Drug-related problems in older patients with advanced chronic kidney disease identified during pretransplant comprehensive geriatric assessment

Drug-Related Problems Among Peritoneal Dialysis Patients: A 12-Year Retrospective Cohort Study

Introduction Studies regarding drug-related problems (DRPs) can be found in other diseases, but data are lacking among peritoneal dialysis (PD) populations. Despite advancements in PD care, there remains a significant gap in understanding and addressing DRPs in the PD population. DRPs can lead to serious consequences, including medication errors, adverse reactions, and nonadherence, affecting patient outcomes and healthcare costs. Aim The aim of this study was to identify the prevalence of DRPs, types, causes, interventions performed, acceptance of interventions, and outcomes of DRPs among patients undergoing PD. In addition to this, the study sought to identify factors associated with DRPs in the PD population. Methods This single-center retrospective study recruited adult PD patients with at least one medication from January 2009 until November 2021. Pharmacy medication therapy adherence clinic (MTAC) clinical activity sheets were reviewed, and DRPs were classified based on the Pharmaceutical Care Network Europe Classification (PCNE) v9.1. The PCNE system consists of five essential domains: Problems (P), Causes (C), Interventions (I), Acceptance of the Intervention (A), and Outcomes (O). As part of the pharmacists' MTAC activities, DRPs were meticulously documented. Three pharmacists initially gathered and examined these recorded DRPs. Each identified DRP was then classified according to the type of problem, the underlying cause, any intervention performed to address the DRP, the level of acceptance, and the resulting outcome. Subsequently, these classifications were reviewed by two independent pharmacists to ensure accuracy and consistency. Results Out of 562 patients, 70.6% (n = 397) were on more than 10 drugs. Most patients (n = 520, 92.5%) had at least one DRP. From the 3,333 DRPs identified, the most common were effects of drug treatment not optimal (n = 1,595, 47.8%), followed by untreated symptoms (n = 843, 25.3%) and adverse drug events (n = 730, 21.9%). The main cause of the suboptimal treatment effect was patients' noncompliance (n = 891, 55.9%). For untreated symptoms, the main cause was no drug prescribed despite existing indications (n = 789, 93.6%). Interventions for DRPs were at either prescriber level (n = 2,064, 61.9%), patient-level (n = 1,244, 37.3%), or at other levels, such as with nurses (n = 25, 0.8%). Prescribers accepted 83% (n = 1713) of interventions suggested by pharmacists. Overall, 73.2% (n = 2,439) of DRPs were resolved. Number of medications (b = 0.223, 0.102-0.345) and number of MTAC visits (b = 0.381, 0.344-0.419) were predictive factors of the number of DRPs (p < 0.001). Conclusion There is a high prevalence of DRPs in PD patients. Pharmacists play an important role in detecting, intervening, and resolving DRPs to improve patients' outcomes.

Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital

BACKGROUND

Dialysis patients are at high risk for drug-related problems (DRPs), which have significant consequences for their morbidity, mortality, and quality of life. Improved clinical outcomes can be achieved by preventing, identifying, and resolving these problems.

METHODS

This is a retrospective observational study. In this study, the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) was validated for use in Turkish. Validation consisted of three stages: translation back-translation with expert panel evaluation, reliability analysis using the test-retest method, and conceptual validity with both Pharmaceutical Care Network Europe (PCNE) and PAIR used to determine DRPs prevalence.

RESULTS

In total, 104 patients (mean ± SD age, 54.1 ± 15.8 years; 53.8% male) were included in the study. An expert panel evaluated the items in the criterion based on their intelligibility, service of purpose, differentiation, and cultural suitability during the translation stage. Content validity index (CVI) score was found to be 0.95. The reliability analysis was performed by applying the test-retest method and calculating correlation coefficient on 30 randomly selected patients one month later. Correlation coefficient (p) was found to be 0.8. To evaluate conceptual validity, 104 patients' pharmacotherapy plans were assessed using both the PAIR and PCNE criteria. The prevalence of DRPs according to PAIR criteria (100.0%) and PCNE (73.1%) were statistically significantly different (p < 0.001).

CONCLUSIONS

As a result, PAIR criteria can identify clinically relevant DRPs in patients with CKD and is a new, validated tool to be used in Turkey, but may not be adequate for patients receiving dialysis. Therefore, it needs to be reviewed and updated for dialysis patients.

Impact of a multidisciplinary approach involving clinical pharmacist on resolving drug related problems in chronic kidney patients: a prospective interventional study

BACKGROUND

Chronic kidney disease (CKD) is a major public health concern due to its high mortality risk, high hospitalization rates and cost, and low life expectancy. Thus, CKD patients are among patient group that may benefit from clinical pharmacy services the most.

METHODS

This was a prospective interventional study conducted between October 1, 2019, and March 18, 2020, in the nephrology ward of Ankara University School of the Medicine, Ibn-i Sina Hospital. DRPs were classified according to PCNE v8.03. The main outcomes were interventions proposed and the rate of acceptance by the physicians.

RESULTS

269 pre-dialysis patients were included to determine DRPs during the treatment process of the patients. 205 DRPs were found in 131 (48.7%) patients. Treatment efficacy was found to be the main type of DRPs (56.2%) followed by treatment safety (39.6%). When patients with and without DRPs were compared, it was found that the number of female patients (55.0%) was higher in the group with DRPs (p < 0.05). The length of hospital stays (11.3 ± 7.7) and the mean number of drugs used (9.6 ± 3.6) in the group with DRPs were significantly higher than those without DRPs (9.3 ± 5.9; 8.1 ± 3.5, respectively) (p < 0.05). 91.7% of the interventions were accepted by the physicians, and patients and found clinically beneficial. 71.7% of DRPs were fully resolved, 1.9% partially resolved and 23.4% could not be resolved.

CONCLUSIONS

A high prevalence of DRPs in patients with chronic kidney disease was determined during therapy. Clinical pharmacist interventions were highly accepted by the physicians and patients. This may indicate implementation of clinical pharmacy services in the nephrology ward has a great impact on optimized therapy and prevention DRPs.