Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea

Abstract

Background: The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics.

Aim: The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients.

Methods: For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS.

Results: A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m² in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m² (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26-0.96), indicating a significantly lower risk compared to the control group.

Conclusion: Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings.

Keywords: clinical effectiveness; kidney transplant; outpatient clinic; pharmaceutical care service.

Figure 1

Overview of pharmaceutical care services (PCS). The PCS (medication reconciliation (MR), medication evaluation and management (MEM), and pharmaceutical care transition (PCT) service) was provided to the patients for 3 years in a kidney transplant outpatient clinic.

Figure 2

Study flow chart pharmaceutical care services, PCS.

Figure 3

Box plot for change of estimated glomerular filtration rate. The box represents the interquartile range (IQR) and contains the middle 50% of the data. The left edge of the box corresponds to Q1, and the right edge corresponds to Q3. The median is represented as a horizontal line inside the box. The diamond inside the box of a box plot represents the mean of estimated glomerular filtration rate change. The left whisker extends from Q1 to the smallest data point within 1.5 times the IQR, and the right whisker extends from Q3 to the largest data point within 1.5 times the IQR. Medication evaluation and management, MEM; medication reconciliation, MR; pharmaceutical care services, PCS; pharmaceutical care transition, PCT.