The Role of Community Pharmacists in the Detection of Clinically Relevant Drug-Related Problems in Chronic Kidney Disease Patients

Abstract

Community pharmacists (CPs) have traditionally had limited access to patients’ estimated glomerular filtration rate (eGFR) during the medication-dispensing process. The increasing access to shared electronic health records is making eGFR available, but the skills needed to detect and manage clinically relevant drug-related problems (DRPs) are poorly documented. The primary objective of this study was to investigate the role of CPs in the medication-dispensation process for elderly patients with renal impairment. A total of 70 CPs participated in this 6 month study. Community pharmacists asked all patients ≥65 years to bring their laboratory test values for the next medication-dispensing process. Drug-related problem detection rates were compared between CPs (prospective period) and expert pharmacists (retrospectively). The clinical relevance of each DRP was assessed by nephrologists and general practitioners using an appropriate tool. Community pharmacists recruited n = 442 patients with eGFR < 60 mL/min/1.73 m2 and detected n = 99 DRPs, whereas expert pharmacists detected n = 184 DRPs. The most frequently detected DRPs were dosage problems and contraindications. According to assessment by clinicians, CPs and expert pharmacists identified 54.0% and 84.7% of clinically relevant DRPs, respectively. This study suggests a positive impact of the systematic availability of eGFR to CPs on the detection of several DRPs with clinical relevance.

Clinical and Organizational Impacts of Medical Ordering Settings on Patient Pathway and Community Pharmacy Dispensing Process: The Prospective ORDHOSPIVILLE Study

“…Nevertheless, this problem should decrease with the emergence of computerized discharge orders. The frequencies of the two main DRPs showed no significant difference according to the setting and are in agreement with those reported in previous studies [ 5 , 11 , 19 , 20 ].…”

Ghent Older People’s Prescriptions Community Pharmacy Screening (GheOP3S)-Tool Version 2: Update of a Tool to Detect Drug-Related Problems in Older People in Primary Care

“…This is also confirmed by the literature, since several studies have suggested positive effects (e.g. increased detection of DRPs [42]) on clinical (e.g. blood pressure, haemoglobin, parathyroid hormone, and creatinine clearance), humanistic (e.g.…”

“…blood pressure, haemoglobin, parathyroid hormone, and creatinine clearance), humanistic (e.g. health-related quality of life, patient satisfaction) and economic outcomes when information on renal function was available to pharmacists [ 42 , 43 ].…”

“…The updated tool facilitates evidence-based recommendations to physicians, and therefore facilitates interprofessional collaboration to optimise the patient’s medication use. The tool can be applied without the need for extra clinical patient data, yet if the patient’s renal function is also available, the new addendum with READs can further aid pharmacists to detect additional clinically relevant DRPs and to help in optimising medication use [ 42 , 43 , 51 ].…”

Medication-related problems among adults with chronic kidney disease in Southwest, Nigeria: A Retrospective Study

“…In addition, since MRPs are very common in patients with CKD, identification, prevention, and management would 15, 16 require competency and an interdisciplinary approach . Identifying, resolving actual, and preventing potential MRPs is a major role pharmacist in community and hospital [17][18][19] practice have assumed with the consent of clinicians . MRPs unidentified and unresolved in CKD have a negative impact on desired patient and therapeutic outcomes resulting in reduced quality of life, increased hospital-stay, increased overall healthcare cost and even increasing the 20, 21 risk of morbidity and mortality…”