of employed pharmacists, e.g., “increased staffing to file WardPharm-1” (all 34 national Rousai hospitals responding) [23]; “insufficient pharmacist staffing most commonly cited reason for not filing WardPharm-1” (Gifu Prefecture; 47/91 responding hospitals) [24]; and “across all hospital functions, hospitals wished to engage in ward pharmacist services if staffing were sufficient” (Kyushu, Yamaguchi, Okinawa; 262/896 responses) [25]. Therefore, we hypothesized an association between WardPharm-1 filing and the number of employed pharmacists. Because hospitals with more pharmacists may also employ more of other professionals, we compared staffing for physicians, nurses, assistant nurses, nursing aides, physical therapists, occupational therapists, and speech–language–hearing therapists—professions commonly working on wards. Using the total number of beds and staff counts of each hospital, we calculated per-100-bed staffing for each profession (e.g., pharmacists per 100 beds = Ph/100 beds) to adjust for bed scale. The full-time equivalent number of part-time staff in the bed function report is the number of working hours per week of part-time staff divided by the scheduled working hours per week of the facility. Bed counts (total, and by general, long-term care, psychiatric, infectious disease, and tuberculosis) were collected from the “List of Registered Medical Care Providers (Medical).” To explore the relationship between hospital function and WardPharm-1 filing, we used Diagnosis Procedure Combination (DPC) group categories—university hospital main group, specified hospital group, standard hospital group, and non-DPC hospitals—available in the Bed Function Report. In DPC hospitals, hospital roles are evaluated based on factors such as the basic coefficient and function evaluation coefficients I (e.g., add-ons for infection prevention, medical safety, and WardPharm-1) and II (e.g., emergency care, complexity, coverage, and regionality). We defined hospitals filing WardPharm-1 as “WardPharm-1 hospitals” and those not filing as “non-filers.” Hospitals that transitioned from non-filer in year t to filer in year t+1 were defined as “new filers,” those maintaining filing for 2 or 3 consecutive years were defined as “sustained filers,” and those transitioning from filer to non-filer were defined as “withdrawn filers.” 3. Regional classification of secondary medical areas Japan had 335 secondary medical areas (SMAs) during 2021–2023. We classified the SMAs into three types based on the population distribution as follows: metropolitan (population ≥1,000,000 or population density ≥2000 persons/km), provincial city (population ≥200,000 or population 100,000–200,000 with density ≥200 persons/km), and depopulated (all others). 4. Hospital type Hospitals were categorized according to the composition ratio of general, long-term care, and psychiatric beds among total authorized beds as follows: “general hospitals” (general beds ≥80%), “long-term care hospitals” (long-term care beds ≥80%), and “care-mix hospitals” (neither of the above). 5. Statistical analysis Logistic regression analysis was conducted using the number of staff per 100 beds for each healthcare profession as explanatory variables and the presence or absence of WardPharm-1 filing as the dependent variable. When analyzing staff numbers per 100 beds, personnel were categorized in increments of 0.5 persons per 100 beds. Logistic regression and receiver operating characteristic (ROC) analyses were performed to calculate the cutoff (CO) values and the area under the ROC curve (AUC) for the number of pharmacists per 100 beds (Ph/100 beds) and the number of hospital beds required for WardPharm-1 filing. All statistical analyses were conducted using JMP ® version 18 (SAS Institute Japan Inc., Tokyo, Japan). Results 1. Per-100-bed staffing and contribution to WardPharm-1 filing Across the eight professions examined in this study (physicians, pharmacists, nurses, assistant nurses, nursing aides, physical therapists, occupational therapists, and speech–language–hearing therapists), the logistic regression revealed that the odds ratio (OR) for Ph/100 beds contributing to WardPharm-1 filing was ~1.2 each year and was the highest among professions (Tables 1A–C) (Insert Table 1 near here). The ORs for other professions ranged from 0.95 to 1.01, suggesting limited contribution to filing. Among the eight counted professions in surveyed hospitals, Ph/100 beds exerted the strongest positive effect on filing. 2. National WardPharm-1 filing status and relationships with Ph/100 beds and bed count Nationally, the numbers (and proportions) of hospitals eligible to file WardPharm-1 were 5833 (91.3%), 5512 (90.9%), and 5401 (90.5%) in 2021–2023, with 1820 (31.2%), 1801 (32.7%), and 1856 (34.4%) actually filing, respectively (Table 2A) (Insert Table 2 near here). Median (IQR) Ph/100 beds among eligible hospitals were 3.26 (2.10–5.00), 3.33 (2.14–5.00), and 3.41 (2.17–5.15). Among WardPharm-1 hospitals, the median Ph/100 beds were 5.24 (3.92–6.71), 5.21 (3.92–6.80), and 5.24 (3.92–6.96) and among non-filers, the bed counts were 2.58 (1.83–3.75), 2.63 (1.85–3.76), and 2.63 (1.86–3.85), respectively (Table 2B). Median differences between filers and non-filers were 2.76, 2.58, and 2.61 pharmacists/100 beds, respectively. The Ph/100-bed CO values (AUCs) for being a WardPharm-1 hospital were 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83), respectively (Table 2B). Median bed counts of WardPharm-1 hospitals were ≥2.1 times those of non-filers each year (ratios 2.19, 2.16, and 2.12, respectively). 3. Three-year filing/withdrawal patterns and trends in Ph/100 beds and bed counts Trends in Ph/100 beds and bed counts based on 3- or 2-year filing patterns are presented in Table 3(Insert Table 3 near here). There were 1431 sustained filers over all 3 years (“F-F-F”), with median (IQR) Ph/100 beds of 5.34 (4.02–6.80), 5.33 (4.04–6.93), and 5.41 (4.02–7.04) in 2021–2023, respectively. Two-year sustained filers in the first half (“F-F-”) were 1600 with 5.26 (4.00–6.77) and 5.24 (4.00–6.81), and those in the second half (“-F-F”) were 1602 with 5.28 (4.00–6.91) and 5.31 (4.00–7.03). Withdrawn filers (“F-F-N”) were 54 with 4.88 (2.97–5.52), 4.34 (3.29–5.35), and 4.11 (2.82–4.98), respectively; those of “F-N-N” were 32 with 3.95 (2.83–5.64), 3.38 (2.66–4.47), and 3.57 (2.23–4.65), respectively. First-half withdrawals (“F-N-”) were 48 with 3.99 (3.02–5.64) and 3.49 (2.72–5.00); those of second-half withdrawals (“-F-N”) were 61 with 4.35 (3.06–5.40) and 4.28 (2.74–5.13). New filers (“N-N-F”) were 72 with 3.96 (2.58–5.41), 4.17 (2.71–5.31), and 4.46 (3.29–5.81), respectively; those of “N-F-F” were 86 with 4.06 (2.94–5.42), 4.53 (3.26–5.59), and 4.33 (3.44–5.30), respectively. First-half new filers (“N-F-”) were 101 with 4.04 (2.94–5.43) and 4.51 (3.24–5.68) and those of second-half new filers (“-N-F”) were 90 with 4.21 (2.76–5.71) and 4.55 (3.32–5.82). Median bed counts exhibited slight changes within groups over 3 years. Groups sustaining filing for 3 years or for either 2-year period had a median count of ≥200 beds and other groups had <200 beds. 4. WardPharm-1 filing according to SMA density type: Ph/100 beds and bed counts According to the SMA category, WardPharm-1 filing proportions were highest in metropolitan SMAs and increased annually as follows: 42.3%, 43.8%, and 46.1% (all >40%), respectively. Provincial city SMAs were 26.2%, 28.0%, and 29.2% (<30%), and those in depopulated SMAs were 21.3%, 22.1%, and 23.1% (<25%), respectively (Table 4) (Insert Table 4 near here). For Ph/100 beds, median counts and CO values increased with population density. The national CO values (AUCs) of 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83) were lower than the metropolitan median values but higher than provincial and depopulated median values. Median bed counts were also higher in denser SMAs; in any SMA type, WardPharm-1 hospitals had approximately double the median beds of non-filers. 5. WardPharm-1 filing hospital type: Ph/100 beds and bed counts Among general, care-mix, and long-term care hospitals (Table 5) (Insert Table 5 near here), the filing proportions were ~50% in general hospitals (49.4%, 51.5%, and 52.7%, respectively) but lower in care-mix (17.2%, 17.7%, and 18.8%, respectively) and long-term care (~3%; 2.78%, 2.42%, and 3.04%, respectively) hospitals. In all general hospitals, the median Ph/100 beds were 4.53 (3.09–6.15), 4.54 (3.20–6.22), and 4.59 (3.23–6.33), respectively. The CO values for all hospitals were 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83), and the CO values within general hospitals were 4.23 (0.77), 4.23 (0.77), and 4.31 (0.76), respectively. Hence, the median CO values for general hospitals exceeded those of both overall and general hospital. In contrast, the median Ph/100 beds in care-mix were 2.51 (1.82–3.48), 2.56 (1.85–3.52), and 2.58 (1.83–3.62) with CO values of 3.06 (0.79), 3.12 (0.78), and 2.98 (0.78), respectively; those in long-term care were 2.06 (1.49–2.94), 2.08 (1.52–3.08), and 2.11 (1.56–3.18) with CO values of 2.50 (0.82), 2.80 (0.82), and 2.34 (0.79), respectively—all median values less than the CO values. Median bed counts were ~3.1–3.4× higher in WardPharm-1 general hospitals than in non-filers, and ~1.2× higher in care-mix and long-term care hospitals. 6. WardPharm-1 filing according to the DPC group: Ph/100 beds and bed counts Across DPC categories (Table 6) (Insert Table 6 near here), the median Ph/100 beds among WardPharm-1 hospitals consistently ranked university main > specified > standard > non-DPC, indicating higher Ph/100 beds with higher hospital function. Regarding CO values, the values for specified hospitals slightly exceeded those of university main in 2021 and 2023, but as their functional levels are comparable, with higher hospital function generally corresponding to higher Ph/100-bed CO values. Among non-DPC hospitals, median Ph/100 beds for filers were lower than the CO values for university main and specified DPC hospitals and even lower than the median values of non-filers in those higher DPC groups; in 2021–2022, they were also less than the CO values for DPC standard hospitals. Discussion Nationally, WardPharm-1 filing increased annually over the 3 study years; however, even in 2023—the year with the highest —the rate was 34.4%. According to the Japan Hospital Pharmacists Association “How to Promote Ward Pharmacist Services, Ver. 1.2,” the tasks of ward pharmacist are generally divided into services provided before administration (ward pharmacist services) and after administration (pharmaceutical management and counseling) [26]. Delivering both services on the ward may achieve high-quality hospital pharmacist practice. A 2018 survey of 7416 hospitals (3430 respondents plus 3986 with bed function reports) reported a 64.8% filing rate for the Pharmaceutical Management and Guidance Fee [27]. This fee is billable when, on the basis of pharmaceutical care records, direct medication counseling and support and other pharmaceutical management (including checks for drug dose, route, rate, interactions, duplications, incompatibilities/contraindications, and ongoing assessment of patient status for efficacy and adverse effects) are provided [22]. Considering the importance of this work, increasing the proportion of WardPharm-1 hospitals is important. A previous survey (8380 hospitals targeted; 3430 responses) argued that increasing the number of pharmacists per 100 beds is vital to improve WardPharm-1 filing [27]. Nevertheless, hospitals with numerous pharmacists often have more staff in other professions as well, leaving uncertainty on the unique contribution of pharmacists. Our study clarified that among per-100-bed staffing metrics, Ph/100 beds exhibited the strongest association with WardPharm-1 filing. Across the 3 years, the median values were ~5.2 pharmacists/100 beds in filers vs. ~2.6 in non-filers—approximately a two-fold difference (~2.6 per 100 beds). Bed counts also differed approximately two-fold (≈220 vs. ≈100). When viewed in terms of hospital function, the Ph/100 beds of DPC university hospitals and DPC-designated hospitals that have not notified WardPharm-1 showed higher values than the Ph/100 beds of non-DPC hospitals that have notified WardPharm-1. This finding suggests that even if a non-DPC hospital has a sufficient number of pharmacists to register WardPharm-1, a more sophisticated hospital may not be able to register WardPharm-1 with the same number of pharmacists. Care-mix and long-term care hospitals demonstrated lower Ph/100-bed median and C values than general hospitals. These results suggest that higher hospital functional complexity and shorter lengths of stay require higher Ph/100 beds. Examining 3-year filing dynamics, sustained filers showed stable Ph/100 beds (median >5.2; year-to-year change −0.02 to +0.08/100 beds). Withdrawn filers showed decreases (−0.57 to −0.07), with median values of 3.38–4.28 in the withdrawal year. New filers showed increase (+0.29 to +0.47), with median values of 4.46–4.55 in the filing year. These data suggest that (i) sustaining filing is associated with Ph/100 beds ~5.2 and minimal fluctuation; (ii) withdrawal is associated with Ph/100 beds approximately 3.4–4.3 and declining; and (iii) new filing is associated with Ph/100 beds of ~4.5 and increasing. Across ten groups (three SMA density types, three hospital bed-type categories, and four DPC categories, including non-DPC), we compared medians and COs for Ph/100 beds. In groups with ≳50% filing (general hospitals; DPC university main, specified, and standard), the group-wide median Ph/100 beds exceeded the group’s CO. In groups with <50% filing (all SMA types by density, care-mix, long-term care, and non-DPC), the median values were less than the CO values (with a marginal exception in 2021 non-DPC). Therefore, surpassing the group-specific CO with the group-wide median Ph/100 beds may be a practical benchmark for increasing WardPharm-1 filing. Remarkably, for the SMA density classification, the median values in all three regional groups were less than the CO values, consistent with the MHLW pharmacist maldistribution index showing that 94.9% of SMAs lack sufficient hospital pharmacists [28]. In the 2022 index, 17 SMAs were considered sufficient, including 11 metropolitan and 6 provincial city SMAs. Considering that there were 48 metropolitan, 156 provincial city, and 131 depopulated SMAs, the pharmacist sufficiency rates were 22.9% and 7.1% in the first two categories and 0% in depopulated areas. WardPharm-1 filing rates also reflected population density and hospital functional level ~50% in general hospitals vs. 17%–19% in care-mix and ≈3% in long-term care hospitals; 94% in DPC university main, 88%–92% in specified, 65%–66% in standard, but 16%–18% in non-DPC hospitals; and 42%–46% metropolitan, 26%–29% provincial city, and 21%–23% depopulated SMAs. These patterns suggest maldistribution according to geography and hospital function. To summarize, considering WardPharm-1 as an indicator of high-quality hospital pharmacist services, the pharmacist-to-bed ratio most strongly determines filing; higher-function hospitals require higher Ph/100 beds; and filing is more common in larger-bed hospitals. Conversely, lower-density regions, hospitals with less advanced functions, and smaller bed scales have lower filing rates, probably driven partially by lower Ph/100 beds. Conclusion Methods for estimating the number of doctors, nurses, and other medical professionals required have long been considered and reflected in medical plans, which are implemented separately as demand and supply estimates. Demand estimates for doctors and nurses use data such as the number of hospital beds for inpatient care and the number of outpatients for outpatient care [29,30], data such as the number of tests charged for clinical laboratory technicians [31], and open data from sources such as the National Database of MHLW (database of information on medical prescriptions and specific health checkups) and e-stat (a comprehensive portal for government statistics operated by the National Statistics Center of Japan). Pharmacist demand estimation in the MHLW maldistribution index aggregates survey-based time for dispensing/clinical work and concurrent prescription/patient volumes to yield time per prescription/patient [32], typically reported according to the prefecture or SMA due to data sources. Unlike previous survey-based estimations, our study used complete national datasets of hospitals with bed functions, providing an unbiased, accurate picture that is not skewed by respondent, regional, or ownership factors. As outcomes for pharmacist maldistribution countermeasures, the filing status of pharmacist-intensive fee items—such as WardPharm-1—can monitor hospital pharmacist activity, and trends in Ph/100 beds can inform adequacy and maldistribution. To further improve accuracy, future research should incorporate non-open data on time-consuming pharmacist activities (e.g., in-house outpatient prescriptions and counts of Pharmaceutical Management and Guidance Fee claims) and filing statuses of items requiring dedicated/assigned pharmacists (WardPharm-1/II, cancer patient counseling fees, and perioperative pharmaceutical management add-ons). Nevertheless, such detailed operational data are not publicly available. Our approach could also capture efficiency gains over time independent of manpower by tracking annual shifts in the Ph/100-bed CO required to file pharmacist-intensive items such as WardPharm-1. We did not consider digital transformation (DX), contributions of nonpharmacist staff such as supply processing and distribution personnel or pharmacy assistants, or interprofessional task reallocation. Recent studies describe efficiency gains from DX [33–38], utilization of non-pharmacists [39–42], and team collaboration [43, 44]. With the declining population of Japan and proportion of older adults, the labor force will shrink, whereas the relative numbers of care recipients will increase. Moreover, considering the current pharmacist shortages in hospitals, promoting ward pharmacist services is hampered, and sustained large increases in the numbers of hospital pharmacists are unlikely. Single interventions rarely lead to large reductions in pharmacist work hours. Along with intensified measures against maldistribution, progress in DX, task shifting to non-pharmacists, and deeper team-based care—including collaboration with community pharmacists—will be essential to create work environments that enable hospital pharmacists to deliver safe, effective pharmacotherapy that improves the quality of life of patients. Continuous efforts and a mindset shift to accept changing environments and roles will be required. Abbreviations Ward Pharmaceutical Care Fee I” (WardPharm-1), digital transformation (DX), Diagnosis Procedure Combination (DPC), information and communications technology (ICT), Declarations Ethics approval and consent to participate This study was based entirely on publicly available anonymized datasets and did not involve any human participants, interventions, or personal information. Therefore, ethics approval and informed consent were not required.Consent for publications Availability of data and materials This study used only publicly available datasets from the Ministry of Health, Labour and Welfare (MHLW) and e-Stat. No proprietary or personally identifiable data were used. Additional data supporting the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no conflicts of interest.Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Authors' contributions MK conceived and designed the study, collected and analyzed the data, and drafted the manuscript. MT and HY contributed to data interpretation and critically revised the manuscript. AK supervised the study and reviewed the final version. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank all institutions providing public healthcare datasets used in this study. References Ministry of Health, Labour and Welfare. Guidelines for the formulation of medical care plans: Attachment to “About medical care plans” (Notification No. 21, June 15, 2023, by the Director-General of the Health Policy Bureau). Tokyo: Ministry of Health, Labour and Welfare; 2023. (in Japanese) inistry of Health, Labour and Welfare. Report of the Study Group on Work Style Vision for Physicians, Nurses, and Other Healthcare Professionals Based on the Future of Medical Care. Tokyo: Ministry of Health, Labour and Welfare; April 6, 2017. p.36. (in Japanese) Tsubota Y, Kodawara T, Igarashi T, Aratani T, Yamashita S, Iwasaki A, Kiyokawa M, Morita Y, Watanabe K, Yano R, Tsukamoto H, Goto N. Efforts to Promote Medical Safety and Reduce the Work of Physicians by the Temporary Prescription Order of the Hospital Pharmacist. Jpn J Pharm Health Care Sci. 2020;46(3):153–159. Suzuki C, Kobayashi J, Chiba M, Takatori S, Mizutani A, Sato H, Morita M, Kubo J, Takagi A, Sato K. Impact of Expanding Pharmacist Duties in Wards on Nursing Duties. J Jpn Assoc Rural Med. 2020;69(2):137–142. Sugimoto M, Yonezawa A, Tadehara M, Morita Y, Yoshida Y, Onoue M, Omura T, Kayano Y, Fukatsu S, Yano I, Matsubara K. Protocol-Based Pharmacotherapy Management (PBPM) Involving Ward-Pharmacists as a Member of Medical Team on Outpatient Prescriptions Brought to the Hospital. Jpn J Pharm Health Care Sci. 2014;40(5):297–303. Isaka Y, Isaka E, Yokota H, Shimada H, Kaneko Y, Yanagimachi N, Konishi K, Suzuki Y, Hosono T, Kambayashi Y, Homma M. Pharmacists' Involvement in Prescription Data Entry Tasks at Surgical Departments for Proper Prescriptions. J Jpn Soc Hosp Pharm. 2019;55(10):1223–1227. Tateishi H, Yano Y, Goto T, Miyazu D, Watanabe H. Speed and accuracy of recording medication history by pharmacists in secondary emergency rooms. Yakugaku Zasshi. 2024;144:691–695. Hayashida S, Yamamoto S, Sadoh S, Yoshino K, Kawahara T, Mutsukura K, Higuchi N. Investigation of pharmaceutical interventions by pharmacists in dementia support team. J Jpn Soc Hosp Pharm. 2021;57(10):1086–1091. Suzuki R, Asai N, Oda Y, Nakamura A, Sakai T, Nagaoka K, Tanabe K, Takahashi M, Ohtsu F. Pharmaceutical care in community-based integrated care wards: Efforts to Optimize and Evaluate the Provision of Drug Therapy. Jpn J Pharm Health Care Sci. 2021;47(2):61–69. Aimatsu S, Katayama T, Ichikawa H, Ogawa O, Yamaguchi H, Ishii M, Ogawa A, Matsuda H. Survey on a pharmacist’s prescription proposal using STOPP-J in a community-based integrated care ward. J Jpn Soc Hosp Pharm . 2020;56(8):886–893. Ishimura A, Watanabe F, Kanaka S. Efficacy of pharmacists’ intervention in preventing polypharmacy in hospitals for chronic care. Jpn J Geriatr Pharm . 2020;3(1):4–8. Shinoda Y, Mabuchi S, Sawada M, Nishimura M, Ito R, Usami E. Evaluation of the usefulness of perioperative pharmacist audit and feedback for general anesthesia surgery patients. Jpn J Pharm Health Care Sci . 2025;51(6):345–354. Konaka K, Saito T, Ito S, Morimoto M, Kuroda T, Tsuzuki D, Fushitani S. Effect on treatment intensity of cancer chemotherapy by pharmacist intervention based on collaboration enhancement addition at an outpatient chemotherapy center. J Jpn Soc Pharm Oncol . 2023;29:1–8. Japan Hospital Association. Survey on securing pharmacists. June 2022. Available from: https://www.hospital.or.jp/site/news/file/1679296011.pdf (accessed October 14, 2025). (in Japanese) Ministry of Health, Labour and Welfare. Report on the study and research project for securing pharmacists, commissioned by the General Affairs Division, Pharmaceutical and Food Safety Bureau, FY2021. Tokyo: Ministry of Health, Labour and Welfare; March 2022. (in Japanese) Ministry of Health, Labour and Welfare. FY2022 Task Shifting and Sharing Promotion Project: Survey report on the working conditions of hospital pharmacists [Internet]. Tokyo: Ministry of Health, Labour and Welfare; 2022 [cited 2025 Nov 8]. 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Available from: https://www.mhlw.go.jp/kouseiroudoushou/shozaiannai/chihoukouseikyoku.html Ministry of Health, Labour and Welfare. Hospital Bed Function Report [Internet]. Tokyo: Ministry of Health, Labour and Welfare; [cited 2025 Sep 13]. Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000055891.html Statistics Bureau of Japan. Statistical Observations of Municipalities 2022 [Internet]. Tokyo: Government Statistics Portal (e-Stat); [cited 2025 Sep 13]. Available from: https://www.e-stat.go.jp/stat-search/files?page=1&toukei=00200502&result_page=1 Ministry of Health, Labour and Welfare. Notification No. 1 of the Health Insurance Bureau, issued on March 4, 2022: Implementation guidelines accompanying partial revisions to the calculation methods of medical service fees (Attachment 1). Tokyo: Ministry of Health, Labour and Welfare; 2022. (in Japanese) omioka K, Takeda Y, Takahashi H, Kawasaki E, Hamano K, Matsuda T, Ito K, Matsubara F, Maeda Y. Evaluation on the Ward Pharmaceutical Service in Rosai Hospital Group. J Jpn Soc Hosp Pharm. 2014;50:485–490. Hiei K, Usami E, Sadaoka K, Takeyama M, Yamamoto E, Kanda T, Miyabe Y, Suzuki A. Awareness Survey on the Status of Notification of Pharmacist-Related Medical Treatment Fees and the Sufficiency of Pharmacists at Hospitals and Clinics in Gifu Prefecture. J Jpn Soc Hosp Pharm. 2024;60(11):1257–1264. Terazono H, Sugawara H, Arima J. A Survey in the Kyushu-Yamaguchi Pharmaceutical Society:Changes in Pharmacistsʼ Duties Due to Work Style Reform. J Kyushu Pharm Assoc. 2024;78:137–146. Japan Society of Hospital Pharmacists. Guidelines for implementing ward pharmacy services (Ver.1.2). Tokyo: Japan Society of Hospital Pharmacists; 2016. (in Japanese) Takeda Y. Research on improving productivity and the role of pharmacists based on the actual working conditions of hospital pharmacists. Grant-in-Aid for Health and Labour Sciences Research, Project for the Promotion of Regional Medical Infrastructure Development. Tokyo: Ministry of Health, Labour and Welfare; 2020. (in Japanese) Ministry of Health, Labour and Welfare, General Affairs Division, Pharmaceutical and Food Safety Bureau. Pharmacist maldistribution indicators by hospital and pharmacy: Appendix 1-1 to “On pharmacist maldistribution indicators.” (Administrative Notice, June 9, 2023). Tokyo: Ministry of Health, Labour and Welfare; 2023. (in Japanese) Ministry of Health, Labour and Welfare, Study Group on the Supply and Demand of Healthcare Professionals, Subcommittee on Physician Supply. The fifth interim summary report. Tokyo: Ministry of Health, Labour and Welfare; February 7, 2022. (in Japanese) Ministry of Health, Labour and Welfare, Study Group on the Supply and Demand of Healthcare Professionals, Subcommittee on Nursing Staff Supply. Interim summary report. Tokyo: Ministry of Health, Labour and Welfare; November 15, 2019. (in Japanese) Koga H, Maruta H, Fukazawa K, Masuda T, Sato S, Nemoto S, Shiraishi G. Forecasting supply and demand for medical technologists from open data. Jpn J Med Technol. 2023;72(4):522–531. Ministry of Health, Labour and Welfare. FY2022 Report on the Study for Securing Pharmacists: survey and research project for developing guidelines on pharmacist workforce planning. Tokyo: Ministry of Health, Labour and Welfare; March 2023. Kiryu Y, Homma N, Yoshino T, Murai Y, Sobue H, Sato Y. Development and evaluation of a multi-functional drug discrimination system mounted with automatic data analysis of the clinical examination values for medication brought to hospital. Jpn J Drug Inform. 2017;19(1):8–16. Takahashi K, Higuchi K, Yamaguchi K, Inoue T, Mizukawa N, Tatsumichi T, Shinohara N, Nozaki T, Tanaka H, Naitou H, Kitamura K, Kaji M, Kosaka S, Houchi H. Study of Usefulness of Automatic Restocking and Dispensing Machine. Jpn J Pharm Health Care Sci. 2020;46(2):84–91. Ishimura C, Aohara M, Sakamoto T, Furuya Y, Furuya K, Furukawa A, Kadoyama K, Nakamura T. Evaluation of the M*Adhere Standard for patient efficacy and health economics system (M*Adhere SPEHEC ® ) in pharmaceutical management. Jpn J Drug Inform. 2020;22(2):108–115. Kishimoto M, Chogahara T, Kishimoto K, Kurata N. Effectiveness of a camera support system for the prevention of occupational anti-cancer drug exposure. J Jpn Soc Pharm. 2021;40(1):12–19. Sasuga C, Ishibashi M, Orii T, Umetani N. Construction of Protocol-Based Pharmacotherapy Management (PBPM) Using an Electronic Medical Record Interlocking Support System to Prevent Hepatitis B Virus Reactivation Induced by Cancer Chemotherapy. Jpn J Pharm Health Care Sci. 2022;48(1):9–19. Kubota N, Nishizawa S, Takizawa Y. Impact of introducing an automatic dispensing device to pharmacist duties for internal and external medications. Jpn Pharmacol Ther. 2024;52(9):1077–1081. Terada K, Nakajima T, Sato K, Yoshino M, Ishikawa M, Akagi T, Hashimoto H, Furukawa T. Efficacy of Preventive Drug Preparation Errors by Non-Pharmacists Using Personal Digital Assistance and Audit Support Systems. Jpn J Pharm Health Care Sci. 2023;49(2):51–58. Suzuki H, Matsuno M, Itakura M, Yamazaki M, Okabe S, Yamashiro T. The Effect of Task-Sharing with Non-Pharmacists in Setting Task for Oral and External Medicines. J Kyushu Pharm Assoc. 2024;78:113–116. Nagase S, Moriki K, Kumai M, Nawata S, Chiba T, Fukamizu T, Shida T. Findings from a Questionnaire Survey on the Effectiveness of Task Shifting to Pharmacy Assistants in the Pharmaceutical Department: Reducing the Workload and Examining Interpersonal Dynamics. Jpn J Pharm Health Care Sci. 2024;50(4):143–152. Manabe K, Okada N, Baba A, Saisyo A, Toyota K, Takasago M, Kitahara T. Implementing Medical SPD Supports Optimization of Ward-based Clinical Pharmacy Practices: An Interrupted Time-series Analysis. Jpn J Pharm Health Care Sci. 2024;50(7):366–373. Hirata Y, Onoue H, Fujioka T, Nishio H, Son N, Masuyama K, Kitagaki K. A study on the usefulness of information collaboration between community pharmacists and hospital pharmacists for hospital admission and discharge. Reg Sci Med Prod. 2022;12(1):3–15. Nakashima M, Terashima K, Hombo T, Osako M, Yamashita S, Hayashi H. Establishment an outpatient cancer chemotherapy information sharing system in collaboration with community pharmacies: a multidisciplinary approach and questionnaire survey evaluation. Jpn. J. Drug. Inform., 2024;26(2):92–101. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Patient and community needs for healthcare have been increasing and diversifying; patient profiles continuously changing; and relationships with long-term care and daily life becoming more interwoven. Simultaneously, the environment surrounding healthcare is undergoing a rapid transformation due to population aging, advances in medical technology, tighter constraints on public finances, a shrinking labor force, and faster-than-expected progress in information and communications technology (ICT). Against this background, there exists an urgent need to establish an environment in which everyone can access healthcare without anxiety [1]. To this end, we must look ahead as far as possible and design a forward-looking, constructive pathway for functioning of healthcare delivery and healthcare professionals in the future [2].\u003c/p\u003e\n\u003cp\u003eFor sustainable maintenance of Japan’s healthcare sector, it is essential to improve the productivity and added value of healthcare professionals; the expertise and insights of pharmacists are particularly critical contributors to this goal. Building on the professional knowledge developed through 6-year pharmacy education, pharmacists must assume efficient, high-productivity roles that can address workforce shortages [2]. Specifically, it is necessary to reform the work structure centered on dispensing to strengthen functions that are core to the profession—such as analyzing prescriptions, advising patients and other professionals, and developing pharmacotherapy protocols. Through these efforts, pharmacists proactively demonstrate their presence as members of multidisciplinary teams, acting as professionals in pharmaceutical services [2].\u003c/p\u003e\n\u003cp\u003eIn hospitals, team-based care has advanced through ward assignment of pharmacists and a collaboration with other professions. Beyond managing patients’ own medications and medication adherence on the ward, pharmacists are expected to further enhance the effectiveness and safety of pharmacotherapy by proposing treatment plans to physicians—including monitoring therapeutic effects and adverse reactions and ordering tests as required [2]. Implementing these activities alleviates the burden on physicians and nurses [3–5] and has been widely reported to improve the quality of drug therapy and safe use of medicines across a broad range of settings such as acute care wards, subacute wards, chronic care wards, operating rooms, and oncology chemotherapy units [6–13].\u003c/p\u003e\n\u003cp\u003eNevertheless, in the “Survey on Securing Hospital Pharmacists” conducted by the Japan Hospital Association in 2022 (2467 hospitals surveyed; 706 responses), 74.9% of responding hospitals reported lack of hospital pharmacists. Reasons cited for determining the required number of pharmacists included improving the quality of pharmaceutical services (90.5%), responding to requests from other departments such as clinical and nursing divisions (80.5%), and improving work schedules (71.1%) [14]. In the Ministry of Health, Labor, and Welfare (MHLW) project report on measures to secure pharmacists (questionnaire to 3183 hospitals; 631 valid responses), 64.8% of hospitals and 41.2% of community pharmacies recognized pharmacist shortages. Hospitals with pharmacist shortages reported impacts on routine work such as ward services (72.1%), overtime work (53.3%), and participation in team-based care (52.3%) [15]. Furthermore, the proportion of hospitals filing claims for the “Ward Pharmaceutical Care Fee I” (hereafter, WardPharm-1)—an indicator of clinical pharmacist activity—was reported as 35% in the 2022 Task Shift/Share Promotion Project report on the working conditions of hospital pharmacists (8194 hospitals surveyed; 2829 responses) [16] and 47% in a special survey on the results of the 2020 fee schedule revision (1500 hospitals surveyed; 494 responses) [17], i.e., less than half in both reports. These surveys suggest that hospital pharmacist services are not being completely implemented.\u003c/p\u003e\n\u003cp\u003eAn MHLW Pharmaceutical and Food Safety Bureau study group on the training and quality improvement of pharmacists predicted a future overall surplus of pharmacists and also noted maldistribution across practice settings and regions. Securing hospital pharmacists was identified as an emergent issue, and attempts to address maldistribution—tailored to local circumstances and integrated with workforce measures in regional healthcare plans—were recommended. After reports and deliberations in the Social Security Council’s Medical Care Subcommittee, pharmacist maldistribution countermeasures were incorporated into the 8th Medical Care Plan [18, 1].\u003c/p\u003e\n\u003cp\u003eDespite the high expectations for hospital pharmacists, it is difficult to state that their expected functions are being completely verified under current conditions. This study analyzes data to clarify differences between institutions where hospital pharmacists are sufficiently functional and those where they are not, with an aim to identify factors that facilitate thriving of hospital pharmacists.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1. Databases\u003c/p\u003e\n\u003cp\u003eWe used two open datasets viz., the “List of Registered Medical Care Providers (Medical)” and the Hospital Bed Function Report. The former is an open dataset published monthly by the Regional Bureaus of Health and Welfare (Hokkaido, Tohoku, Kanto-Shinetsu, Tokai-Hokuriku, Kinki, Chugoku-Shikoku, Shikoku, and Kyushu) on the acceptance status of notifications for medical fee items at hospitals and clinics that provide insured medical services [19]. The latter is an annual open dataset (aggregated for July each year) published by the MHLW and contains information on bed functions and staffing at medical institutions with general and long-term care beds [20].\u003c/p\u003e\n\u003cp\u003eWe examined the data for 2021, 2022, and 2023. To align with the Hospital Bed Function Report month, we used the July files of the “List of Registered Medical Care Providers (Medical)” for each year. The number of hospitals registered in the July “List” was 8211 (2021), 8161 (2022), and 8133 (2023), and the number of hospitals published in the Hospital Bed Function Report was 7018, 6959, and 6974, respectively. We linked the two datasets using facility codes and hospital names. Because the Bed Function Report excludes psychiatric beds, we removed hospitals with ≥80% psychiatric beds (resulting in 6875 6806 and 6837 hospitals, respectively). We further excluded hospitals that did not fulfill legally required minimum staffing levels for physicians or pharmacists—judged to undermine the credibility of notifications—resulting in 6386 6064 and 5966 hospitals, respectively. Among these, hospitals billing any of the following were considered eligible to file WardPharm-1 and comprised the analytic sample: basic hospitalization fees for general wards, long-term care wards, tuberculosis wards, psychiatric wards, advanced treatment hospitals, or specialty hospitals. The resulting number of hospitals was 5833 (71.0%), 5512 (67.5%), and 5401 (66.0%), respectively. Population data were obtained from the 2020 Population Census basic tabulations, and habitable land area for municipalities was recorded from “Statistical Observations of Municipalities 2022” [21].\u003c/p\u003e\n\u003cp\u003e2. Analytic items\u003c/p\u003e\n\u003cp\u003eAs a claims-based indicator of high-quality hospital pharmacist services, we focused on WardPharm-1. Requirements to file WardPharm-1 include assigning a dedicated pharmacist to each ward and providing ≥20 h/week of ward pharmacist services. Required activities are (a) obtaining medication and injection histories and adverse event information from patients/families and identifying fundamental issues; (b) collecting and disseminating to staff the latest safety communications (e.g., emergency safety information, PMDA safety information, risk management plans, and recalls); (c) at admission, reconciling brought-in medications (names, strengths, dosage forms, etc.) and proposing a written medication plan to physicians; (d) checking for drug–drug interactions before the coadministration of two or more agents; (e) providing preadministration explanations to patients/families concerning medicines requiring special safety management; (f) performing necessary calculations (e.g., infusion rates and doses) before administration for such high-risk medicines; and (g) in addition to (a)–(f), performing the following as applicable: (1) under pre-agreed protocols, changing drug selection, dose, route, duration, or ordering tests; (2) actively proposing prescriptions to physicians regarding drug selection, dose, route, and duration; (3) proposing changes based on therapeutic drug monitoring and adverse event surveillance; and (4) performing appropriate aseptic preparation of anticancer agents [22]. It has been suggested that performing these WardPharm-1–required activities contributes to improved quality of pharmacotherapy and patient safety [23]. Therefore, we considered WardPharm-1 filing as an indicator expressing that hospital pharmacists are delivering adequate pharmaceutical care.\u003c/p\u003e\n\u003cp\u003ePrevious literature suggests a relationship between WardPharm-1 filing and the number of employed pharmacists, e.g., “increased staffing to file WardPharm-1” (all 34 national Rousai hospitals responding) [23]; “insufficient pharmacist staffing most commonly cited reason for not filing WardPharm-1” (Gifu Prefecture; 47/91 responding hospitals) [24]; and “across all hospital functions, hospitals wished to engage in ward pharmacist services if staffing were sufficient” (Kyushu, Yamaguchi, Okinawa; 262/896 responses) [25]. Therefore, we hypothesized an association between WardPharm-1 filing and the number of employed pharmacists. Because hospitals with more pharmacists may also employ more of other professionals, we compared staffing for physicians, nurses, assistant nurses, nursing aides, physical therapists, occupational therapists, and speech–language–hearing therapists—professions commonly working on wards. Using the total number of beds and staff counts of each hospital, we calculated per-100-bed staffing for each profession (e.g., pharmacists per 100 beds = Ph/100 beds) to adjust for bed scale. The full-time equivalent number of part-time staff in the bed function report is the number of working hours per week of part-time staff divided by the scheduled working hours per week of the facility. Bed counts (total, and by general, long-term care, psychiatric, infectious disease, and tuberculosis) were collected from the “List of Registered Medical Care Providers (Medical).”\u003c/p\u003e\n\u003cp\u003eTo explore the relationship between hospital function and WardPharm-1 filing, we used Diagnosis Procedure Combination (DPC) group categories—university hospital main group, specified hospital group, standard hospital group, and non-DPC hospitals—available in the Bed Function Report. In DPC hospitals, hospital roles are evaluated based on factors such as the basic coefficient and function evaluation coefficients I (e.g., add-ons for infection prevention, medical safety, and WardPharm-1) and II (e.g., emergency care, complexity, coverage, and regionality).\u003c/p\u003e\n\u003cp\u003eWe defined hospitals filing WardPharm-1 as “WardPharm-1 hospitals” and those not filing as “non-filers.” Hospitals that transitioned from non-filer in year t to filer in year t+1 were defined as “new filers,” those maintaining filing for 2 or 3 consecutive years were defined as “sustained filers,” and those transitioning from filer to non-filer were defined as “withdrawn filers.”\u003c/p\u003e\n\u003cp\u003e3. Regional classification of secondary medical areas\u003c/p\u003e\n\u003cp\u003eJapan had 335 secondary medical areas (SMAs) during 2021–2023. We classified the SMAs into three types based on the population distribution as follows: metropolitan (population ≥1,000,000 or population density ≥2000 persons/km), provincial city (population ≥200,000 or population 100,000–200,000 with density ≥200 persons/km), and depopulated (all others).\u003c/p\u003e\n\u003cp\u003e4. Hospital type\u003c/p\u003e\n\u003cp\u003eHospitals were categorized according to the composition ratio of general, long-term care, and psychiatric beds among total authorized beds as follows: “general hospitals” (general beds ≥80%), “long-term care hospitals” (long-term care beds ≥80%), and “care-mix hospitals” (neither of the above).\u003c/p\u003e\n\u003cp\u003e5. Statistical analysis\u003c/p\u003e\n\u003cp\u003eLogistic regression analysis was conducted using the number of staff per 100 beds for each healthcare profession as explanatory variables and the presence or absence of WardPharm-1 filing as the dependent variable. When analyzing staff numbers per 100 beds, personnel were categorized in increments of 0.5 persons per 100 beds. Logistic regression and receiver operating characteristic (ROC) analyses were performed to calculate the cutoff (CO) values and the area under the ROC curve (AUC) for the number of pharmacists per 100 beds (Ph/100 beds) and the number of hospital beds required for WardPharm-1 filing. All statistical analyses were conducted using JMP\u003csup\u003e®\u003c/sup\u003e version 18 (SAS Institute Japan Inc., Tokyo, Japan).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Per-100-bed staffing and contribution to WardPharm-1 filing\u003c/p\u003e\n\u003cp\u003eAcross the eight professions examined in this study (physicians, pharmacists, nurses, assistant nurses, nursing aides, physical therapists, occupational therapists, and speech–language–hearing therapists), the logistic regression revealed that the odds ratio (OR) for Ph/100 beds contributing to WardPharm-1 filing was ~1.2 each year and was the highest among professions (Tables 1A–C)\u0026nbsp;(Insert Table 1 near here). The ORs for other professions ranged from 0.95 to 1.01, suggesting limited contribution to filing. Among the eight counted professions in surveyed hospitals, Ph/100 beds exerted the strongest positive effect on filing.\u003c/p\u003e\n\u003cp\u003e2. National WardPharm-1 filing status and relationships with Ph/100 beds and bed count\u003c/p\u003e\n\u003cp\u003eNationally, the numbers (and proportions) of hospitals eligible to file WardPharm-1 were 5833 (91.3%), 5512 (90.9%), and 5401 (90.5%) in 2021–2023, with 1820 (31.2%), 1801 (32.7%), and 1856 (34.4%) actually filing, respectively (Table 2A)\u0026nbsp;(Insert Table 2 near here). Median (IQR) Ph/100 beds among eligible hospitals were 3.26 (2.10–5.00), 3.33 (2.14–5.00), and 3.41 (2.17–5.15). Among WardPharm-1 hospitals, the median Ph/100 beds were 5.24 (3.92–6.71), 5.21 (3.92–6.80), and 5.24 (3.92–6.96) and among non-filers, the bed counts were 2.58 (1.83–3.75), 2.63 (1.85–3.76), and 2.63 (1.86–3.85), respectively (Table 2B). Median differences between filers and non-filers were 2.76, 2.58, and 2.61 pharmacists/100 beds, respectively. The Ph/100-bed CO values (AUCs) for being a WardPharm-1 hospital were 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83), respectively (Table 2B). Median bed counts of WardPharm-1 hospitals were ≥2.1 times those of non-filers each year (ratios 2.19, 2.16, and 2.12, respectively).\u003c/p\u003e\n\u003cp\u003e3. Three-year filing/withdrawal patterns and trends in Ph/100 beds and bed counts\u003c/p\u003e\n\u003cp\u003eTrends in Ph/100 beds and bed counts based on 3- or 2-year filing patterns are presented in Table 3(Insert Table 3 near here). There were 1431 sustained filers over all 3 years (“F-F-F”), with median (IQR) Ph/100 beds of 5.34 (4.02–6.80), 5.33 (4.04–6.93), and 5.41 (4.02–7.04) in 2021–2023, respectively. Two-year sustained filers in the first half (“F-F-”) were 1600 with 5.26 (4.00–6.77) and 5.24 (4.00–6.81), and those in the second half (“-F-F”) were 1602 with 5.28 (4.00–6.91) and 5.31 (4.00–7.03).\u003c/p\u003e\n\u003cp\u003eWithdrawn filers (“F-F-N”) were 54 with 4.88 (2.97–5.52), 4.34 (3.29–5.35), and 4.11 (2.82–4.98), respectively; those of “F-N-N” were 32 with 3.95 (2.83–5.64), 3.38 (2.66–4.47), and 3.57 (2.23–4.65), respectively. First-half withdrawals (“F-N-”) were 48 with 3.99 (3.02–5.64) and 3.49 (2.72–5.00); those of second-half withdrawals (“-F-N”) were 61 with 4.35 (3.06–5.40) and 4.28 (2.74–5.13).\u003c/p\u003e\n\u003cp\u003eNew filers (“N-N-F”) were 72 with 3.96 (2.58–5.41), 4.17 (2.71–5.31), and 4.46 (3.29–5.81), respectively; those of “N-F-F” were 86 with 4.06 (2.94–5.42), 4.53 (3.26–5.59), and 4.33 (3.44–5.30), respectively. First-half new filers (“N-F-”) were 101 with 4.04 (2.94–5.43) and 4.51 (3.24–5.68) and those of second-half new filers (“-N-F”) were 90 with 4.21 (2.76–5.71) and 4.55 (3.32–5.82).\u003c/p\u003e\n\u003cp\u003eMedian bed counts exhibited slight changes within groups over 3 years. Groups sustaining filing for 3 years or for either 2-year period had a median count of ≥200 beds and other groups had \u0026lt;200 beds.\u003c/p\u003e\n\u003cp\u003e4. WardPharm-1 filing according to SMA density type: Ph/100 beds and bed counts\u003c/p\u003e\n\u003cp\u003eAccording to the SMA category, WardPharm-1 filing proportions were highest in metropolitan SMAs and increased annually as follows: 42.3%, 43.8%, and 46.1% (all \u0026gt;40%), respectively. Provincial city SMAs were 26.2%, 28.0%, and 29.2% (\u0026lt;30%), and those in depopulated SMAs were 21.3%, 22.1%, and 23.1% (\u0026lt;25%), respectively (Table 4)\u0026nbsp;(Insert Table 4 near here). For Ph/100 beds, median counts and CO values increased with population density. The national CO values (AUCs) of 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83) were lower than the metropolitan median values but higher than provincial and depopulated median values. Median bed counts were also higher in denser SMAs; in any SMA type, WardPharm-1 hospitals had approximately double the median beds of non-filers.\u003c/p\u003e\n\u003cp\u003e5. WardPharm-1 filing hospital type: Ph/100 beds and bed counts\u003c/p\u003e\n\u003cp\u003eAmong general, care-mix, and long-term care hospitals (Table 5)\u0026nbsp;(Insert Table 5 near here), the filing proportions were ~50% in general hospitals (49.4%, 51.5%, and 52.7%, respectively) but lower in care-mix (17.2%, 17.7%, and 18.8%, respectively) and long-term care (~3%; 2.78%, 2.42%, and 3.04%, respectively) hospitals. In all general hospitals, the median Ph/100 beds were 4.53 (3.09–6.15), 4.54 (3.20–6.22), and 4.59 (3.23–6.33), respectively. The CO values for all hospitals were 3.72 (0.84), 3.95 (0.83), and 3.73 (0.83), and the CO values within general hospitals were 4.23 (0.77), 4.23 (0.77), and 4.31 (0.76), respectively. Hence, the median CO values for general hospitals exceeded those of both overall and general hospital. In contrast, the median Ph/100 beds in care-mix were 2.51 (1.82–3.48), 2.56 (1.85–3.52), and 2.58 (1.83–3.62) with CO values of 3.06 (0.79), 3.12 (0.78), and 2.98 (0.78), respectively; those in long-term care were 2.06 (1.49–2.94), 2.08 (1.52–3.08), and 2.11 (1.56–3.18) with CO values of 2.50 (0.82), 2.80 (0.82), and 2.34 (0.79), respectively—all median values less than the CO values. Median bed counts were ~3.1–3.4× higher in WardPharm-1 general hospitals than in non-filers, and ~1.2× higher in care-mix and long-term care hospitals.\u003c/p\u003e\n\u003cp\u003e6. WardPharm-1 filing according to the DPC group: Ph/100 beds and bed counts\u003c/p\u003e\n\u003cp\u003eAcross DPC categories (Table 6) (Insert Table 6 near here), the median Ph/100 beds among WardPharm-1 hospitals consistently ranked university main \u0026gt; specified \u0026gt; standard \u0026gt; non-DPC, indicating higher Ph/100 beds with higher hospital function. Regarding CO values, the values for specified hospitals slightly exceeded those of university main in 2021 and 2023, but as their functional levels are comparable, with higher hospital function generally corresponding to higher Ph/100-bed CO values. Among non-DPC hospitals, median Ph/100 beds for filers were lower than the CO values for university main and specified DPC hospitals and even lower than the median values of non-filers in those higher DPC groups; in 2021–2022, they were also less than the CO values for DPC standard hospitals.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNationally, WardPharm-1 filing increased annually over the 3 study years; however, even in 2023—the year with the highest —the rate was 34.4%. According to the Japan Hospital Pharmacists Association “How to Promote Ward Pharmacist Services, Ver. 1.2,” the tasks of ward pharmacist are generally divided into services provided before administration (ward pharmacist services) and after administration (pharmaceutical management and counseling) [26]. Delivering both services on the ward may achieve high-quality hospital pharmacist practice. A 2018 survey of 7416 hospitals (3430 respondents plus 3986 with bed function reports) reported a 64.8% filing rate for the Pharmaceutical Management and Guidance Fee [27]. This fee is billable when, on the basis of pharmaceutical care records, direct medication counseling and support and other pharmaceutical management (including checks for drug dose, route, rate, interactions, duplications, incompatibilities/contraindications, and ongoing assessment of patient status for efficacy and adverse effects) are provided [22]. Considering the importance of this work, increasing the proportion of WardPharm-1 hospitals is important.\u003c/p\u003e\n\u003cp\u003eA previous survey (8380 hospitals targeted; 3430 responses) argued that increasing the number of pharmacists per 100 beds is vital to improve WardPharm-1 filing [27]. Nevertheless, hospitals with numerous pharmacists often have more staff in other professions as well, leaving uncertainty \u0026nbsp;on the unique contribution of pharmacists. Our study clarified that among per-100-bed staffing metrics, Ph/100 beds exhibited the strongest association with WardPharm-1 filing.\u003c/p\u003e\n\u003cp\u003eAcross the 3 years, the median values were ~5.2 pharmacists/100 beds in filers vs. ~2.6 in non-filers—approximately a two-fold difference (~2.6 per 100 beds). Bed counts also differed approximately two-fold (≈220 vs. ≈100). When viewed in terms of hospital function, the Ph/100 beds of DPC university hospitals and DPC-designated hospitals that have not notified WardPharm-1 showed higher values than the Ph/100 beds of non-DPC hospitals that have notified WardPharm-1. This finding suggests that even if a non-DPC hospital has a sufficient number of pharmacists to register WardPharm-1, a more sophisticated hospital may not be able to register WardPharm-1 with the same number of pharmacists. Care-mix and long-term care hospitals demonstrated lower Ph/100-bed median and C values than general hospitals. These results suggest that higher hospital functional complexity and shorter lengths of stay require higher Ph/100 beds.\u003c/p\u003e\n\u003cp\u003eExamining 3-year filing dynamics, sustained filers showed stable Ph/100 beds (median \u0026gt;5.2; year-to-year change −0.02 to +0.08/100 beds). Withdrawn filers showed decreases (−0.57 to −0.07), with median values of 3.38–4.28 in the withdrawal year. New filers showed increase (+0.29 to +0.47), with median values of 4.46–4.55 in the filing year. These data suggest that (i) sustaining filing is associated with Ph/100 beds ~5.2 and minimal fluctuation; (ii) withdrawal is associated with Ph/100 beds approximately 3.4–4.3 and declining; and (iii) new filing is associated with Ph/100 beds of ~4.5 and increasing.\u003c/p\u003e\n\u003cp\u003eAcross ten groups (three SMA density types, three hospital bed-type categories, and four DPC categories, including non-DPC), we compared medians and COs for Ph/100 beds. In groups with\u0026nbsp;≳50% filing (general hospitals; DPC university main, specified, and standard), the group-wide median Ph/100 beds exceeded the group’s CO. In groups with \u0026lt;50% filing (all SMA types by density, care-mix, long-term care, and non-DPC), the median values were less than the CO values (with a marginal exception in 2021 non-DPC). Therefore, surpassing the group-specific CO with the group-wide median Ph/100 beds may be a practical benchmark for increasing WardPharm-1 filing.\u003c/p\u003e\n\u003cp\u003eRemarkably, for the SMA density classification, the median values in all three regional groups were less than the CO values, consistent with the MHLW pharmacist maldistribution index showing that 94.9% of SMAs lack sufficient hospital pharmacists [28]. In the 2022 index, 17 SMAs were considered sufficient, including 11 metropolitan and 6 provincial city SMAs. Considering that there were 48 metropolitan, 156 provincial city, and 131 depopulated SMAs, the pharmacist sufficiency rates were 22.9% and 7.1% in the first two categories and 0% in depopulated areas.\u003c/p\u003e\n\u003cp\u003eWardPharm-1 filing rates also reflected population density and hospital functional level ~50% in general hospitals vs. 17%–19% in care-mix and ≈3% in long-term care hospitals; 94% in DPC university main, 88%–92% in specified, 65%–66% in standard, but 16%–18% in non-DPC hospitals; and 42%–46% metropolitan, 26%–29% provincial city, and 21%–23% depopulated SMAs. These patterns suggest maldistribution according to geography and hospital function.\u003c/p\u003e\n\u003cp\u003eTo summarize, considering WardPharm-1 as an indicator of high-quality hospital pharmacist services, the pharmacist-to-bed ratio most strongly determines filing; higher-function hospitals require higher Ph/100 beds; and filing is more common in larger-bed hospitals. Conversely, lower-density regions, hospitals with less advanced functions, and smaller bed scales have lower filing rates, probably driven partially by lower Ph/100 beds.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMethods for estimating the number of doctors, nurses, and other medical professionals required have long been considered and reflected in medical plans, which are implemented separately as demand and supply estimates. Demand estimates for doctors and nurses use data such as the number of hospital beds for inpatient care and the number of outpatients for outpatient care [29,30], data such as the number of tests charged for clinical laboratory technicians [31], and open data from sources such as the National Database of MHLW (database of information on medical prescriptions and specific health checkups) and e-stat (a comprehensive portal for government statistics operated by the National Statistics Center of Japan).\u003c/p\u003e\n\u003cp\u003ePharmacist demand estimation in the MHLW maldistribution index aggregates survey-based time for dispensing/clinical work and concurrent prescription/patient volumes to yield time per prescription/patient [32], typically reported according to the prefecture or SMA due to data sources.\u003c/p\u003e\n\u003cp\u003eUnlike previous survey-based estimations, our study used complete national datasets of hospitals with bed functions, providing an unbiased, accurate picture that is not skewed by respondent, regional, or ownership factors. As outcomes for pharmacist maldistribution countermeasures, the filing status of pharmacist-intensive fee items—such as WardPharm-1—can monitor hospital pharmacist activity, and trends in Ph/100 beds can inform adequacy and maldistribution. To further improve accuracy, future research should incorporate non-open data on time-consuming pharmacist activities (e.g., in-house outpatient prescriptions and counts of Pharmaceutical Management and Guidance Fee claims) and filing statuses of items requiring dedicated/assigned pharmacists (WardPharm-1/II, cancer patient counseling fees, and perioperative pharmaceutical management add-ons). Nevertheless, such detailed operational data are not publicly available.\u003c/p\u003e\n\u003cp\u003eOur approach could also capture efficiency gains over time independent of manpower by tracking annual shifts in the Ph/100-bed CO required to file pharmacist-intensive items such as WardPharm-1. We did not consider digital transformation (DX), contributions of nonpharmacist staff such as supply processing and distribution personnel or pharmacy assistants, or interprofessional task reallocation. Recent studies describe efficiency gains from DX [33–38], utilization of non-pharmacists [39–42], and team collaboration [43, 44]. With the declining population of Japan and proportion of older adults, the labor force will shrink, whereas the relative numbers of care recipients will increase. Moreover, considering the current pharmacist shortages in hospitals, promoting ward pharmacist services is hampered, and sustained large increases in the numbers of hospital pharmacists are unlikely. Single interventions rarely lead to large reductions in pharmacist work hours. Along with intensified measures against maldistribution, progress in DX, task shifting to non-pharmacists, and deeper team-based care—including collaboration with community pharmacists—will be essential to create work environments that enable hospital pharmacists to deliver safe, effective pharmacotherapy that improves the quality of life of patients. Continuous efforts and a mindset shift to accept changing environments and roles will be required.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWard Pharmaceutical Care Fee I” (WardPharm-1), digital transformation (DX), Diagnosis Procedure Combination (DPC), information and communications technology (ICT),\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was based entirely on publicly available anonymized datasets and did not involve any human participants, interventions, or personal information. Therefore, ethics approval and informed consent were not required.Consent for publications\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThis study used only publicly available datasets from the Ministry of Health, Labour and Welfare (MHLW) and e-Stat. No proprietary or personally identifiable data were used. Additional data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.Funding\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Authors' contributions\u003c/p\u003e\n\u003cp\u003eMK conceived and designed the study, collected and analyzed the data, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eMT and HY contributed to data interpretation and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAK supervised the study and reviewed the final version.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all institutions providing public healthcare datasets used in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. 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Special survey on the verification of the results of the 2020 revision of medical service fees (FY2021 survey): Survey on the status of implementation regarding reduction of the burden on medical workers and promotion of work style reform for physicians (Part 2). Tokyo: Ministry of Health, Labour and Welfare; 2021. p.612. (in Japanese)\u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. Study Group on the Education and Professional Development of Pharmacists. Summary report of the Study Group on the Education and Professional Development of Pharmacists. Tokyo: Ministry of Health, Labour and Welfare; June 30, 2021. (in Japanese)\u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. List of locations of Regional Health (Branch) Bureaus [Internet]. Tokyo: Ministry of Health, Labour and Welfare; [cited 2025 Sep 13]. Available from: https://www.mhlw.go.jp/kouseiroudoushou/shozaiannai/chihoukouseikyoku.html\u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. Hospital Bed Function Report [Internet]. Tokyo: Ministry of Health, Labour and Welfare; [cited 2025 Sep 13]. Available from: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000055891.html\u003c/li\u003e\n\u003cli\u003eStatistics Bureau of Japan. Statistical Observations of Municipalities 2022 [Internet]. Tokyo: Government Statistics Portal (e-Stat); [cited 2025 Sep 13]. Available from: https://www.e-stat.go.jp/stat-search/files?page=1\u0026amp;toukei=00200502\u0026amp;result_page=1\u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare. Notification No. 1 of the Health Insurance Bureau, issued on March 4, 2022: Implementation guidelines accompanying partial revisions to the calculation methods of medical service fees (Attachment 1). Tokyo: Ministry of Health, Labour and Welfare; 2022. (in Japanese)\u003c/li\u003e\n\u003cli\u003eomioka K, Takeda Y, Takahashi H, Kawasaki E, Hamano K, Matsuda T, Ito K, Matsubara F, Maeda Y. Evaluation on the Ward Pharmaceutical Service in Rosai Hospital Group. \u003cem\u003eJ Jpn Soc Hosp Pharm.\u003c/em\u003e 2014;50:485\u0026ndash;490.\u003c/li\u003e\n\u003cli\u003eHiei K, Usami E, Sadaoka K, Takeyama M, Yamamoto E, Kanda T, Miyabe Y, Suzuki A. Awareness Survey on the Status of Notification of Pharmacist-Related Medical Treatment Fees and the Sufficiency of Pharmacists at Hospitals and Clinics in Gifu Prefecture. J Jpn Soc Hosp Pharm. 2024;60(11):1257\u0026ndash;1264.\u003c/li\u003e\n\u003cli\u003eTerazono H, Sugawara H, Arima J. A Survey in the Kyushu-Yamaguchi Pharmaceutical Society:Changes in Pharmacistsʼ Duties Due to Work Style Reform. \u003cem\u003eJ Kyushu Pharm Assoc.\u003c/em\u003e 2024;78:137\u0026ndash;146.\u003c/li\u003e\n\u003cli\u003eJapan Society of Hospital Pharmacists. Guidelines for implementing ward pharmacy services (Ver.1.2). Tokyo: Japan Society of Hospital Pharmacists; 2016. (in Japanese)\u003c/li\u003e\n\u003cli\u003eTakeda Y. Research on improving productivity and the role of pharmacists based on the actual working conditions of hospital pharmacists. Grant-in-Aid for Health and Labour Sciences Research, Project for the Promotion of Regional Medical Infrastructure Development. Tokyo: Ministry of Health, Labour and Welfare; 2020. (in Japanese)\u003c/li\u003e\n\u003cli\u003eMinistry of Health, Labour and Welfare, General Affairs Division, Pharmaceutical and Food Safety Bureau. Pharmacist maldistribution indicators by hospital and pharmacy: Appendix 1-1 to \u0026ldquo;On pharmacist maldistribution indicators.\u0026rdquo; (Administrative Notice, June 9, 2023). Tokyo: Ministry of Health, Labour and Welfare; 2023. 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Development and evaluation of a multi-functional drug discrimination system mounted with automatic data analysis of the clinical examination values for medication brought to hospital. \u003cem\u003eJpn J Drug Inform.\u003c/em\u003e 2017;19(1):8\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eTakahashi K, Higuchi K, Yamaguchi K, Inoue T, Mizukawa N, Tatsumichi T, Shinohara N, Nozaki T, Tanaka H, Naitou H, Kitamura K, Kaji M, Kosaka S, Houchi H.\u003cbr\u003eStudy of Usefulness of Automatic Restocking and Dispensing Machine. \u003cem\u003eJpn J Pharm Health Care Sci.\u003c/em\u003e 2020;46(2):84\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003eIshimura C, Aohara M, Sakamoto T, Furuya Y, Furuya K, Furukawa A, Kadoyama K, Nakamura T. 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A study on the usefulness of information collaboration between community pharmacists and hospital pharmacists for hospital admission and discharge. \u003cem\u003eReg Sci Med Prod.\u003c/em\u003e 2022;12(1):3\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eNakashima M, Terashima K, Hombo T, Osako M, Yamashita S, Hayashi H.\u003cbr\u003eEstablishment an outpatient cancer chemotherapy information sharing system in collaboration with community pharmacies: a multidisciplinary approach and questionnaire survey evaluation. \u003cem\u003eJpn. J. Drug. Inform.,\u003c/em\u003e 2024;26(2):92\u0026ndash;101.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hospital pharmacists, WardPharm-1 filing, Pharmacist-to-bed ratio, Workforce distribution, Team-based care, Healthcare system in Japan","lastPublishedDoi":"10.21203/rs.3.rs-8259359/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8259359/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eThe healthcare system of Japan faces mounting challenges, including population aging, medical complexity, and workforce shortages. Hospital pharmacists are expected to ensure the safe and effective use of medicines and contribute to multidisciplinary care; however, their availability and functions remain uneven. The “Ward Pharmaceutical Care Fee I” (WardPharm-1) serves as an indicator of the implementation of advanced ward-based pharmaceutical care. This study investigated the national trends and determinants of WardPharm-1 filing, focusing on pharmacist-to-bed ratios and hospital characteristics, to identify factors enabling high-quality pharmacist services.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eWe examined national open datasets from the Ministry of Health, Labor, and Welfare for fiscal years 2021–2023, linking the “List of Registered Medical Care Providers (Medical)” and the “Hospital Bed Function Report.” Hospitals eligible for WardPharm-1 filing were identified, excluding psychiatric facilities and those not fulfilling minimum staffing standards. Per-100-bed staffing for eight healthcare professions and hospital bed counts were determined. Logistic regression and receiver operating characteristic (ROC) curve analyses determine the association between pharmacist staffing (Ph/100 beds) and WardPharm-1 filing, stratified by hospital type, Diagnosis Procedure Combination (DPC) group, and regional population density.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eAmong ~5800 eligible hospitals annually, 31%–34% filed WardPharm-1. Pharmacist staffing per 100 beds demonstrated the strongest association with filing (odds ratio ≈1.2 annually), exceeding that in all other professions. Median Ph/100 beds were ~5.2 in filing hospitals and 2.6 in non-filers, with cutoff values of 3.7–4.0 pharmacists/100 beds (area under the ROC curve 0.83–0.84). WardPharm-1 filing was most frequent in general hospitals (≈50%) and DPC university or specified-function hospitals (≈90%) and least frequent in long-term care hospitals (≈3%) and depopulated regions (\u0026lt;25%). Sustained filers maintained Ph/100 beds around 5.2, whereas withdrawal correlated with declines to 3.4–4.3. Filing hospitals generally had twice the bed counts of non-filers.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eWardPharm-1 filing strongly depends on the pharmacist-to-bed ratio. Higher-function hospitals require higher staffing density, whereas smaller or rural hospitals exhibit lower filing rates, suggesting workforce maldistribution. Strengthening ward-based pharmacist services will necessitate addressing staffing imbalances and advancing digital transformation, task shifting, and interprofessional collaboration to ensure administration of safe, efficient pharmacotherapy across Japan.\u003c/p\u003e","manuscriptTitle":"Research on the Current Status of Pharmacists’ Professional Functions in Hospitals and Factors Influencing Their Improvement and Expansion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 09:49:34","doi":"10.21203/rs.3.rs-8259359/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39ac9def-4458-4f87-aaf6-cb08bc192faa","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T00:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 09:49:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8259359","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8259359","identity":"rs-8259359","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}