MO927: The Impact of Medication Therapy Management on Medication Burden Quality of Life Among Haemodialysis Patients in Egypt: An Intervention Study

Abstract

Abstract BACKGROUND AND AIMS End-stage kidney disease (ESKD) is a rapidly increasing global health burden. Renal replacement therapy is essential to save the lives of ESKD patients and is done either through kidney transplantation, peritoneal dialysis or hemodialysis (HD). Patients on HD are subjected to polypharmacy, increase in drug-related problems (DRPs), adverse effects, impaired drug adherence and consequently poor medication burden quality of life (MBQoL). Medication therapy management (MTM) plays an essential role in resolving those problems. The MTM involves performing a medication review, selecting, modifying or administering medication therapy, evaluating the patient’s response to therapy, identifying and resolving any DRPs and providing patient education to enhance the patient’s understanding and adherence to the treatment plan. These pharmaceutical services have shown a positive impact on dialysis patients regarding the economic, humanistic and clinical aspects. We therefore aimed to evaluate the impact of the application of MTM on MBQoL and determine its predictors. METHOD We collected baseline data (sociodemographic, clinical, hemodialysis vintage, hospital admission, drug adverse effects and laboratory) in a pre–post one-group intervention study from all adults on regular maintenance dialysis for >3 months at Alexandria University Hospital. The MBQoL was assessed using the patient-reported outcomes measure of the pharmaceutical therapy (PROMPT) questionnaire after being translated and validated into Arabic. Data on drug adherence was collected by comparing prescribed doses to the actually administered by patients. A structured checklist instrument was used to identify adverse effects. The MTM intervention was applied (medication therapy review, developing a personalized medication record, participating in the medication-related action plan, and patient education sessions). All haemodialysis patients were re-assessed after 3 months. Construct validity was assessed using exploratory factor analysis and reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Multiple linear regression was used to determine the predictors of the post-MBQoL and change in MBQoL from pre- to post MTM after adjusting for variables with P < 0.10 in bivariate analysis. RESULTS The study included 130 patients who were on average 52 year old (±13), 53.1% were males, 25.8% were smokers, 64.6% had cardiovascular diseases, 26.9% had hepatitis C virus and 14.6% were diabetics. The median (interquartile range) of the dialysis vintage was 5 (2–15) years. The validation of the PROMPT questionnaire was done on an additional 80 haemodialysis patients with similar baseline criteria as the study sample. Exploratory factor analysis revealed that items of the PROMPT were distributed on five domains. Cronbach's alpha was >0.70 for all domains except for ‘impact on patient's life’ (0.52). The ICC was significant (P < 0.01) for all items of the PROMPT questionnaire. The application of MTM had significant effects on the overall PROMPT score (50.74 ± 9.68 versus 59.3 ± 9.86; P < .001), the total number of DRPs (1245 versus 794; P < .001), and calcium level in mg/dL (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). There was a statistically significant reduction in the reported proportion of dry mouth, change of appetite, nausea and vomiting, stomach pain and dyspepsia, diarrhea, constipation and flatulence (P < 0.05). Calcium level (mg/dL) was significantly declined after the MTM application (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). The total number of DRPs was the only significant predictor for change in MBQoL, while university graduates and the a total number of DRPs were the predictors for the post-score of MBQoL. CONCLUSION There is a potentially relevant impact of MTM provision by a clinical pharmacist on medication burden, quality of life, drug-related problems and adverse events among haemodialysis patients.