Pharmacist-led medication reviews in pre-dialysis and dialysis patients

The Effects of Pharmacist-Led Medication Therapy Management on Medication Adherence and Use of Non-Steroidal Anti-Inflammatory Drug in Patients with Pre-End Stage Renal Disease

Purpose

Patients with chronic kidney disease (CKD) are particularly vulnerable to the risks of polypharmacy, largely owing to various comorbid conditions. This vulnerability is further compounded by an escalated risk of renal function deterioration when exposed to nephrotoxic medications. As part of the national health insurance program in Taiwan, the pre-end-stage kidney disease patient care and education plan has included pharmaceutical care since October 2021. This study aims to explore the effect of pharmacist involvement in a multidisciplinary care team for patients with kidney disease in outpatient settings.

Patients and Methods

This retrospective observational study was conducted at a single center. It analyzed data from May 2022 to May 2023, focusing on patients who received medication therapy management in the kidney disease pharmacist-managed clinic. The study assessed changes in patient medication adherence, non-steroidal anti-inflammatory drugs (NSAIDs) usage, CKD stage, and urine protein-to-creatinine ratio (UPCR) after pharmacist intervention. It also documented pharmacists' medication recommendations and the rate of acceptance by physicians.

Results

A total of 202 patients who had at least two clinic visits were included in the study. After pharmacist intervention, the proportion of poor medication adherence reduced significantly from 67.8% to 43.1% (p<0.001). The proportion of NSAID users also decreased significantly from 19.8% to 8.4% (p=0.001). CKD stage showed a significant reduction (p=0.007), and the average UPCR improved from 2828.4 to 2111.0 mg/g (p<0.001). The pharmacists provided a total of 56 medication recommendations, with an acceptance rate of 86%.

Conclusion

The involvement of pharmacists in the multidisciplinary care team can effectively provide medication-related recommendations, ensuring the effectiveness and safety of patients' medication use, and lead to better kidney function and lower proteinuria.

Telephone versus In-Person Pharmacist-Led Medication Reviews in Home Dialysis Patients: Evaluating Quality of Care and Patient Satisfaction

The COVID-19 pandemic required pharmacists in a provincial Home Dialysis Clinic to adapt from in-person to telephone-based medication reviews. Studies have shown that in-person pharmacist interventions in patients with chronic kidney disease (CKD) lead to a reduction of drug therapy problems (DTPs), however, it's unknown if telephone interventions provide similar outcomes. The purpose of this study was to evaluate whether differences in quality of care exist between in-person vs. telephone medication reviews in home dialysis patients and to evaluate patient satisfaction with telephone medication reviews. Data from the two most recent in-person medication reviews was compared with the two most recent telephone medication reviews for each patient (n = 46). There were no statistically significant differences in DTPs identified between in-person and telephone medication reviews (p = 0.431). Physician acceptance of pharmacist recommendations was higher for in-person medication reviews (p = 0.009). Patients were satisfied with the care they received with pharmacist-led telephone medication reviews, however, 29% (n = 7) would prefer an in-person medication review once per year with telephone medication reviews the rest of the time. Overall, patients were satisfied with the care they received from telephone medication reviews.

The impact of clinical pharmacist-physician communication on reducing drug-related problems: a mixed study design in a tertiary teaching Hospital in Xinjiang, China

Background

The incidence of drug-related problems (DRPs) has caused serious health hazards and economic burdens among polymedicine patients. Effective communication between clinical pharmacists and physicians has a significant impact on reducing DRPs, but the evidence is poor. This study aimed to explore the impact of communication between clinical pharmacists and physicians on reducing DRPs.

Methods

A semistructured interview was conducted to explore the communication mode between clinical pharmacists and physicians based on the interprofessional approach of the shared decision-making model and relational coordination theory. A randomized controlled trial (RCT) was used to explore the effects of communication intervention on reducing DRPs. Logistic regression analysis was used to identify the influencing factors of communication.

Results

The mode of communication is driven by clinical pharmacists between clinical pharmacists and physicians and selectively based on different DRP types. Normally, the communication contents only cover two (33.8%) types of DRP contents or fewer (35.1%). The communication time averaged 5.8 minutes. The communication way is predominantly face-to-face (91.3%), but telephone or other online means (such as WeChat) may be preferred for urgent tasks or long physical distances. Among the 367 participants, 44 patients had DRPs. The RCT results indicated a significant difference in DRP incidence between the control group and the intervention group after the communication intervention (p = 0.02), and the incidence of DRPs in the intervention group was significantly reduced (15.6% vs. 0.07%). Regression analysis showed that communication time had a negative impact on DRP incidence (OR = 13.22, p < 0.001).

Conclusion

The communication mode based on the interprofessional approach of the shared decision-making between clinical pharmacists and physicians in medication decision-making could significantly reduce the incidence of DRPs, and the length of communication time is a significant factor. The longer the communication time is, the fewer DRPs that occur.

Trial registration

This trial was approved by the ethics committee of The First Affiliated Hospital of Medical College of Xinjiang Shihezi University Hospital (kj2020–087-03) and registered in the China clinical trial registry (https://www.chictr.org.cn, number ChiCTR2000035321 date: 08/08/2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08505-1.

Pharmacists’ strategies to detect, resolve, and prevent DRPs in CKD patients

Pharmacists have undergone obstacles in the process of detecting, resolving, and preventing CKD patients’ DRPs. Thus, optimal strategies were needed. A total of 19 articles were included based on the article searching process. Based on the articles, it can be concluded: The strategies of detecting DRPs in CKD patients were carried out through medication reconciliation and medication review. The outcomes of these strategies were the number of DRPs/patients and types of DRPs detected. Strategies to resolve and prevent DRPs in CKD patients were conducted through interprofessional collaboration, education, and counselling. The outcome of these strategies was a change in the patients’ DRPs status. Optimization of detection, resolution, and prevention strategies were performed by improving pharmacists’ professional hard and soft-skills as well as modifying the pharmaceutical care delivery model. A decrease in the number of DRPs/patients and a change in DRPs status were reported as the outcomes of optimizing this process.

Pharmacist impact on medication dosing and billable coding accuracy in outpatients with chronic kidney disease

BACKGROUND

Ambulatory care pharmacists can enhance economic and clinical outcomes as part of interdisciplinary health care teams. Patients with chronic kidney disease (CKD) often have complex medication regimens, potentially resulting in dosing errors and drug interactions.

OBJECTIVE

To demonstrate the impact that clinic-based pharmacists may have in populations comprising ambulatory patients with CKD.

PRACTICE DESCRIPTION

Community-owned, not-for-profit health system with outpatient, primary, and specialty care clinics.

PRACTICE INNOVATION

This quality-assurance, cohort, interventional study included patients aged at least 18 years with a CKD- or end-stage renal disease-associated diagnosis code seen by a clinic primary care provider at least once between January and June 2019. Primary outcomes included the number of medications requiring pharmacist intervention, pharmacist-initiated recommendations, and associated outcomes.

EVALUATION METHODS

Patients were randomly assigned to 2 cohorts. Providers of patients in the proactive pharmacist intervention group were notified of pharmacist recommendations immediately after initial data collection. Providers of patients in the group undergoing usual care (control group) were notified of identified medication recommendations after a 3-month period of usual care. Demographics were assessed using descriptive statistics. Differences in CKD staging, number of recommendations made, and provider responses were assessed using the chi-square, Fisher exact, and Mann-Whitney U tests.

RESULTS

A total of 182 patients were eligible for inclusion. In the intervention group, 22.1% of patients were identified as having inappropriately dosed medications versus 19.5% in the control group. In the intervention group, 46 of the 95 patients (48.4%) had an inaccurate CKD stage documented compared with 48 of the 87 patients (55.2%) in the control group (P = 0.772). The rate of pharmacist recommendation rejection substantially decreased between the intervention and control groups' provider responses (24% to 11.8%).

CONCLUSION

Pharmacist-initiated recommendations resulted in the identification and resolution of medication-dosing errors and improved collaboration between providers and pharmacists.