Pharmacists’ attitude, self‐reported knowledge and practice of dosage adjustment among chronic kidney disease patients in Malaysia

Abstract

Drug-related issues, such as inappropriate drug dosing, are pervasive patient issues that are particularly common among chronic kidney disease (CKD) patients. Pharmacists have the expertise to play an important role in avoiding such problems. The aim of the present study was to explore pharmacists' self-perceived knowledge, attitude and practice towards dosage adjustment among CKD patients. A cross-sectional, Web-based, self-administered survey was conducted among 1594 registered pharmacists in Malaysia. Participants were surveyed regarding their perceived knowledge, attitude and implementation of drug dosage adjustment based on renal function among CKD patients in their practice. The study was completed by 234 pharmacists (14.7%). More than four-fifths of respondents (n = 199) reported that they are practicing dosage adjustment. The median self-perceived knowledge score was 27.0 (of a total of 45). Pharmacists younger than 29 years of age and those practicing in hospitals had higher knowledge of drug dosage adjustments. Female pharmacists were more likely to express interest in being involved in the identification, monitoring and resolution of drug therapy problems for CKD patients (p = 0.02). The two most common obstacles reported by pharmacists who did not practice dosage adjustment were a lack of information regarding a patient's renal function status (76%) and medical history (74%). Further training should be given to pharmacists to improve knowledge and awareness. An alert card could be implemented to record a patient's renal function to improve communication between hospitals and primary care settings.

Knowledge, attitude and perceptions of pharmacists regarding renal dose adjustment among chronic kidney disease patients in Pakistan

“…Given the scope of their roles, clinical pharmacists, especially those in inpatient settings, frequently engage in medication reviews and dose adjustments. These findings mirror the results from a study conducted in Malaysia [ 10 ]. Our data also revealed that chief pharmacists showcased a notably higher attitude score than other pharmacists.…”

“…Their vast experience usually involves diverse training programs and the use of various decision support tools. This aligns with existing literature, suggesting that training, expert clinical support, and a robust clinical decision support system can mitigate drug-related issues in CKD patients [ 10 , 31 ]. Moreover, the perception scores were significantly higher among resident pharmacists.…”

“…These included constraints on time due to a high patient load, the absence of information about a patient's renal function, and a lack of comprehensive patient medical history. Similar findings were echoed in a study that pointed out the challenges pharmacists face in procuring detailed patient medical histories, including renal function [ 10 ]. Another study reported barriers, such as difficulties in obtaining information on a patient's renal function, the oversight of prescriptions due to other pressing responsibilities, and a deficiency in the pharmacists' skills related to relevant pharmaceutical information [ 17 ].…”

“…In CKD, diminished renal function impacts both the pharmacokinetics and pharmacodynamics of various drugs [ 8 , 9 ]. Consequently, dose adjustments are essential to attain the desired clinical outcomes, mitigate adverse drug events, and prevent disease progression [ 10 ]. Yet, even with available dosing adjustment guidelines, 25–77% of CKD patients experience inappropriate dose adjustments [ 11 , 12 ].…”

Assessment of Inappropriate Dose Adjustment of Antimicrobials and Other Medicines Among Chronic Kidney Disease Patients: A Multicenter Observational Study

“…Notably, failures in dosage adjustments compound treatment costs and lengthen hospital stays, placing further strain on both patients and healthcare infrastructures [43] . Past research has indicated that between 25-77% of drugs, which required dosage modifications, were adjusted improperly [45,46] . Many such drugs, crucial for CKD patients, are routinely disregarded, inviting health complications [44] .…”