Enhancing collaborative pharmaceutical care for patients with chronic kidney disease: survey of community pharmacists

Assessment of Pharmacists' Knowledge and Practices towards Prescribed Medications for Dialysis Patients at a Tertiary Hospital in Riyadh Saudi Arabia

Objective: The present study examined pharmacists’ knowledge and practices towards prescribed medications for hemodialysis patients. The impact of a pharmacist’s current positions and years of experience on practices and knowledge was also assessed. Methods: A cross-sectional survey was distributed to pharmacists working at King Abdul-Aziz Medical City-Central Region over a period of 4 months from July to October in 2015. Results: Of the 85 approached pharmacists, 66 pharmacists completed the questionnaire, among which 45 (68.2%), 9 (13.6%), and 12 (18.2%) of them were outpatient hospital pharmacists, discharge counselling pharmacists, and pharmacy practice residents, respectively. In total, 47 (55.3%) of the pharmacists sought drug information resources for newly prescribed medications to hemodialysis patients. Among the surveyed pharmacists, around two-thirds of them (63.6%) were completely confident during counselling hemodialysis patients, while 32% were moderately confident, and only 4.5% were not confident. All of the participating pharmacists checked each patient’s allergic status before dispensing hemodialysis medications. The majority of the outpatient hospital pharmacists (35; 77.8%), discharge pharmacists (8; 88.9%), and the pharmacy practice residents (11; 91.7%) agreed that oral ciprofloxacin should be given after dialysis session on the same dialysis days, while 18 (40%), 5 (55.6%), and 9 (75%) of the outpatient hospital pharmacists, discharge pharmacists, and pharmacy practice residents agreed that IV route is preferred for hemodialysis patients to administer epoetin alfa, respectively. Sixty-six percent of discharge pharmacists (n = 6), 91.7% (n = 11) of the pharmacy practice residents, and 55.6% (n = 25) of the outpatient hospital pharmacists checked patient laboratory results prior to dispensing medications (p = 0.001). Conclusions: Despite the limited knowledge regarding some prescribed medications, most of the hospital pharmacists showed good practices toward dialysis patients.

Processes and determinants of integration of eGFR in physicians' drug prescriptions: a qualitative study of semi-structured interviews

AIM

Our objective was to explore the processes and determinants leading physicians to integrate estimated glomerular filtration rate (eGFR) in their drug prescriptions.

BACKGROUND

Access to patients' eGFR would allow primary care pharmacists to optimise their role in the procedure of safe prescribing. Some rare physicians actively integrate eGFR in their prescriptions, in a sporadically and uncoordinated manner.

METHODS

Qualitative study using semi-directed interviews conducted among 12 French physicians who integrated eGFR in their drug prescriptions, (February 2016-April 2017). These voluntary participants were recruited through different means: Twitter®, forums, direct contact and snowball sampling. Data analysis was based on the grounded theory approach, underpinned by a comprehensive perspective of interactionist orientation.

FINDINGS

Residency and training, professional experience - including experiences of adverse drug reactions - and the membership in various communities of professionals were key drivers for the integration of eGFR in prescriptions. The theoretical aim was above all safe prescribing in order to reduce adverse drug reactions, with the control by a dispensing pharmacist and/or other healthcare professionals. Nevertheless, none of the physicians had received any feedback from any healthcare professionals. Despite their disappointment, the physicians remained convinced of the interest of integrating eGFR in their prescriptions and would continue to do so. Characteristics associated with integration of eGFR in drug prescriptions belong partly to Roger's theory of innovations. If a widespread diffusion of this habit takes place, it will be necessary to evaluate its adoption by both physicians and pharmacists.