Table 3 Concepts and categories

 【Barrier to medicine counseling】

(Patient who does not want to talk)

(Medication counseling without information)

If the patient does not want to talk about his own illness at the community pharmacy, it was impossible to ensure reliable pharmaceutical management (adverse events and proper dose confirmation), and the community pharmacist had to provide medicine while grappling with anxiety.

 【Mindset of being the hospital’s subcontractor】

(Patient who cannot be honest with their doctor)

(Minimal instruction acceptance)

(Sparse involvement with hospitals)

(One-way meetings)

(Unapproachable university hospital)

Community pharmacists became passive because they felt like they were the hospitals’ subcontractors rather than equals. The meetings over the past year had not provided opportunities to exchange opinions and, as a result, they had a basically non-existent relationship with the hospital. Community pharmacists often hesitated to convey a trivial problem with patient treatment to the attention of hospital doctors or the pharmacy department.

 【Hospital pharmacist’s visit】

Community pharmacists were very surprised that the director of Kyoto University Hospital pharmacy visited their community pharmacies. This interaction helped close the gap between them and hospital pharmacists.

 【The beginning of the medical collaboration】

Hospital pharmacists actively encouraged community pharmacists, and they in turn were motivated to provide treatment support for hospital patients.

 【Confrontation with blood test data】

Community pharmacists had minimal experience in pharmacological management via blood test values and felt that they could not master it.

 【Puzzled by the tracing report】

(Difficulty of document transmission)

(Speed of doubt inquiry)

Community pharmacists could provide the tracing report to the hospital doctor without knowing what to report. Furthermore, they felt it was faster to call the doctors by telephone than faxing the tracing report to them.

 【Recognition of roles】

(Friendship with hospital)

Community pharmacists participated in a meeting hosted by a hospital pharmacy where they shared their therapeutic policies with patients. This helped them become aware of their role in terms of providing information to the patient about the treatment prescribed by the doctor.

 【Interaction with doctors】

(Understanding of prescription intention)

Community pharmacists interacted directly with the hospital doctors at the study meetings, which helped to familiarize them with the doctors’ personalities. This made it easier to consult with doctors when they noticed prescription problems.

 【Awareness of their responsibility】

(Indicator of disease condition)

(Accurate medication consultation)

(Place of OJT)

Community pharmacists felt a sense of responsibility and confusion about having to corroborate the prescription with blood test values, which they had hardly used before. However, by applying the knowledge gained at the blood test study meeting, their pharmacy became a place for on-the-job training (OJT).

 【Change to proper administration of medication dose】

(Confirmation of adverse events using blood test values)

Community pharmacists could consider inquiries to hospital doctors after checking the prescriptions and taking into consideration factors such as renal and liver function. Furthermore, it became possible for them to deliver drugs after confirming adverse events.

 【Support of the hospital pharmacists】

(Anxiety about future policy change)

(Willingness to improve skills)

When a community pharmacist reported patients’ drug adherence to a doctor, they gained the support of hospital pharmacists; this helped them submit tracing reports without anxiety.

 【Active use of the tracing report】

(Giving adherence reports to doctor)

If a community pharmacist noticed a therapeutic problem in a patient, no matter how small, they submitted a tracing report.

 【Being motivated to participate in team care】

(Pharmacist trusted by patient)

Community pharmacists had more opportunities to receive gratitude from physicians and patients. As a result, they began feeling a sense of responsibility and satisfaction, and wanted to be increasingly involved in patients’ treatment.