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. 2021 Apr 20;10(8):1788.
doi: 10.3390/jcm10081788.

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Yun-Kyoung Song  1   2 , Sohyun Jeong  1   3   4 , Nayoung Han  1   5 , Heejin Na  1 , Ha Young Jang  1 , Minji Sohn  1   6 , Yon Su Kim  7 , Kwon-Wook Joo  7 , Kook-Hwan Oh  7 , Dong Ki Kim  7 , Hajeong Lee  7 , Jung Mi Oh  1 , DrugTEAM Study Group
Affiliations

Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial

Yun-Kyoung Song et al. J Clin Med. .

Abstract

(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, including medication reconciliation, medication evaluation and management, and discharge pharmaceutical care transition services. Participants in the control group received usual care. The primary outcome was the number of DRPs per patient at discharge. (3) Results: The baseline characteristics of 100 participants included the following: mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m2. The number of DRPs in the intervention group during hospitalization increased significantly with decreasing eGFR (PR, 0.970; 95% CI, 0.951-0.989) and an increasing number of unintentional medication discrepancies at admission (PR, 1.294; 95% CI, 1.034-1.620). At discharge, the number of DRPs per patient was 0.94 ± 1.03 and 1.96 ± 1.25 in the intervention and control groups, respectively (p < 0.001). The service had a significant effect on the reduction of the unintentional discrepancies at discharge (p < 0.001). (4) Conclusion: Hospital pharmacists play an important role in the prevention of DRPs at discharge and unintentional medication discrepancies in inpatients with CKD.

Keywords: chronic kidney disease; drug-related problems; hospitalized patients; pharmaceutical care service.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Drug Therapy Evaluation and Management (DrugTEAM) service model for hospitalized patients with chronic kidney disease. Abbreviation: ADR, adverse drug reaction; DRP, drug-related problem; EMR, electronic medical record; MEM, medication evaluation and management; MR, medication reconciliation; dPCT, discharge pharmaceutical care transition.
Figure 2
Figure 2
CONSORT flow diagram of randomization and patient participation. Abbreviation: MEM, medication evaluation and management; MR, medication reconciliation; dPCT, discharge pharmaceutical care transition.
Figure 3
Figure 3
Changes in medication discrepancies at discharge compared to hospitalization in clinical pharmacist intervention and control groups.
See this image and copyright information in PMC

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