Patient-centered Pharmacist Care in the Hemodialysis Unit: a quasi-experimental interrupted time series study

Abstract

Background: Nonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes. Limited data exist to demonstrate the effect of incorporating patient-centered interventions using concepts of medication therapy management and motivational interview by pharmacists on pharmacoadherence in patients requiring HD. Therefore, we assessed the impact of patient-centered pharmacist care on pharmacoadherence and its outcomes in patients requiring HD.

Methods: Adult patients who had received outpatient HD for at least 3 months were enrolled. The study was conducted from October 2016 to April 2017. Pharmacists interviewed the patients at month 1, 2, 4 and 6, and the intervention (comprehensive review) occurred at months 3 and 5. The primary outcome was the change in pharmacoadherence as assessed by pre-HD serum phosphate levels and the differences in the number of medications between patient' self-report and medications records at the electronic healthcare records (EHRs). The secondary outcomes included changes in systolic blood pressure (SBP), glycosylated hemoglobin levels, serum low-density lipoprotein (LDL) levels, and the prevalence and types of medication-related problems (MRPs).

Results: Seventy-two patients were enrolled. Their median age was 59 (interquartile range: 47-67.5) years, and 53% were men. Pre- and post-intervention pharmacoadherence, as indicated by serum phosphate levels and the differences in the number of medications between patient' self-report and the medication records at the EHRs, did not significantly differ (p = 0.682 and 0.348, respectively). Mean SBP and mean LDL did not significantly change post-intervention. The median number of MRPs declined between Months 3 and 5 (p = 0.002): the prevalence of MRPs at Month 3 was 44.9% (95 confidence interval [CI]: 40.4-49.3) and decreased to 29.8% (95 CI: 25.6-34.3) at Month 5. Drug use without indication was the most frequent MRP (23.9%).

Conclusions: Patient-centered pharmacist care did not result in significant changes in pharmacoadherence. However, its clinical utility as a tool to identify and mitigate MRPs in patients requiring HD is indisputable.

Trial registration: ClinicalTrials.gov identifier: NCT03576404 (retrospectively registered on July 3rd, 2018).

Keywords: Adherence; Hemodialysis; Medication therapy management; Medication-related problems; Motivational interview; Patient-centered pharmacist care; Pharmacoadherence.

Fig. 1

Study layout. The blood pressure and laboratory parameters are recorded on monthly basis during those 6 months and one additional month afterwards

Fig. 2

Trial profile: flow of participants through the trial

Fig. 3

Mean (a) and fitted mean (b) differences in the number of medications . 3a. The mean difference between self-reported medication use and medications records at the electronic healthcare records identified during the six interviews. 3b.The fitted mean resulting from linear mixed regression analysis demonstrating the fitted mean before and after the intervention with a model prediction for the seventh month

Fig. 4

Mean (a) and fitted mean (b) phosphate levels. The fitted mean resulting from linear mixed regression analysis demonstrating the fitted mean before and after the intervention

Fig. 5

Mean (a) and fitted mean (b) systolic blood pressure. The fitted mean resulting from linear mixed regression analysis demonstrating the fitted mean before and after the intervention

Fig. 6

Mean (a) and fitted mean (b) low-density lipoprotein levels. The fitted mean resulting from linear mixed regression analysis demonstrating the fitted mean before and after the intervention

Fig. 7

Box plot of Median number of medication-related problems

Fig. 8

Frequencies and types of medication-related problems