Abstract
Rationale & ObjectiveHemodialysis (HD) patients have complicated disease states, placing them at higher risk for medication-related problems, medication discrepancies, and nonadherence. The objective of this study is to evaluate the impact of a clinical pharmacist in a single HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on a single health care system.Study DesignRetrospective study.Setting & ParticipantsGreenfield Health Systems, a wholly owned subsidiary of Henry Ford Health System, operates 14 HD facilities throughout Southeast Michigan. The West Pavilion facility is located in Detroit, MI. Patients with end-stage kidney disease included in the study had a minimum of 4 encounters with the clinical pharmacist or pharmacy interns between August 2017 and October 2018.ExposureA clinical pharmacist performed medication reconciliation and medication reviews with HD patients to assess medication-related problems and identify gaps in care. Interventions made by the pharmacist were prespecified through a collaborative practice agreement.OutcomesTo evaluate the impact of a clinical pharmacist in an HD facility by assessing the efficacy of medication reconciliation in HD patients and evaluating the potential impact on this health system through an estimated cost avoidance.Analytical ApproachDescriptive statistics were used to collect medication-related problems and classified based on a modified Hepler-Strand approach.ResultsThere were 1,403 medication-related problems, with an average of 8.96 medication-related problems per patient. Adherence was the most common medication-related problem (31%). Antihypertensive medication was the most common drug class in which the pharmacist intervened (37%), followed by vitamin D analogues and calcimimetics (29%). A projected total of US $447,355 was saved.LimitationsRetrospective analysis of observational data and descriptive statistics with the potential for residual bias and confounding.ConclusionsPharmacists in HD facilities have a positive influence on HD patients through medication management that results in cost savings.
Highlights
Documented improved blood pressure (BP) management, reduced anemia in chronic kidney disease, and improvement in calcium and phosphate levels
A total of 268 patients are dialyzed at Greenfield Health System (GHS) West Pavilion dialysis center
The total amount of health care provider interventions made during the study period was 964, about 6.1 per patient
Summary
Documented improved blood pressure (BP) management, reduced anemia in chronic kidney disease, and improvement in calcium and phosphate levels. The latter have been associated with reduced mortality, number of hospitalizations, and inpatient length of stay and enhanced cost savings with clinical pharmacist interventions.[8,9,10,11,12,13] these studies show promising outcomes with pharmacy service intervention, it is important to continually assess patient outcomes and cost savings using different patient care models
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