Role of clinical pharmacist in the management of blood pressure in dialysis patients

Qudah, Bonyan; Albsoul-Younes, Abla; Alawa, Ezat; Mehyar, Nabil

doi:10.1007/s11096-016-0317-2

Cited by 22 publications

(44 citation statements)

References 24 publications

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“…The proportion of patients whose blood pressure declined after received several counseling sessions were higher compared to that in the control group, significantly in terms of predialysis and intradialysis blood pressure, with some confounders namely sex, age, and education level as in Tables 5 and 6. The result was in line with studies that also showed positive outcome in home blood pressure control involving patient education or collaboration care of pharmacist and physician in the management of blood pressure in dialysis patients 31 .…”

Section: Discussionsupporting

confidence: 86%

Pharmacist counseling is an important factor in lowering blood pressure of hemodialysis patients with hypertension

Resmiati

Sauriasari²,

Supardi

2020

Pharm Sci Asia

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Hypertension is major comorbidity yet difficult to manage in hemodialysis patients. Pharmacist's role to improve the clinical outcome of hypertensive hemodialysis patients needs to be evaluated. The study objective was to evaluate the effect of pharmacist counseling in lowering systolic and diastolic blood pressure in hypertensive hemodialysis patients in hemodialysis unit of Fatmawati Hospital Jakarta in 2018, by controlling some confounders. The study used a quasi-experimental design with pretest-posttest, conducting on age, gender, education, smoking habit, and payment method-matched intervention and control groups. The research sample was taken by consecutive sampling method for 30 patients in the intervention group and 28 patients in the control group. Pharmacist counseling was carried out only in the intervention group. The parameter used were predialysis, intradialysis, and postdialysis systolic and diastolic blood pressure. The results showed that there were significant differences in pretest and posttest (p < 0.05) for predialysis systolic and diastolic blood pressure in the counseling group. In multivariate analysis with backward method, pharmacist counseling was found to be the most determinant factor in reducing predialysis systolic blood pressure (p < 0.05) controlled by education level. It also significantly reduced predialysis diastolic blood pressure controlled by gender, intradialysis systolic blood pressure, and intradialysis diastolic blood pressure controlled by age. In conclusion, pharmacist counseling counseling was the most determinant factor in lowering pre-and intradialysis blood pressure in the hypertensive hemodialysis patient.

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Section: Discussionsupporting

confidence: 86%

Pharmacist counseling is an important factor in lowering blood pressure of hemodialysis patients with hypertension

Resmiati

Sauriasari²,

Supardi

2020

Pharm Sci Asia

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“…However, it tended to increase screening of previously unscreened patients (78.6% in the pharmacist MTM group compared to 33.3% in the control group; (OR 7.3, 95% CI: 0.96–56.3; p = 0.05). Qudah et al (2016) Jordan [ 32 ] Randomised controlled study (6 months) Outpatient haemodialysis units of a university hospital To evaluate clinical pharmacists role in the management of blood pressure in haemodialysis patients guided by home blood pressure monitoring 60 HD patients Intervention 55.3 (15.1), and control 51.7 (18.5) Physician-pharmacist collaborative care to optimize antihypertensive pharmacologic therapy (n = 29) Control group (n = 27) 46% of patients in the intervention arm achieved BP target (mean home BP ≤ 135/85 mmHg) compared to only 14.3% of patients in the control arm ( p = 0.02). Average decline in weekly mean home SBP was 10.9 ± 17.7 mmHg in the intervention arm ( p = 0.004) Weekly mean home systolic blood pressure increased by 3.5 ± 18.4 mmHg in the control arm ( p = 0.396) Chia et al (2017) Singapore [ 52 ] Non-randomised, controlled study (24 months) Outpatient nephrology clinic of a tertiary hospital To determine whether a collaborative care (CC) model with pharmacist involvement can reduce admissions and healthcare utilization in patients receiving dialysis, compared to usual care (UC) 134 patients CC 62 (11.4), UC 60.4 (10.8) Pharmacists performed medication review, disease and medication counselling.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of processes (often labelled as interventions) included medication chart review to identify any drug-related problems (DRPs) [ 15 – 31 ]. Many studies reported pharmacists’ interventions in: modifying drug doses and recommending new pharmacotherapy; [ 16 , 19 , 21 – 23 , 25 – 27 , 29 , 30 , 32 – 40 , 52 , 59 ]; interacting with a member of the multidisciplinary team; [ 15 – 17 , 19 – 21 , 23 – 25 , 27 , 31 , 32 , 34 – 38 , 40 – 43 ] requesting and monitoring laboratory parameters; [ 15 , 23 , 25 , 27 , 33 , 34 , 36 , 37 , 43 ] assessing appropriateness of medications prescribed for hospitalised patients at each point of care; [ 17 , 22 , 29 , 30 , 35 – 38 , 40 , 57 ]. Fewer studies described pharmacist processes at out-patient, pharmacist-led clinics relating to the management of specific CKD complications, such as anaemia; [ 34 , 39 , 44 ] hypertension and diabetes; [ 54 ] managing hypertension through telemedicine; [ 41 ] optimising dyslipidaemia management; [ 37 , 45 ] improving haemoglobin A1c levels (HbA1c); [ 43 ] and emphasising smoking cessation.…”

Section: Resultsmentioning

confidence: 99%

“…Intervention in the management of BP in CKD and haemodialysis resulted in achieving target BP in the intervention versus the control group [ 32 , 54 , 55 ], significant reductions in mean systolic and diastolic BP in a group of kidney transplant recipients [ 41 ], and significant reduction in systolic and diastolic BP in diabetic nephropathy [ 43 ]. Only one article showed that pharmacists’ intervention in an intensive care unit (ICU) setting reduced the length of ICU stay [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review

et al. 2019

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Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease patients. Aim of the review To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease. Method PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists’ involvement in the multidisciplinary team providing care to patients with chronic kidney disease, more high-quality research is warranted. Electronic supplementary material The online version of this article (10.1007/s11096-019-00816-4) contains supplementary material, which is available to authorized users.

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“…The second is provider-centered care delivery. The focus of this model is on physician support, with the assistance of nurses, clinical pharmacists, medical educators, dietitians, or clinical decision support algorithms [40–45]. The third and latest approach is centered on the combination of both models [46–51].…”

Section: Discussionmentioning

confidence: 99%

A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial

Fang

et al. 2017

Trials

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BackgroundHypertension is a major risk factor for cardiovascular disease, and its control rate has remained low worldwide. Studies have found that telemonitoring blood pressure (BP) helped control hypertension in randomized controlled trials. However, little is known about its effect in a structured primary care model in which primary care physicians (PCPs) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions. This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China.Methods/designPatients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital, Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet. Study subjects are randomly assigned to three interventional groups: (1) usual care; (2) home-based BP telemonitor with embedded Global System for Mobile Communications (GSM) module and unlimited data plan, an app to access personal healthcare record and receive personalized lifestyle coaching contents, and proficiency training of their use; or (3) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches. The primary outcome is mean change in systolic blood pressure over a 12-month period. Secondary outcomes are changes of diastolic blood pressure, HbA1C, blood lipids, and medication adherence measured by the eight-item Morisky Medication Adherence Scale.DiscussionThis study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care. Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension.Trial registrationClinicalTrials.gov, NCT02919033. Registered on 23 September 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1970-z) contains supplementary material, which is available to authorized users.

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Role of clinical pharmacist in the management of blood pressure in dialysis patients

Cited by 22 publications

References 24 publications

Pharmacist counseling is an important factor in lowering blood pressure of hemodialysis patients with hypertension

Pharmacist counseling is an important factor in lowering blood pressure of hemodialysis patients with hypertension

Clinical pharmacy practice in the care of Chronic Kidney Disease patients: a systematic review

A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial

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