Abstract
Kidney transplant recipients are at risk of pharmacological interactions and adverse drug reactions. Community pharmacists are uniquely poised to detect and intervene in cases of drug‐related problems. The aims of this study were to develop and validate a list of explicit criteria to be used by community pharmacists to assess drug‐related problems in kidney transplant patients, and to assess their frequency and their determinants. First, we used a modified RAND method where a panel of experts established the PART (Pharmacotherapy Assessment in Renal Transplant Patient) criteria. Then, we performed a cross‐sectional study in which we applied the PART criteria to 97 prevalent kidney transplant recipients followed at a single university‐affiliated center. The final list of PART criteria included 70 drug‐related problems and was reliable (kappa: 0.88). An average of 1.2 drug‐related problems per patient was detected when the PART criteria were applied, with 68% of patients having at least 1 problem. This figure was 1.4 per patient using the expert judgment of renal transplant pharmacists who had no access to the PART list. The total number of medications taken was the only factor associated with the number of drug‐related problems (β: 0.27 for an increase of five medications, 95% CI 0.005, 0.547). The PART criteria provide a novel tool for community pharmacists to systematically detect drug‐related problems in kidney transplant recipients.
Highlights
Renal transplantation is the optimal treatment modality for patients with end‐stage renal disease, improving both quality of life and life expectancy compared to dialysis.[1,2] transplantation entails significant changes in pharmacotherapy for patients, with complex medication regimen including multiple immunosuppressive agents that have pharmacokinetic and pharmacodynamic interactions with other drugs, frequent adverse events and a narrow therapeutic index.[3]After the early post‐transplant period, patients are regularly returned to their referring center and may have limited access to expert transplant pharmacists who would rapidly intervene when problems occur with the medication regimen.[4]
Future studies will be needed to assess the use of our tool in community pharmacies, here we report the first step of a quality improvement process where the ultimate goal is to improve the quality of pharmacotherapy in kidney transplant recipients (KTR) while providing community‐based services
We developed and validated a set of criteria that can be used by the community pharmacists to assess clinically relevant drug‐related problems (DRPs) in KTR
Summary
Transplantation entails significant changes in pharmacotherapy for patients, with complex medication regimen including multiple immunosuppressive agents that have pharmacokinetic and pharmacodynamic interactions with other drugs, frequent adverse events and a narrow therapeutic index.[3]. After the early post‐transplant period, patients are regularly returned to their referring center and may have limited access to expert transplant pharmacists who would rapidly intervene when problems occur with the medication regimen.[4]. This is relevant as transplant patients are at risk for serious adverse events such as graft rejection, opportunistic infections, hospitalization, and drug toxicity due to errors in their pharmacotherapy.[3]. A DRP is an event or circumstance involving drug therapy that or potentially interferes with desired health outcomes.[6,7]
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