Exploring the role of pharmacists in outpatient dialysis centers: a qualitative study of nephrologist views

Abstract

Implementation of pharmacy services in dialysis centers seems to be limited and requires acceptance from nephrologists. The aim of this study was to explore the opinions of Australian and Portuguese nephrologists toward a potential future provision of clinical pharmacy services in outpatient dialysis centers. A qualitative study using semistructured interviews was conducted with a purposeful sample of 7 Australian and 14 Portuguese nephrologists. The audiotaped interviews were transcribed verbatim and thematically analyzed. Three themes emerged from the analysis: 'attitudes of nephrologists towards pharmacist involvement', 'types of pharmacy services' and 'consequences of implementation of pharmacy services'. Australian nephrologists showed positive attitudes and reported several pharmacy services that could be performed by pharmacists in dialysis centers, whereas Portuguese nephrologist views restricted pharmacists to administrative duties. In addition, Portuguese nephrologists showed concerns with professional boundaries and demonstrated lack of awareness and knowledge of pharmacist skills. Pharmacy services suggested by Australian nephrologists included medication review, medication reconciliation, medication history update, patient and staff education, patient compliance improvement and development and implementation of anemia protocols. Nephrologists expected economic benefits from the services implementation by minimizing the inappropriate use of drugs, avoiding medication errors, and reducing drug wastage due to noncompliance. Australian and Portuguese nephrologists hold different views regarding the future provision of pharmacy services in outpatient dialysis centers. Acceptability seems to be related to a previous acquaintance with pharmacists and pharmacy services. Different health policies in the two countries that promote collaborative practice between physicians and pharmacists may also account for the differences.