Demonstrating the value of community pharmacists in New Zealand educating a targeted group of people to temporarily discontinue medicines when they are unwell to reduce the risk of acute kidney injury

Abstract

Objective Acute kidney injury (AKI) prevention strategies for community‐acquired AKI associated with severe acute illness have received attention in recent years. The objective of this study was to evaluate a community pharmacist AKI education programme aimed at patient self‐management during acute dehydrating illnesses. Methods This was a multimethod study. Potential participants were identified by community pharmacists when they presented a prescription containing a study medicine. The intervention consisted of completion of a short demographic questionnaire and a pharmacist providing verbal AKI information and advice on self‐management during acute dehydrating illness, including medicine withholding. This information was supported with take‐home information. Participants were telephoned between 4 and 11 months later and invited to participate in a structured telephone interview. Descriptive statistics were generated from questionnaire responses, and interview data were analysed using manifest content analysis. Key findings One hundred and thirteen adults were recruited and 93 (82%) interviewed. Fifty‐four (58%) interviewees remembered the pharmacist’s education, and 51 (55%) had retained the information sheet. Fifty‐eight (62%) would temporarily withhold medicines during acute dehydrating illnesses. Thirty‐nine were comfortable they knew when to restart their medicines; 15 (38%) indicated this was once symptom‐free for 48 h. Forty‐six interviewees were comfortable about contacting their general practice; 16 (35%) would do this after 24 h of illness. Participants found the educational content and pharmacist approach acceptable. Conclusion A majority of participants accepted and remembered the information provided by their community pharmacist and felt comfortable to self‐manage during acute dehydrating illness. A caveat is participant actions in practice may not be consistent with stated intentions.

Sick Day Medication Guidance for People With Diabetes, Kidney Disease, or Cardiovascular Disease: A Systematic Scoping Review

“…A recommendation to temporarily stop metformin was included in more than 50% of documents (n = 29). 8 , 11 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 Diabetes Canada used an acronym to help remind users of medications that should be stopped—SADMANS (sulfonylureas, angiotensin converting enzyme inhibitors, diuretics/direct renin inhibitors, metformin, angiotensin receptor blockers, nonsteroidal anti-inflammatory drugs, and sodium/glucose cotransporter 2 inhibitors)—which was included in 3 documents. 11 , 30 , 33…”

The role of pharmacists in the management of AKI patients: What recent studies added to our knowledge?

“…Additionally, 49% of the patients were willing to contact their physicians upon stopping their medication due to severe nausea and vomiting, while only 35% would contact them after one day. The educational intervention provided by the community pharmacists in New Zealand was found to be practical as it would help patients temporarily withhold certain medications when having an acute illness to reduce the risk of AKI, as concluded by the researchers (7).…”

“…Vicary and associates conducted a study in New Zealand, in which they assessed the current practices of general practitioners (n = 37) and community pharmacists (n = 25) in educating their patients on when to withhold their medications during acute dehydrating illnesses (6). The assessment was followed by a second study (7), in which the researchers evaluated an intervention that aimed to provide information to patients regarding key medications that could worsen AKI. These key medications were also known as "Double Whammy" (NSAIDs with angiotensin-converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]/diuretics) and "Triple Whammy" (NSAIDs with ACEIs/ARBs and diuretics), which were associated with an increased risk of AKI during dehydrating illness.…”

“…Vicary et al (7) Original research 39 community pharmacists and 113 consenting patients who received intervention.…”

“…The previous findings led Vicary and colleagues to conduct a second study to evaluate an educationalbased intervention, which was provided by community pharmacists (n = 39), to discontinue the key medications whenever their patients feel unwell, therefore the risk of AKI is reduced (7). The intervention consisted of verbal education by community pharmacists, along with a sickday guidance sheet, which provides graphic and direct information regarding the list of medications that cause AKI, instructions on withholding the medication for 24 to 48 hours, instructions on contacting a general practitioner if the symptoms of AKI worsen, as well as actions to be taken to self-manage when taking medications that would cause AKI.…”