Effectiveness of pharmacist intervention in patients with chronic kidney disease

Cabello-Muriel, Aurelio; Gascón-Cánovas, Juan José; Urbieta-Sanz, Elena; Navalón, Carles Iniesta

doi:10.1007/s11096-014-0001-3

Cited by 29 publications

(37 citation statements)

References 17 publications

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“…While almost half of the studies were cross‐sectional, 21 studies implemented interventions to reduce IP . Of these interventions, almost half were manual decision aids (n = 10), others were computerised decision support aids to physicians and pharmacists (n=9) and in the remaining studies (n=2), physicians were prompted with calculated eGFR values (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Forty‐three of the included studies were rated as moderate or high quality (can be accessed on supporting information). All studies defined their inclusion criteria and evaluated IP objectively with comparators described clearly, where applicable .…”

Section: Resultsmentioning

confidence: 99%

“…Most studies have used the CG to estimate renal function for drug dosing (n=26), whereas 16 studies used MDRD . Six other studies employed either Jelliffe's equation or a combination of formulas to determine renal function status (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies reported clinical outcomes like prolonged hospital stay, different adverse drug events and mortality due to the IP in patients with CKD (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the interventional studies (n=21), almost half of them (n=10) were manual supports to physicians in the form of interactive training, education, and feedback by pharmacists or clinical experts . Immediate concurrent feedback given to physicians had brought the highest reduction in IP, ie, from 77% to 19% ( P< .001) (Shown in Figure ).…”

Section: Resultsmentioning

confidence: 99%

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Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

et al. 2017

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Eight studies reported clinical outcomes like prolonged hospital stay, different adverse drug events and mortality due to the IP in patients with CKD (Table ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

et al. 2017

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Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center

Cheung

Cooper

et al. 2020

J Am Coll Clin Pharm

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Introduction: Kidney disease is a major worldwide public health problem. An increased risk for adverse drug events is associated with drug dosing errors in hospitalized patients with renal impairment. A pharmacist-driven renal protocol may improve dosing compliance by allowing pharmacists to monitor renal function and adjust drug doses as needed.Objectives: To evaluate the utilization and financial impact of a pharmacist-driven renal dosing protocol.Methods: This was a retrospective cohort study of patients admitted to an academic medical center from 1 April 2017 to 30 May 2017 who had drug(s) from the protocol dose adjusted by a pharmacist. Outcomes of interest included protocol use frequency, patient characteristics, type of dose adjustments, and when adjustments were made. Two subgroup analyses were performed to: (1) determine cost savings of the seven most adjusted drugs and (2) determine if any missed opportunities for dose adjustments for cefepime.Results: A total of 422 dosage adjustments, performed on 317 patients, were included. The mean age of the patients was 63 years with 51.2% female. The majority (62.8%) had no history of renal dysfunction, 22.4% had chronic kidney disease, 14.8% had end-stage renal disease, and 25.3% had acute kidney injury on admission.Most dose adjustments (73.5%) were dose decreases, while 24.4% were dose increases. The seven most commonly adjusted drugs contributed to a cost savings of approximately $3919.87 per duration of therapy which extrapolates to an annual cost savings of $23 519.22. Of all the cefepime orders reviewed over a 7-day period, 84% were dosed correctly, 9% needed dose adjustments that could have been made sooner, and 7% had incorrect dose based on renal function.Conclusion: This analysis demonstrates that implementation of a pharmacist-driven renal dose adjustment protocol was consistently utilized at our institution and resulted in cost savings.

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Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

Tong

Edwards

Hua

et al. 2020

Pharmacy Practice and Res

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Aim The role of clinical pharmacists in the care of hospitalised general medicine patients is evolving from a reactive model of care to a model with an emphasis on interdisciplinary care and more advanced models of care. The purpose of this review was to evaluate the published literature on the effects of roles of clinical pharmacists that extend beyond those activities considered to be standard clinical practice in Australia, on clinical outcomes in hospitalised general medicine patients. Data sources A search of English‐language publications in six databases was conducted. Study selection Peer‐reviewed, English‐language articles were identified across the date range January 2000 to June 2020. Studies were included if they evaluated an inpatient pharmacy service in a general medicine population and the article included a study design with a clear comparator and outcomes such as medication errors or medication appropriateness. Studies evaluating pharmacists’ activities that are considered standard clinical practice for pharmacists in Australia, such as participation on ward rounds, medication reconciliation and patient education were excluded. Results Twelve studies met the inclusion criteria: four evaluating pharmacist‐led anticoagulation or thromboprophylaxis management, one evaluating pharmacist‐led vaccination, three evaluating a pharmacist charting model, two evaluating pharmacist‐led de‐escalation of therapy, one evaluating a pharmacist intervention in patients with chronic kidney disease and one evaluating pharmacist‐led glycaemic control. Conclusions The addition of advanced clinical pharmacist services in the care of general medicine inpatients generally resulted in improved care, with no evidence of harm. Future studies should include multiple sites, larger sample sizes, reproducible interventions and identification of patient‐specific factors that lead to improved outcomes.

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Effectiveness of pharmacist intervention in patients with chronic kidney disease

Abstract: The implementation of a monitoring program for CKD patients was effective in the group in which monitoring was conducted, especially in patients with more advanced stage of CKD.

Cited by 29 publications

References 17 publications

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

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