Pharmaceutical Coordination in the Ishinomaki Zone after the 2011 Great East Japan Earthquake Improved the Disaster Health Management.

INTRODUCTION: On March 24, thirteen days after the 2011 Great East Japan Earthquake (GEJE), the Ishinomaki Zone Joint Relief Team (IZJRT) started the Melon Pan System - an ad hoc pharmaceutical coordination system - for the first time in Japan to efficiently prescribe, dispense, deliver, and explain medication to patients in evacuation centers and at their homes. The Japan Red Cross (JRC) Ishinomaki Hospital, a disaster base hospital (DBH), serves as a coordination hub for emergency medical teams (EMTs), pharmacists, and medication supplies. STUDY OBJECTIVE: This study aimed to retrospectively examine trends in medication needs and delivery before (Phase A: March 11 to March 23; 13 days) and after (Phase B: March 24 to April 5; 13 days) the system's implementation. METHODS: Using an anonymized disaster medical record (DMR) database, patient characteristics, number of new and returning patients, prescription numbers, prescribed medications, and prescription durations in Phase A and Phase B were compared. The locations of the evacuation centers with significant improvements in Phase B were identified on a map. RESULTS: There were 3,830 new patients in Phase A and 6,984 in Phase B. The number of returning patients increased significantly during Phase B. The overall number of prescriptions increased 2.6-times (353.7/day versus 935.2/day) and the number of prescribed medications increased 3.1-times (764.1/day versus 2,367.8/day) in Phase B. The median prescription duration of anti-hypertensive drugs increased from seven days (95% confidence interval [CI], 2-14 days) in Phase A to nine days (95% CI, 3-30 days) in Phase B (P < 0.0001), suggesting that medication was efficiently delivered to people in need. The effect of the system was more prominent in evacuation centers located within the tsunami-inundated areas or remote areas (>10km from the JRC Ishinomaki Hospital), considering that 33 (89.2%) of the 37 evacuation centers where prescriptions increased more than three-fold and 39 (94.9%) of the 41 evacuation centers where the prescription started in Phase B were located in such areas. CONCLUSION: The ad hoc pharmaceutical coordination system was effective and necessary, enabling EMTs to focus on patient care and pharmacists to provide personalized pharmaceutical assistance, especially in evacuation centers with limited access. The Melon Pan system was the first pharmaceutical coordination model to be developed in Japan to improve disaster health management.