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Pehlivanli A, Akkan Eren S, Sengul S, Basgut B, Erturk S, Ozcelikay AT. Determination of drug-related problems according to PAIR criteria in dialysis patients: a cross-sectional study in tertiary care hospital. BMC Pharmacol Toxicol 2024; 25:28. [PMID: 38637817 PMCID: PMC11025200 DOI: 10.1186/s40360-024-00754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
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.
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Affiliation(s)
- Aysel Pehlivanli
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey.
- Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara University, Ankara, Turkey.
| | - Sayeste Akkan Eren
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Sule Sengul
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - Bilgen Basgut
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University, School of Medicine, Ankara, Turkey
| | - A Tanju Ozcelikay
- Faculty of Pharmacy, Department of Pharmacology, Ankara University, Ankara, Turkey
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Alam K, Hayat AH, Ullah A, Syed Sulaiman SA, Ahmad W, Ooi GS. The Prevalence and Impact of Clinical Pharmacists' Intervention on Drug-Related Problems in Patients With Chronic Kidney Disease. Cureus 2024; 16:e59402. [PMID: 38817515 PMCID: PMC11137644 DOI: 10.7759/cureus.59402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health issue of growing concern. According to projections from the Worldwide Health Observatory, it is currently one of the rapidly increasing contributors to global mortality. The prevalence of CKD and end-stage renal disease (ESRD) is increasing globally. The objective was to evaluate the prevalence and impact of clinical pharmacist intervention in resolving drug-related problems (DRPs) among patients with CKD. A single-arm, pre- and post-intervention study design was used, which was assessed to be suitable in testing for the feasibility of the implementation of an intervention in clinical practice. With this study pre- and post-intervention variables of interest were measured before and after an intervention in the same patients to evaluate the impact of clinical pharmacists on ambulatory patients with CKD. The findings of this study indicate a high prevalence of DRPs, with every patient experiencing at least one DRP. The mean DRP per patient was found to be 2.903 with STD ± 1.148. The study assessed the considerable influence of clinical pharmacist intervention on DRPs. The predominant form of DRP was drug interaction 167 (45.1%) which was reduced to 76 (20.5%) after intervention carried out by clinical pharmacists statistically significant (p = 0.032). Another common DRP was found to be poor compliance issues in pre-interventions (n = 144 (38.9%)) and was reduced to 80 (21.6%) at post-intervention significantly (p = 0.042). Untreated indications were noticed in 137 cases (37.0%), after pharmacist intervention, this number was significantly reduced to 27 cases (7.3%), with a statistically significant difference (p = 0.004). However, it is noteworthy that medication compliance among patients in our study was unsatisfactory and fell below expectations. As a clinical pharmacist played an important role in reducing the prevalence of poor medication adherence to lower levels in these CKD outpatients. This research emphasizes the vital role of clinical pharmacists in mitigating DRPs among CKD patients, resulting in improved medication management and potentially better health outcomes.
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Affiliation(s)
- Khurshid Alam
- Clinical Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
| | - Amer H Hayat
- Clinical Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
| | - Amir Ullah
- Nephrology, District Head Quarter (DHQ) Hospital Medical Teaching Institution (MTI) Bannu, Bannu, PAK
| | | | - Waqas Ahmad
- Pharmaceutical Chemistry, Universiti Sains Malaysia, Gelugor, MYS
| | - Guat See Ooi
- Pharmacy, Universiti Sains Malaysia, Gelugor, MYS
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Shamas N, Khamis F, Eljaaly K, Al Salmi Z, Al Bahrani M. Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e2. [PMID: 38234415 PMCID: PMC10789993 DOI: 10.1017/ash.2023.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
The vulnerability of patients on hemodialysis (HD) to infections is evident by their increased susceptibility to infections in general and to resistant organisms in particular. Unnecessary, inappropriate, or suboptimal antimicrobial prescribing is common in dialysis units. This underscores the need for dedicated antimicrobial stewardship (AMS) interventions that can be implemented both in the inpatient and outpatient settings. In this review, we provide a comprehensive approach for clinicians with the most updated coordinated AMS principles in HD setting in six areas: prevention, diagnosis, treatment, education and empowerment, monitoring, and research.
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Affiliation(s)
- Nour Shamas
- Infection Prevention and Control Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faryal Khamis
- Division of Infectious Diseases, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Khalid Eljaaly
- Department of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zaher Al Salmi
- Department of Pharmaceutical Care, Royal Hospital, Muscat, Oman
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
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Pehlivanli A, Eyupoglu S, Basgut B, Erturk S, Ozcelikay AT. Impact of a multidisciplinary approach involving clinical pharmacist on resolving drug related problems in chronic kidney patients: a prospective interventional study. BMC Nephrol 2023; 24:149. [PMID: 37237342 DOI: 10.1186/s12882-023-03210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/22/2023] [Indexed: 05/28/2023] Open
Abstract
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.
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Affiliation(s)
- Aysel Pehlivanli
- Faculty of Pharmacy, Department of Clinical Pharmacy, Ankara University, Ankara, Turkey.
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey.
| | - Sahin Eyupoglu
- School of Medicine, Department of Nephrology, Ankara University, Ankara, Turkey
| | - Bilgen Basgut
- Faculty of Pharmacy, Department of Pharmacology, Baskent University, Ankara, Turkey
| | - Sehsuvar Erturk
- School of Medicine, Department of Nephrology, Ankara University, Ankara, Turkey
| | - A Tanju Ozcelikay
- Faculty of Pharmacy, Department of Pharmacology, Ankara University, Ankara, Turkey
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Karattuthodi MS, Thorakkattil SA, Abdulsalim S, Sridhar SB, Parakkal SA, Arain S, Madathil H, Karumbaru Kuzhiyil A, Mohammed Ahmed Ageeli M, Unnikrishnan MK. The Pharmacist's Role in Managing COVID-19 in Chronic Kidney Disease Patients: A Review of Existing Strategies and Future Implications. PHARMACY 2022; 10:pharmacy10040094. [PMID: 36005934 PMCID: PMC9412434 DOI: 10.3390/pharmacy10040094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
The global burden of the COVID-19 pandemic has not only disrupted healthcare delivery but has also compromised patients’ access to healthcare on account of the scarcity of medications and trained healthcare professionals. COVID-19 has been particularly challenging for patient subpopulations constituting immunocompromised individuals, geriatric patients, and those afflicted by chronic ailments. Reports indicate that diminished kidney function in chronic kidney disease (CKD) renders patients highly susceptible to complications during COVID-19 treatment. Pharmacists, being medication experts, have a significant role in making treatment decisions during COVID-19 infection. This article describes pharmacists’ interventions for monitoring and managing COVID-19 in patients with CKD. Given the massive increase in off-label use of medications to treat COVID-19, pharmacists can contribute substantially towards dosing decisions, reporting adverse medication events, and managing drug–drug interactions in COVID-19 patients suffering from CKD. In addition to traditional methods of delivering their services, the pharmacist should also adopt innovative tele-health systems to optimize patient care and ensure that patients receive safe and effective therapy during the pandemic.
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Affiliation(s)
- Mohammed Salim Karattuthodi
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India
- Correspondence: (M.S.K.); (S.A.T.); Tel.: +91-96-5679-8071 (M.S.K.)
| | - Shabeer Ali Thorakkattil
- Pharmacy Services Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran 34465, Saudi Arabia
- Correspondence: (M.S.K.); (S.A.T.); Tel.: +91-96-5679-8071 (M.S.K.)
| | - Suhaj Abdulsalim
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 51911, Saudi Arabia
| | - Sathvik Belagodu Sridhar
- Department of Clinical Pharmacy & Pharmacology, RAK Medical & Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
| | - Sainul Abideen Parakkal
- Pharmacy Services Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran 34465, Saudi Arabia
| | - Savera Arain
- Pharmacy Services Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran 34465, Saudi Arabia
| | - Hafees Madathil
- Pharmacy Services Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran 34465, Saudi Arabia
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