Introduction
Organ transplantation is currently the most effective treatment for end-stage organ failure [
1]. In the past few decades, the number of organ transplants in China has increased rapidly. Currently, China ranks 2nd in the world and 1st in Asia in terms of the number of organ transplants [
2]. For organ transplant recipients, in most the cases, they need to take multiple medications for a lifetime [
3]. It means that they need to face the complexities of adverse drug reactions and drug interactions for life, which is a great challenge. A comprehensive and high-quality pharmacy service system is essential to guarantee the survival and quality of life of transplant recipients. However, there are still deficiencies in the construction of pharmacy service systems for organ transplant recipients in developing countries such as China, and the pharmacy service needs of organ transplant patients are difficult to be adequately met [
4]. This may be one of the significant reasons for the notable difference in the survival rates of organ transplant patients in China compared to developed countries such as the United States. Taking liver transplantation as an example, in 2020, the cumulative survival rates of recipients of citizen postmortem organ donation in China were 83.6% and 74.9% in the 1st and 3rd years postoperatively, respectively, while in the United States, they were 94.25% and 88.07% [
5]. Although there are various factors influencing the survival rates of transplant recipients, such as donor-recipient matching, surgical technique, post-transplant ICU care, long-term care, and others; accurately identifying the pharmacy service needs of organ transplant patients to address the mismatch between supply and demand for organ transplant pharmacy services is an effective means for China and other developing countries to improve the survival rates of organ transplant recipients.
In the past decades, clinical pharmacy services for organ transplantation have developed rapidly in developed countries [
6]. The designation of organ transplantation professional clinical pharmacists was established in 2018 by the Board of Pharmacy Specialties. In the USA, organ transplant pharmacists provide pharmacy services throughout the whole process from preoperative to postoperative transplantation, which meets the needs of both inpatients and outpatients [
7]. The Canadian Society of Hospital Pharmacists has established the Transplant Pharmacists Network, which aims to promote “optimal clinical outcomes and patient-centered pharmacy practice” through information sharing. A systematic evaluation of 12 clinical studies showed that organ transplant pharmacists improved medication adherence, reduced morbidity, medication errors, and healthcare costs through patient counseling and education, optimization of medication regimens, and medication reconciliation [
8]. Driven by the increasing demand for pharmacy services from organ transplant recipients, clinical pharmacy services for organ transplantation in China are gradually developing and have made some progress in recent years. However, the development of the organ transplantation clinical service system is relatively lagging behind in China [
2]. One of the main manifestations is the lack of a comprehensive clinical pharmacy service system for organ transplant recipients. At present, only a few hospitals have opened organ transplantation pharmacy clinics, and specialized clinical pharmacists are even more lacking [
2]. Most of the organ transplant clinical pharmacists are pharmacists who have received a full-time pharmacy or clinical pharmacy bachelor’s degree or above with chemical education and have been qualified by the 1-year full-release organ transplant professional or immune system drug standardization training held by Chinese Hospital Management Association or Chinese Medical Association. Domestic organ transplantation clinical pharmacists are relatively weak in medical knowledge and clinical experience [
9]. Their service capabilities are insufficient, and their daily work is mostly focused on the determination of blood drug concentration and case reports of pharmacological monitoring of patients with post-transplantation infection [
9]. Overall, the pharmacy service needs of organ transplant recipients in China have not been fulfilled. Therefore, it is necessary to conduct an exploratory and in-depth study designed from the demand-side perspective to explore the actual needs of organ transplant recipients for pharmacy services from their life constructs and personal experiences, and to provide empirical data for the construction of an ideal organ transplant pharmacy service system.
It is well known that pharmacy services are patient-centered and it is more relevant to recognize and evaluate pharmacy services from the patient’s perspective [
10]. However, most of the available studies were conducted from healthcare practitioners’ perspective [
11,
12]. In order to gain a more comprehensive understanding of the needs of patients, this study was designed to explore the experiences of transplant recipients with focus group discussions that are rich in interactive processes. In addition, most of the previous studies were cross-sectional studies based on questionnaires [
4,
8]. Only a few studies have adopted a qualitative research design, using in-depth interviews to understand the pharmacy service needs of community residents [
13], or refugees and asylum seekers [
14]. From a methodological point of view, exploratory research from the perspective of transplant recipients is beneficial for us to delve deeper into their true ideas. By understanding their perceptions, needs and expectations of hospital pharmacists and pharmacy services, the present study aims to provide an objective basis for the construction of organ transplant pharmacy service systems in China and other developing countries.
Discussion
To our knowledge, the present study is one of the first to use a qualitative approach to explore organ transplant recipients’ perceptions, needs, and expectations of hospital pharmacists and pharmacy services in mainland China. This study provides an in-depth understanding of transplant recipients’ perceptions and potential acceptance of pharmacy services. At the same time, the findings provide directions for the future development of transplant pharmacy services.
The findings of the present qualitative study reveal a prevailing lack of awareness among patients regarding pharmacists and pharmacy services, aligning with the current status of delayed initiation and lagging advancements in clinical pharmacy within China [
20]. Despite some progress, the clinical pharmacy system in China remains in its early or transitional stage [
21]. Furthermore, due to socioeconomic disparities, such as uneven development between eastern and western regions, there exists a significant disparity in the distribution of pharmaceutical service resources across regions, urban and rural areas, and different levels of hospitals [
22]. In underdeveloped regions, patients have limited direct interaction with pharmacists, resulting in lower levels of trust [
23]. This could explain why many respondents in this study still exhibit a low level of recognition of the work of clinical pharmacists. However, the findings of this research also suggest a positive aspect: the majority of participants explicitly expressed their demand for and expectations of pharmaceutical services. This underscores that transplant recipients exhibit a high potential for accepting pharmacy services and harbor elevated expectations, thereby establishing a fundamental foundation for the development of organ transplant pharmacy services [
7,
24]. In recent years, with the transition of pharmacy services to a “patient-centered” approach, the role of pharmacists in China has evolved from merely dispensing medications to directly providing services to patients [
25]. This shift in focus has stimulated specific patient populations, such as organ transplant recipients, to express heightened demands and expectations for pharmaceutical services. Nevertheless, the current capabilities and service coverage of pharmacy services are yet to fully meet their needs. This observation indicates a directional guide for future development in this field.
The primary demand mentioned by participants in this study pertains to pharmaceutical services related to the monitoring of blood drug concentrations of immunosuppressants [
26]. Immunosuppressive therapy is the cornerstone of successful transplantation in organ transplant patients [
27]. In most cases, patients require lifelong immunosuppression, and with the need for transplant recipients to take multiple drugs simultaneously due to comorbidities, the management of adverse drug reactions and drug interactions becomes particularly critical [
28,
29]. Therefore, monitoring of blood levels of immunosuppressive drugs has a significant impact on the prognosis of transplant recipients [
26]. The findings of the present study showed that some patients do not know how to schedule their medication on the day of blood level monitoring. Pharmacists should use their professional knowledge to inform patients in detail about the specific time, dose, and precautions to take the medication [
30]. In addition, unlike the general population, transplant recipients are more concerned about drug interactions between therapeutic drugs and immunosuppressants when they have mild illnesses such as colds and fevers [
31]. Therefore, future organ transplant pharmacy service programs can focus on these areas and utilize their expertise to address the concerns of transplant recipients about the rational use of medications [
32].
Over the past 20 years, the United States has gradually emphasized the importance of multidisciplinary pharmacy services in the postoperative medication management of organ transplant recipients [
4]. In the United States, the multidisciplinary management team for organ transplant recipients includes clinicians, clinical pharmacists, nursing staff, dietitians, and counselors [
7,
33]. This model also fits the practical needs of the participants in the current study. Therefore, a multidisciplinary collaborative pharmacy service model is an important direction for development [
34]. In addition, participants in this study mentioned that access to appropriate medical care and medication after hospital discharge is a particular concern for transplant recipients [
35]. However, the situation in China is that there is a lack of superior medical resources and they are very unevenly distributed [
36]. In the future, we need to provide them with comprehensive and convenient pharmacy services through multimedia platforms such as telemedicine platforms, Internet hospitals or WeChat to improve the accessibility of advantageous pharmacy services [
37].
There are several limitations of this study that are worth pointing out. First, the study population did not include hospital pharmacists in primary care, which is a notable regret. They will be studied in depth in our future study to provide a more comprehensive explanation of pharmacy services for organ transplant recipients. Meanwhile, the study participants were all from central China and the limited number of participants requires more caution to push the findings to a broader scope. Our next research plan will be to include more key informants using the Delphi method and to conduct a multicenter empirical study to further validate our findings. In addition, this study did not dig deeper into the reasons for low patient perceptions of clinical pharmacists, which we are addressing in another mixed-methods-based study we are conducting.
Conclusions
This study provides an in-depth understanding of transplant recipients’ perceptions, needs and expectations of pharmacy services. In short, the pharmacy services provided by Chinese healthcare institutions are inadequate to meet the needs of organ transplant recipients. However, the acceptance and expectation of pharmacy services by transplant recipients are high. Therefore, China should learn from the experience of developed countries and focus on the actual needs of patients to establish a better pharmacy service system for organ transplantation. The results of this study also provide recommendations for the future development of organ transplant pharmacists, which mainly include providing more targeted pharmacy service programs, providing more convenient pharmacy service models, and improving the professional and technical skills and communication abilities of hospital pharmacists.
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