Abstract
Kidney transplant patients use several medications, which increases the risk of developing drug-related problems. This is a pre-post-intervention study, carried out in a transplant outpatient clinic in Belo Horizonte, Minas Gerais, Brazil, with post-transplant patients using tacrolimus. Pharmacy consultations were carried out in individual offices, and the initial and final status were measured between the first and the last consultation. Satisfaction with the pharmaceutical service was also assessed. Thirty-nine drug-related problems were identified, 64.3% of patients presenting at least one, of which 79.5% were resolved (p<0.001). The most frequent were “use of unnecessary medications” (26.5%), with omeprazole being the most prescribed medication for this situation. Polymedicated patients had more drug-related problems (p = 0.001). 49 interventions were performed, 51.02% were accepted. The most accepted interventions were recommendations for guidelines regarding the time of administration and reduction of adverse drug reactions (100%) and suspension of treatment (92.3%). In the end, the proportion of patients with stable clinical status increased from 35 .7% to 83.3% (p<0.001). Patients related the pharmaceutical service as very good, reporting the desire for its continuity. Comprehensive medication management positively impacted the patient's clinical situation, proved to be effective in solving drug-related problems, and was very well evaluated by the patients. It is recommended that polymedication is a priority criterion for this service.
Highlights
Renal transplantation is a treatment modality available for patients in the final stage of chronic kidney disease (CKD)(Brasil, 2021; Prates et al, 2016) and is associated with higher survival rates, better quality of life, and lower costs compared to hemodialysis (Berns, 2020; Molnar- Varga et al, 2011; Schunelle et al, 1998)
Pharmacotherapy for clinical problems should be the most indicated, effective, safe and convenient for the individual. These pillars support the comprehensive medication management (CMM) “defined as the standard of care that ensures each patient’s medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended”
The present study demonstrated that CMM can detect drug-related problems (DRP) and achieve therapeutic goals, within a holistic approach and improve the patient's clinical situation through individualized interventions, as well as determining which individuals will benefit most from this pharmaceutical service
Summary
(Brasil, 2021; Prates et al, 2016) and is associated with higher survival rates, better quality of life, and lower costs compared to hemodialysis (Berns, 2020; Molnar- Varga et al, 2011; Schunelle et al, 1998) This patient lives with the possibility of rejection of the graft, the need of a lifestyle changes and continued use of medications to maintain immunosuppression (Naik, 2020; Prates et al, 2016; Brito et al, 2016). Pharmacotherapy for clinical problems should be the most indicated, effective, safe and convenient for the individual These pillars support the comprehensive medication management (CMM) “defined as the standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended”. Clinical pharmacists work in collaboration with other professionals to optimize patient outcomes in four steps: assessment of the patient, evaluation of medication therapy, development e initiation of plan and follow up and medication monitoring (ACCP, 2021; Lee et al, 2016; Oliveira, 2011)
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