Analysis of pharmacists’ recommendations to address drug-related problems in chronic kidney disease patients as a basis to develop therapeutic drug monitoring form in an Indonesian hospital

Abstract

This study aimed to develop therapeutic drug monitoring (TDM) form based on analysis of pharmacists’ recommendation to address drug-related problems (DRPs) in chronic kidney disease (CKD) patients in a private hospital. The profile of DRPs and pharmacists’ recommendations, and clinical significance assessment of pharmacists’ recommendations before and after development of TDM form were compared. Focus group discussions (FGD) was undertaken to evaluate the TDM form. There was similar pattern of DRPs identified using either pre-developed or post-developed TDM form with dose selection being the most frequent DRP. No considerable difference regarding physician acceptance rate to pharmacists’ active recommendations before and after form development (70.6% and 65.4%, respectively). The commonest recommendations in both phases were dose change, drug discontinuation and drug change. There was no statistical difference regarding the clinical significance of recommendations between both phases but higher level of clinical significant recommendations was documented after form development. Major issues of pre-developed form identified during FGD including unclear instruction of documentation, inadequacy to justify the reasons for recommendations and non-integration within medical record. Development of TDM form unchanged the profile of DRPs and pharmacists’ recommendations, yet the developed form might generate more responses from other health professions and clinically significant recommendations.