Pharmacist Chart Reviews Cannot Replace Direct Care in the Management of Renal Transplant Recipients.

Abstract

OBJECTIVE: The aim of this study was to determine if a pharmacist executed comprehensive chart review may serve as a sufficient substitution for direct participation during clinic visits beyond the immediate post-transplant period. METHODS: This was a prospective 3 month study of kidney transplant recipients that had a scheduled visit within 3 years of transplant. Within 1 week prior to the visit, a clinical pharmacist completed a comprehensive review of the medical record and placed a note in the chart focusing on identifying all medication-related issues and providing recommendations for management. Providers were notified about the review and, following the visit, were asked to complete a survey about the utility of the note. After the appointment, the visit plan was compared with the pharmacist's note to determine whether the provider accepted the recommendations. An independent blinded transplant surgeon graded the recommendations by severity. Accepted recommendations were identified as novel if the evidence supporting it had been available to the provider but was not previously acted upon. RESULTS: During the study, pharmacists provided 1,401 recommendations from 170 chart reviews. Providers followed 397 (28%) of the recommendations; 232 (34%) of the recommendations pertaining to pharmacologic therapy were accepted, while 410 (29%) were graded as having at least a significant severity (Table 1). Providers completed the usefulness survey after 44 visits and 75% indicated that the pharmacist note impacted their interventions. Greater than 80% of the accepted recommendations were considered novel. CONCLUSIONS: This study demonstrates that a pharmacist chart review was not routinely utilized by providers during follow-up visits and suggests that this method of pharmacist involvement in transplant recipient care may not be effective or efficient. Future analyses should directly compare this form of intervention with direct patient-provider interactions.Table: No Caption available.