The Saskatchewan Medication Assessment Program for Patients With Renal Failure: A Qualitative Study to Understand Health Care Provider Perspectives

Abstract

Background: The Saskatchewan Medication Assessment Program (SMAP) compensates community pharmacists for medication reviews on eligible residents with the goal of optimizing patient care. Although medication reviews are meant to reduce risks associated with complex medication regimens, some patients may already be receiving specialized care from interdisciplinary health care teams from the renal programs in Saskatchewan. Objective: A qualitative analysis was undertaken to examine the perceptions of health care providers about the SMAP process for patients receiving renal care in Saskatchewan. The goal was to explore potential benefits, facilitators, challenges, and/or barriers of the program in this population. Design: Qualitative descriptive study. Setting: The semi-structured interviews took place in the province of Saskatchewan. Participants: Community pharmacists, renal pharmacist, and nephrologists. Methods: All nephrologists, renal pharmacists, and community pharmacies in Saskatoon and Regina were sent an invitation to participate in the study. Semi-structured interviews were completed with participants and were audio-recorded and transcribed verbatim. Coding was performed using NVIVO qualitative software, and meaning units and codes were consolidated into categories and subcategories using qualitative content analysis. Results: A total of 9 community pharmacists, 10 renal pharmacists, and 8 nephrologists were interviewed. Community pharmacists had mixed levels of comfort providing SMAP assessments for renal patients, but expressed the desire to provide the best care possible and described patient benefits. Some categories (eg, barriers and improvements) and subcategories (eg, “collaboration/communication”, “other challenges,” and “suggestions for improvement”) were consistent among all participant groups, while others (eg, “renal patients have complex care needs” and “duplication of service”) were common among both renal pharmacists and nephrologists. The nephrologists had little knowledge of the program and of the role of the community pharmacist, indicating the need for improved education and communication. Limitations: The lack of renal patient perceptions on the SMAP process should be acknowledged and studied in future. A further limitation is the small sample size per subsample group. Conclusion: Despite some negative experiences, all of the participants believed the program can be beneficial. However, several recommendations were suggested to improve the SMAP process in renal patients and other complex patient populations.

Community pharmacists’ perspectives on assessing kidney function and medication dosing for patients with advanced chronic kidney disease: A qualitative study using the theoretical domains framework

“…[36][37][38][39][40][41] The environmental context has further been highlighted as a barrier for community pharmacists to provide quality of care to complex people with CKD. [42][43][44][45][46][47] Pharmacists in this study were not always aware that people had advanced CKD or were on dialysis. In another study, 69% of pharmacists were unsure if a patient had CKD.…”

“…36-41 The environmental context has further been highlighted as a barrier for community pharmacists to provide quality of care to complex people with CKD. 42-47…”

“…These have been previously reported as facilitators of CKD care in community practices. [42][43][44][45]48 System-level leadership and governance will undoubtedly be a vital driver to define and advocate for community pharmacists' role in kidney assessment and prescribing of high-risk medications in renal impairment.…”