Impact of Medication Therapy Management Service Provided by Clinical Pharmacists on Drug Therapy of Patients Undergoing Hemodialysis

Abstract

Background: Drug-related problems are common in patients with haemodialysis patients. Such patients are at higher risk as they require complex therapeutic regimens with 5 or more medications. Objectives: This study was conducted to identify the drug related problems (DRPs) in patients undergoing Haemodialysis for chronic kidney failure. Methods: This was a prospective, observational and interventional study conducted at dialysis unit of the tertiary care teaching hospital in the rural area. The patients with stage III-V chronic kidney failure were enrolled in the study. All the enrolled patients were followed on their scheduled visits of hemodialysis. Medical records, treatment charts and patient interview were sources of data collection. Clinical Pharmacist reviewed treatment chart of enrolled patients and identify DRPs. Identified DRPs were reviewed and discussed with concerned clinicians. Interventions were made to concerned health care professionals to resolve all the identified DRPs. All the DRPs were documented electronically for further assessment of its nature, extent, possible cause(s) and its acceptance by concerned clinicians. Results: A total of 156 DRPs were identified from 482 medication orders of 94 patients undergoing hemodialysis during 9 months of study period. The common DRPs were drug-drug interactions (37.5%) followed by over dosage (19.44%), medication non-adherence (18.05%), untreated indication (16.66%), drug use without indication (8.33%), adverse drug reaction and improper drug selection (6.84%). The possible reasons for DRPs in the enrolled patients were literacy status, trend of selfmedications/ self-adjustments of prescribed drugs, financial limitations, irregular follow up to the clinicians, poor patient counselling system at the study hospital and high work load of the medical staff. Majority (46%) of the DRPs intervened by clinical pharmacists were of "Moderate" significance followed by "Minor" (36%) and "Major" (18%). The most common drugs involved in DRPs were antibiotics, anti-hypertensives, anti-diabetic, anti-hyperlipidemic agents and vitamins and minerals. Acceptance rate of clinical pharmacy interventions was 84%. Conclusions: Structured and dedicated pharmacotherapy approaches by clinical pharmacists can help in early detection and prevention of DRPs. Clinical pharmacist interventions were accepted and appreciated by clinicians.