Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial.

Yun-Kyoung Song,Kook-Hwan Oh,Ha Young Jang,Nayoung Han,Yon Su Kim,Minji Sohn,Sohyun Jeong,Hajeong Lee,Heejin Na,Kwon-Wook Joo,Dong Ki Kim,Jung Mi Oh

doi:10.3390/jcm10081788

Abstract

(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, including medication reconciliation, medication evaluation and management, and discharge pharmaceutical care transition services. Participants in the control group received usual care. The primary outcome was the number of DRPs per patient at discharge. (3) Results: The baseline characteristics of 100 participants included the following: mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m2. The number of DRPs in the intervention group during hospitalization increased significantly with decreasing eGFR (PR, 0.970; 95% CI, 0.951–0.989) and an increasing number of unintentional medication discrepancies at admission (PR, 1.294; 95% CI, 1.034–1.620). At discharge, the number of DRPs per patient was 0.94 ± 1.03 and 1.96 ± 1.25 in the intervention and control groups, respectively (p < 0.001). The service had a significant effect on the reduction of the unintentional discrepancies at discharge (p < 0.001). (4) Conclusion: Hospital pharmacists play an important role in the prevention of DRPs at discharge and unintentional medication discrepancies in inpatients with CKD.

Highlights

Chronic kidney disease (CKD) is defined as 3 or more months of kidney damage or an estimated glomerular filtration rate < 60 mL/min/1.73 m2 [1]
Most patients with CKD have comorbid conditions, such as electrolyte abnormalities, and cardiovascular and mineral bone disorders, and complex medication regimens [6,7]. These might increase the risk of drug-related problems (DRPs), including adverse drug reactions (ADRs), drug–drug interactions, and inappropriate dosing and blood chemistry monitoring, which result in significant morbidity and mortality and excessive cost to the healthcare system [8,9]
Five patients were excluded owing to follow-up loss, consent withdrawal, or death, and 95 participants completed the follow-up visit after discharge (Figure 2)

Summary

Introduction

Chronic kidney disease (CKD) is defined as 3 or more months of kidney damage or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 [1]. In South Korea, the number of patients diagnosed with CKD is increasing by 8.7% annually, and the average incidence of treated end-stage renal disease (ESRD) rose by 19.4 per million people annually from 2009 to 2018 [4,5]. Many risk factors, such as hypertension, diabetes, old age, and use of nephrotoxic drugs, cause CKD progression, which has contributed to a remarkably high hospitalization and renal replacement therapy (RRT) rates [1,6]. The concomitant multiple drugs have been shown to impair medication adherence in patients with CKD, which might lead to disease progression and rehospitalization [6,11,12]

Objectives

Methods

Results

Conclusion