Background Clinical pharmacy services are widely deployed in our UHC department of nephrology. Poor medication adherence (MA) is commonly encountered in kidney transplant recipients (KTRs), although MA is essential in preventing graft rejection. Thus, medication counselling (MC) was implemented to promote MA and safe therapeutic management.

Purpose The objective of this study was to describe MC activity and explore its impact on patient knowledge and motivation.

Material and methods A pharmacy resident presented two MC sessions for each newly grafted KTRs. The first MC session provided information regarding IA, food interactions and the management of forgotten doses, vomiting and travel using educational tools. MA is evaluated with the Morisky score, and patient’s motivation to take their treatment with a visual scale. The second MC session allowed the resident to assess the previously acquired knowledge. Discharge medication prescription was explained through the discharge medication reconciliation.

Results From June 2018 to September 2018, 19 patients had MC (average age 59.7 years±14.5, sex ratio M/F 1.8, average length of stay 12.5 days±6.2). The average cumulative MC time was 39 min±8.4 per patient. The first MC session was carried out on average 7 days±2.9 after kidney transplantation. Eleven patients (58%) presented either minor or major MA problems. Sixteen patients (85%) correctly reported which IA they were taking, 18 (95%) correctly reported their dosing regimen and 18 patients (95%) were aware of food interactions and knew how to manage forgotten doses, vomiting and travel. Patients’ motivation to take their IA significantly increased between the two MC sessions (p=0.03). All patients rated the role of their IA as ‘extremely important’.

Conclusion These results show the benefits of pharmacist-led MC in newly grafted KTRs. Positive feedback from physicians and nurses confirms this approach. However, this service is time-consuming and requires continuous availability of clinical pharmacists in the unit. In order to ensure safe and efficient therapeutic management, documentation of these MC sessions in the medical patient chart is essential.

Reference and/or acknowledgements Morisky DE, et al. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24:67–74.

No conflict of interest.