Exploring staffing and hospital factors associated with WardPharm-1 filing in Japan: a nationwide observational study.

Abstract

Background: The 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 associated factors of WardPharm-1 filing, focusing on pharmacist-to-bed ratios and hospital characteristics, to explore factors that may enable 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 approximately 5,800 eligible hospitals annually, 31%-34% filed WardPharm-1. Pharmacists per 100 beds (Ph/100 beds) showed the strongest association with filing (odds ratio ≈ 1.2 yearly). Median Ph/100 beds were about 5.2 in filing hospitals and 2.6 in non-filers, with ROC cutoffs of 3.7-4.0 (AUC 0.83-0.84). Filing was most frequent in general hospitals (~ 50%) and DPC university or specified hospitals (~ 90%) and least frequent in long-term care hospitals (~ 3%) and depopulated regions (< 25%). Adjusted analyses confirmed that Ph/100 beds remained significantly associated with filing, though effect sizes were modest.

Conclusions: Higher pharmacist-to-bed ratios were associated with higher WardPharm-1 filing rates. Filing was more common in larger and higher-function hospitals and less frequent in smaller or lower-density settings, patterns consistent with uneven workforce distribution. Although causality cannot be inferred, pharmacist staffing levels may serve as a practical indicator related to WardPharm-1 implementation.