Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Intervention
2.4. Outcome Measures
2.5. Statistical Analysis
3. Results
3.1. Demographic Characteristics
3.2. Drug-Related Problems by the DrugTEAM Service
3.3. Adherence and Acute Care Utilization after Discharge by the DrugTEAM Service
3.4. Unintentional Medication Discrepancies by the DrugTEAM Service
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 100) | Intervention Group (n = 50) | Control Group (n = 50) | p Value |
---|---|---|---|---|
Age, mean ± SD, years | 52.5 ± 16.9 | 51.0 ± 16.6 | 54.0 ± 17.4 | 0.381 |
Age, median (IQR), years | 55 (37–67) | 51 (36.3–64) | 57.5 (38–67) | |
Male, n (%) | 60 (60) | 31 (62) | 29 (58) | 0.683 |
eGFR, median (IQR), mL/min/1.73 m2 | 9.2 (5.7–20.8) | 8.9 (5.9–20.6) | 9.2 (5.4–20.9) | 0.834 |
CKD stage, n (%) | ||||
Stage 2 (eGFR 60–89 mL/min/1.73 m2) | 3 (3) | 2 (2) | 1 (2) | 1.000 |
Stage 3 (eGFR 30–59 mL/min/1.73 m2) | 12 (12) | 7 (14) | 5 (10) | 0.538 |
Stage 4 (eGFR 15–29 mL/min/1.73 m2) | 20 (20) | 7 (14) | 13 (26) | 0.134 |
Stage 5 (eGFR < 15 mL/min/1.73 m2) | 65 (65) | 34 (68) | 31 (62) | 0.529 |
Renal replacement therapy, n (%) | ||||
Dialysis | 33 (33) | 13 (26) | 20 (40) | 0.137 |
Kidney transplantation | 17 (17) | 7 (14) | 10 (20) | 0.425 |
None | 50 (50) | 30 (60) | 20 (40) | 0.046 |
CKD etiology, n (%) | ||||
Diabetes mellitus | 28 (28) | 12 (24) | 16 (32) | 0.373 |
Hypertension | 8 (8) | 5 (10) | 3 (6) | 0.715 |
Glomerulonephritis | 40 (40) | 23 (46) | 17 (34) | 0.221 |
Others | 9 (9) | 5 (10) | 4 (8) | 1.000 |
Unknown | 15 (15) | 5 (10) | 10 (20) | 0.161 |
Diagnosis at admission, n (%) | ||||
Uremia | 33 (33) | 17 (34) | 16 (32) | 0.832 |
Renal replacement therapy | 26 (26) | 11 (22) | 15 (30) | 0.362 |
Infection | 16 (16) | 9 (18) | 7 (14) | 0.585 |
Graft rejection | 8 (8) | 3 (6) | 5 (10) | 0.715 |
Cardiovascular diseases | 7 (7) | 5 (10) | 2 (4) | 0.436 |
Others | 10 (10) | 5 (10) | 5 (10) | 1.000 |
Number of comorbid diseases, median (IQR) | 5 (4–6) | 5 (2–9) | 5 (5–7) | 0.009 |
Adherence at admission measured by MMS, mean ± SD | 4.5 ± 1.3 | 4.1 ± 1.5 | 4.5 ± 1.5 | 0.226 |
Number of medicines per patient at admission, median (IQR) | 9 (7–12) | 8 (5.8–12) | 9 (8–12) | 0.241 |
Outcomes | DRPs, n (%) | Resolved DRPs, n (%) |
---|---|---|
Patients with any DRPs during hospitalization, n (%) | 48 (100.0) | NA |
Total number of DRPs during hospitalization | 182 (100.0) | 149 (81.9) |
Number of DRPs per patient during hospitalization, mean ± SD | 3.8 ± 1.8 | NA |
DRP classification a, n (%) | ||
Prescription without indication | 20 (11.0) | 20 (100.0) |
Indication without prescription | 65 (35.7) | 53 (81.5) |
Duplicated prescription | 2 (1.1) | 2 (100.0) |
Inappropriate drug selection | 12 (6.6) | 9 (75.0) |
Inappropriate dosage/administration | 58 (31.9) | 49 (84.5) |
Allergy | 2 (1.1) | 2 (100.0) |
Adverse drug reaction | 11 (6.0) | 7 (63.6) |
Cost issue | 4 (2.2) | 3 (75.0) |
Others | 8 (4.4) | 4 (50.0) |
Planned Interventions | MEM Service, n (%) | dPCT Service, n (%) |
---|---|---|
Drug started | 73 (37.1) | 20 (37.0) |
Drug paused or stopped | 58 (29.4) | 16 (29.6) |
Dosage increased | 19 (9.6) | 0 |
Dosage decreased | 26 (13.2) | 8 (14.8) |
Instructions for use changed | 9 (4.6) | 1 (1.9) |
Administration time changed | 2 (1.0) | 3 (5.6) |
Information of insurance coverage provided | 4 (2.0) | 2 (3.7) |
Laboratory test recommended for drug efficacy monitoring | 6 (3.0) | 3 (5.6) |
Others | 0 | 1 (1.9) |
Total | 197 (100.0) | 54 (100.0) |
Factors | Prevalence Ratio (95% CI) | p Value |
---|---|---|
Age | 0.989 (0.973–1.006) | 0.223 |
Gender (male) | 1.248 (0.742–2.009) | 0.404 |
Estimated glomerular filtration rate | 0.970 (0.951–0.989) | 0.002 |
Renal replacement therapy | ||
None | Reference | |
Dialysis | 0.839 (0.469–1.502) | 0.555 |
Kidney transplantation | 0.979 (0.444–2.160) | 0.958 |
Number of comorbid diseases | 0.924 (0.778–1.097) | 0.368 |
Adherence measured by MMS at admission | 0.979 (0.809–1.183) | 0.823 |
Number of medicines per patients at admission | 0.936 (0.864–1.014) | 0.105 |
Number of medicines per patients during hospitalization | 0.976 (0.904–1.054) | 0.534 |
Number of unintentional medication discrepancies at admission | 1.294 (1.034–1.620) | 0.025 |
Outcomes | Intervention (n = 48) | Control (n = 47) | p Value | |
---|---|---|---|---|
DRPs | Patients with any DRPs at discharge, n (%) | 29 (60.4) | 43 (91.5) | <0.001 |
Total number of DRPs at discharge | 45 | 92 | <0.001 | |
Number of DRPs per patient at discharge, mean ± SD | 0.9 ± 1.0 | 2.0 ± 1.3 | <0.001 | |
DRP classification a, n (%) | ||||
Prescription without indication | 1 (2.2) | 8 (8.7) | 0.271 | |
Indication without prescription | 14 (31.1) | 36 (39.1) | 0.360 | |
Inappropriate drug selection | 5 (11.1) | 4 (4.3) | 0.154 | |
Inappropriate dosage/administration | 15 (33.3) | 19 (20.7) | 0.107 | |
Adverse drug reaction | 3 (6.7) | 10 (10.9) | 0.545 | |
Drug interaction | 0 | 8 (8.7) | 0.053 | |
Cost issue | 2 (4.4) | 4 (4.3) | 1.000 | |
Others | 5 (11.1) | 3 (3.3) | 0.114 | |
Adherence | MMS at first visit after discharge, mean ± SD | 5.2 ± 1.0 | 4.9 ± 1.3 | 0.205 |
Patients with increased MMS score, n (%) | 39 (81.3) | 30 (63.8) | 0.057 | |
Acute care utilization | Patients readmitted or visiting emergency center within 3 months of discharge, n (%) | 16 (33.3) | 12 (25.5) | 0.404 |
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Song, Y.-K.; Jeong, S.; Han, N.; Na, H.; Jang, H.Y.; Sohn, M.; Kim, Y.S.; Joo, K.-W.; Oh, K.-H.; Kim, D.K.; et al. Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial. J. Clin. Med. 2021, 10, 1788. https://doi.org/10.3390/jcm10081788
Song Y-K, Jeong S, Han N, Na H, Jang HY, Sohn M, Kim YS, Joo K-W, Oh K-H, Kim DK, et al. Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial. Journal of Clinical Medicine. 2021; 10(8):1788. https://doi.org/10.3390/jcm10081788
Chicago/Turabian StyleSong, Yun-Kyoung, Sohyun Jeong, Nayoung Han, Heejin Na, Ha Young Jang, Minji Sohn, Yon Su Kim, Kwon-Wook Joo, Kook-Hwan Oh, Dong Ki Kim, and et al. 2021. "Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial" Journal of Clinical Medicine 10, no. 8: 1788. https://doi.org/10.3390/jcm10081788