Background Chronic kidney disease (CKD) is characterised by a decline in kidney function. The decline in kidney function causes an alteration in the pharmacokinetics of the drug; this condition will make patients become vulnerable to drug related problems (DRPs). The role of the clinical pharmacist is important in the drug selection process in accordance with the severity of kidney disease, providing recommendations to use the least nephrotoxic drug and monitoring side effects or toxic drug reactions.
Purpose The purpose of this study was to assess pharmacist’s recommendation profile of DRPs in patients with CKD and factors which influenced physician acceptance of pharmacist’s recommendation.
Material and methods This was an observational prospective study. CKD patients hospitalised during November 2015 to January 2016 who matched with the inclusion and exclusion criteria were recruited to this study. Assessment of DRPs were performed using the PCNE classification scheme for DRPs V6.2. Descriptive analysis was applied for demographic data, drug utilisation, DRP profile and pharmacist’s recommendations. Predicting factors which influenced physician acceptance of the pharmacist’s recommendations was analysed by logistic regression.
Results There were 105 patients hospitalised with CKD and 80% of these patients had CKD stage G5. 1026 DRPs were identified during this study, the most frequent DRP domain was drug effect (47.08%) and adverse reactions (46.39%). 1307 recommendations were given to resolve 653 DRPs. Among 1307 recommendations given by the pharmacist, 47.52% recommendations were at the prescriber level, 29.99% at the drug level, 5.36% at the patient level and 17.14% other recommendations. 30.92% of 621 recommendations at the prescriber level were approved by the prescriber and 24.64% was not approved. Predictor factors which influenced physician acceptance towards the pharmacist’s recommendation were patient’s sex, haemodialysed or non-haemodialysed state, type of DRP, recommendation category and the pharmacist communication.
Conclusion DRPs are prevalent in CKD patients and may result in adverse consequences. Pharmacists’ competencies to identify, prevent and resolve DRPs are vital to improve clinical outcomes in this fragile patient population.
References and/or acknowledgements Fatmawati General Hospital Managements.
No conflict of interest
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