Abstract
BackgroundNonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes. Limited data exist to demonstrate the effect of incorporating patient-centered interventions using concepts of medication therapy management and motivational interview by pharmacists on pharmacoadherence in patients requiring HD. Therefore, we assessed the impact of patient-centered pharmacist care on pharmacoadherence and its outcomes in patients requiring HD.MethodsAdult patients who had received outpatient HD for at least 3 months were enrolled. The study was conducted from October 2016 to April 2017. Pharmacists interviewed the patients at month 1, 2, 4 and 6, and the intervention (comprehensive review) occurred at months 3 and 5. The primary outcome was the change in pharmacoadherence as assessed by pre-HD serum phosphate levels and the differences in the number of medications between patient’ self-report and medications records at the electronic healthcare records (EHRs). The secondary outcomes included changes in systolic blood pressure (SBP), glycosylated hemoglobin levels, serum low-density lipoprotein (LDL) levels, and the prevalence and types of medication-related problems (MRPs).ResultsSeventy-two patients were enrolled. Their median age was 59 (interquartile range: 47–67.5) years, and 53% were men. Pre- and post-intervention pharmacoadherence, as indicated by serum phosphate levels and the differences in the number of medications between patient’ self-report and the medication records at the EHRs, did not significantly differ (p = 0.682 and 0.348, respectively). Mean SBP and mean LDL did not significantly change post-intervention. The median number of MRPs declined between Months 3 and 5 (p = 0.002): the prevalence of MRPs at Month 3 was 44.9% (95 confidence interval [CI]: 40.4–49.3) and decreased to 29.8% (95 CI: 25.6–34.3) at Month 5. Drug use without indication was the most frequent MRP (23.9%).ConclusionsPatient-centered pharmacist care did not result in significant changes in pharmacoadherence. However, its clinical utility as a tool to identify and mitigate MRPs in patients requiring HD is indisputable.Trial RegistrationClinicalTrials.gov identifier: NCT03576404 (retrospectively registered on July 3rd, 2018).
Highlights
Nonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes
In 2003, the World Health Organization (WHO) announced that nonadherence to medications is a public health problem among patients with chronic illnesses that leads to unfavorable clinical outcomes and confers a significant financial burden on medical institutions [1]
The WHO proposed that the optimization of pharmacoadherence [2] should serve as a modifier of the effectiveness of the health-care system, improving patient safety and health
Summary
Nonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes. We assessed the impact of patient-centered pharmacist care on pharmacoadherence and its outcomes in patients requiring HD. Considerable variation in the rate of nonadherence to medications, which ranges from 12.5–98.6%, has been reported in patients requiring hemodialysis (HD) [3]. This variation has been attributed to the different measurement tools used, which include:. Several studies included in a systematic review by Karamanidou et al have utilized adherence to phosphate binders and serum phosphate levels as surrogate markers of adherence in patients requiring HD [5]
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