Background
Methods
Included | Excluded | |
---|---|---|
Study types
| (Randomized) controlled trials ((R)CTs), descriptive studies (DS), before-after studies (BAS) with interventional data | Case reports, case studies, surveys, cost-effectiveness studies, narrative reviews |
Interventions
| Any type of clinical pharmacist intervention embedded in comprehensive clinical pharmacy activities if data were assessable numerically and outcomes were reported | Solely screening for inappropriate renal dosing, evaluations of computerised decision support systems |
Language
| Publications in English and German | Any other language |
Results
General study characteristics
First author, (Year), Population | Design | N (INT/CT)a
| Duration (months) | Interventions | Relevant outcomesb
| Results | p-Value |
---|---|---|---|---|---|---|---|
Lim SB et al. [14], (2003), CKD inpts | DS | 60 | 2 | MR, therapeutic monitoring, feedback to physicians | No./Types of DRPs | 86 | |
Abstract
| Transcription errors
| 44%
| |||||
Renal dosage adjustments
| 10%
| ||||||
PhAR | 93% | ||||||
Significance | |||||||
Somewhat significant
| 26%
| ||||||
Significant
| 67%
| ||||||
Very significant
| 4%
| ||||||
Patel HR et al. [15], (2005), CKD outpts | DS | 119 | NR | Review of medical records, evaluations of DRPs, therapeutic recommendations | No. of DRPs | 381 (100%) | |
Abstract
| Types of Interventions | ||||||
Change of drugs
| NR
| ||||||
Change of dosage
| NR
| ||||||
Interval adjustments
| NR
| ||||||
PhAR | 40.9% | ||||||
Allenet B et al. [31], (2007), CKD outpts | BAS | 10 | 3 | Pharmacist-managed anaemia educational programmes | Knowledge (% of right answers on a 7-item questionnaire) at baseline vs. follow-up at Month 3 | 80 ± 18/93 ± 10 | NS |
QOL judged on a LAS (0-10) at baseline vs. Month 3 | |||||||
Energy
| 3.3 ± 1.7/7.1 ± 1.7
| < 0.05 | |||||
Daily activities
| 4.9 ± 2.1/7.7 ± 1.9
| < 0.05 | |||||
General well-being
| 4.6 ± 2.2/7.5 ± 1.6
| < 0.05 | |||||
Bucaloiu ID et al. [24], (2007), CKD outpts | DS | NR | 32 | Pharmacist-managed anaemia programmes compared to PCP-managed pts | Weekly erythropoietin dose | 6.698/12.000 units | 0.0001 |
Abstract
| Time to achieve Hb goal | 47.5/62.5 days | 0.11 | ||||
Maintenance of Hb values in target range | 69.8/43.9% | 0.0001 | |||||
Maintenance of Tsat values in target range | 64.8/40.4% | 0.043 | |||||
Joy MS et al. [25], (2007), CKD outpts | DS | 128 | 28 | Clinical pharmacist-managed anaemia programmes with darbopoietin | % of pts achieving Hb target compared to retrospective baseline analysis of data (before clinical implementation) | 78/41% | |
Lee J et al. [16], (2009), CKD outpts | CT | 18 (9/9) | 6 | INT: PC CT: SOC | Disease control parameters: Change from baseline to last follow-up visit (INT/CT) | ||
Abstract
| Blood pressure
| -6/+6.8 mmHg
| |||||
HbA
1c
| -0.2/0%
| ||||||
Haemoglobin
| 1.05/-1.85 g/dL
| ||||||
Medication adherence (pill count) | 97.2/88.2% |
First author, (Year), Population | Design | N (INT/CT)a
| Duration (months) | Interventions | Relevant outcomesb
| Results | p-Value |
---|---|---|---|---|---|---|---|
Tang I et al. [17], (1993), HD outpts | DS | NR | 6 | Therapeutic interventions provided by CP | No./Types of interventions | 205 (100%) | |
Abstract
| Drug selection
| 66 (32.2%)
| |||||
Drug discontinuation
| 39 (19.0%)
| ||||||
Dose selection
| 50 (24.4%)
| ||||||
Significance of interventions | |||||||
Preservation of major organ function
| 34.6%
| ||||||
Improvement in quality of care
| 62.4%
| ||||||
PhAR | 91.7% | ||||||
Kaplan B et al. [18], (1994), HD outpts | DS | 24 | NR | Focused DT review programmes | No. of recommendations/informative comments | 114/85 | |
Abstract
| PhAR | 76% (implemented 70%) | |||||
Grabe DW et al. [19], (1997), HD outpts | DS | 45 | 1 | DT reviews by CP Therapeutic recommendations | No./Types of DRPs | 126 (100%) | |
Drug interactions
| 35 (27.5%)
| ||||||
Dialysis-specific DRPs
| 33 (26.5%)
| ||||||
PhAR | 81% | ||||||
No. of interventions | 102 | ||||||
1 - adverse significance
| 0%
| ||||||
2 - no significance
| 6.9%
| ||||||
3 - somewhat significant
| 0%
| ||||||
4 - significant
| 78%
| ||||||
5 - very significant
| 4.9%
| ||||||
6 - extremely significant
| 1%
| ||||||
Possidente CJ et al. [12], (1999), HD and PD inpts | DS | 37 | 3.5 | CPS (MR, pts interviews, identification and resolution of DRPs) | No./Types of DRPs | 161 | |
Pts did not receive drug
| |||||||
Overdosage
| |||||||
Labs needed
| |||||||
More DRPs (77) at admission vs. discharge (41) | < 0.011 | ||||||
PhAR | 95.7% | ||||||
Significance | |||||||
Somewhat significant
| 24.7%
| ||||||
Significant
| 58.4%
| ||||||
Very significant
| 16.9%
| ||||||
To LL et al. [26], (2001), HD outpts | BAS | 49 | 6 | Pharmacist-managed programmes compared to physician-managed pts | Mean HCT (± SD) during physician period vs. pharmacist period | 35.36 ± 3.33/36.21 ± 3.46% | 0.20 |
Total EPO ? dose | 8.5/7.7 million units | 0.37 | |||||
Total elemental iron dose oral | 85.605/95.550 mg | 0.64 | |||||
Total elemental iron dose i.v. | 13.600/33.025 mg | < 0.001 | |||||
Mean (± SD) Tsat level | 29.82 ± 14.92/30.78 ± 13.17% | 0.66 | |||||
Viola RA et al. [27], (2002), HD outpts | DS | 26 | 6 | Pharmacist-managed hyperlipidaemia programmes with HD pts (laboratory management, counselling, statin initiation, and adjustments) | % of pts achieving LDL cholesterol target at baseline vs. Month 6 | 58%/88% | 0.015 |
Mean LDL (± SD) cholesterol at baseline vs. Month 6 | 96c5/80 ± 3 mg/dL | < 0.01 | |||||
Mean total cholesterol (± SD) at baseline vs. Month 6 | 170 ± 7/151 ± 4 mg/dL | < 0.01 | |||||
No./Types of interventions | 15 | ||||||
Dose increase
| 6
| ||||||
Drug change
| 5
| ||||||
Therapy initiation
| 2
| ||||||
Kimura T et al. [28], (2004), HD outpts | DS | 41 | 9 | Pharmacist-managed anaemia programmes | No. pts achieving the HCT target of >30% at baseline vs. Month 9 | 7 (17.1%)/32 (78%) | |
No. pts with EPO dose reductions due to intervention | 23 (56%) | ||||||
Manley HJ et al. [29], (2004), HD outpts
Abstract
| DS | 408 | NR | Implementations of treatment algorithms for CV disease in HD pts by a pharmacist, collections of CV medication-related issues and recommendations to nephrologists, pts interview, MR | No. of recommendations | 1575 | |
PhAR | 79.8% | ||||||
Impact of recommendations on pts care | |||||||
Improvement
| 89.9%
| ||||||
No impact
| 7.6%
| ||||||
Worsened pts care
| 2.4%
| ||||||
LDL cholesterol | -31.2 mg/dL | < 0.001 | |||||
HbA1C | -0.3% | NS | |||||
Adjusted CV mortality hazard ratio | 0.48 (CI 0.18, 1.3) | ||||||
Walton T et al. [30], (2005), HD outpts | DS | 278 | 26 | Pharmacist-managed anaemia programmes | Hb value at baseline and Month 6 | 9.5/11.8 g/dL | |
Mean (± SD) ferritin at baseline and Month 6 | 280.9 ± 326.4/431 ± 232.1 ng/mL | ||||||
Mean (± SD) Tsat at baseline and Month 6 | 21 ± 7.9/33 ± 8% | ||||||
Sathvik BS et al. [32], (2007), HD outpts | RCT | 90 | 4 | Pharmacist-provided pts education | Medication knowledge (MKAQ) at baseline, Month 2 and 4 in Group 1 and 2 | Improvement in MKAQ scores in Group 1 compared to baseline and to Group 2 at Month 2 | < 0.05 |
Group 1: Pharmacist pts education (Month 0-2) | No significant improvement in MKAQ scores in Group 2 compared to baseline at Month 2 | >0.05 | |||||
Group 2: Usual health care w/o pharmacists (Month 0-2) | Improvement in MKAQ scores in Group 2 at Month 4 compared to baseline and to scores at Month 2 | < 0.05 | |||||
Switch at Month 2 | Decrease in MKAQ scores in Group I at Month 4 compared to Month 2 | < 0.05 | |||||
Erickson AI et al. [20], (2008), HD in- and outpts | DS | 1184 pts visits | 4 | Prospective order review by CP and general CPS | Compliance with prospective order review | 1059 (89.4%) | |
No./Types of interventions | 77 (100%) | ||||||
Therapeutic-related
| 11 (14.3%)
| ||||||
Safety-related
| 49 (63.6%)
| ||||||
Compliance-related
| 17 (22.1%)
| ||||||
PhAR | 100% | ||||||
Castro R et al. [13], (2009), HD in- and outpts | BAS | 60 | 6 | MTM | Disease control parameters at baseline vs. follow-up visit at Day 90 | ||
Abstract
| SBP (MTM) | 150 ± 22/144 ± 18 mmHg | 0.12 | ||||
SBP (non-MTM) | 143 ± 21/145 ± 25 mmHg | NS | |||||
HbA1c (MTM) | 9.2 ± 1.6/9.0 ± 2.0% | 0.58 | |||||
HbA1c (non-MTM) | 6.2 ± 1.2/6.5 ± 1.4% | NS | |||||
Phosphorus (MTM) | 6.2/5.6 mg/dL | .096 | |||||
Calcium/phosphorous product (MTM) | 56 ± 19/50 ± 16 | .03 | |||||
Mirkov S [21], (2009), HD outpts | DS | 64 | 8 | DT reviews by CP | No./types of DRPs | 278 (100%) | |
Non-adherence
| 61 (22%)
| ||||||
Overdosage
| 26 (9.3%)
| ||||||
Untreated indication
| 24 (8.6%)
| ||||||
Pai AB et al. [22], (2009), HD outpts | RCT | 104 (57/47) | 24 | INT: PC, DT reviews by CP | No./Types of DRPs | 530 (100%) | |
CT: SOC, DT reviews by dialysis nurse | Drug record discrepancy
| 133 (25%)
| |||||
Untreated indication
| 111 (21%)
| ||||||
Subtherapeutic dosage
| 74 (14%)
| ||||||
PhAR | 100% | ||||||
Reduction in drug use in INT | 14% | < 0.05 | |||||
Reduction of hospitalisations in INT | 42% | 0.02 | |||||
Reduction of LOS in INT | 21% | 0.06 | |||||
Pai AB et al. [23], (2009), HD outpts | RCT | 107 (61/46) | 24 | INT: PC, DT reviews by CP | Total RQLP scores at Year 1 compared to baseline INT/CT | Worsening in Total RQLP score at Year 1 in CT group (88 ± 31/71 ± 34) | 0.03 |
CT: SOC, DT reviews by dialysis nurse | Total RQLP scores at Year 2 compared to baseline INT/CT | Improvement in INT/CT group, no statistically significant difference |
Scope of clinical pharmacy activities
Medication review and monitoring of patient's pharmacotherapy regimen | Education and counselling | Disease management programmes | Further tasks |
---|---|---|---|
Taking a thorough medication history, including OTC drugs, herbal supplements, drugs prescribed by non-nephrologists, and CAM drugs | Provision of medical and therapeutic information for patients and other health care professionals | Basic clinical assessments during patient visists | Medication use evaluation |
Medication review at different time points, such as at admission, during inhospital treatment, during each dialysis session, and at discharge | Training regarding the administration of drugs (e.g. ESAs self injections) | Ordering of laboratory tests | Audit measures |
Matching computerised medication profiles with verbally obtained medication history | Counselling on side effects, interactions | Co-ordering of anaemia therapies and other drugs | |
Medication order review and checking adherence to prescribing guidelines | Compiling of guidelines for proper drug use (e.g., iron and ESAs) and implementation of treatment algorithms (e.g., hyperlipidaemia, hypertension, and renoprotective drugs) | Co-prescribing within the scope of specific guidelines (e.g., anaemia management or lipid management) | |
Development of discharge medication plans | Assessment and monitoring of compliance and adherence | ||
Identification of potential or actual DRPs | |||
Therapeutic recommendations (e.g. change of drugs, dose and/or interval adjustments, discontinuation of drugs, additional laboratory monitoring, nephrologist referral, addition of renoprotective drugs) | |||
Therapeutic monitoring (treatment, laboratory values, and specific drugs) |
Outcomes
Disease-oriented outcomes | Patient-oriented outcomes |
---|---|
Total cholesterol, LDL, HDL | Rate of hospitalization |
HbA1c | Length of stay |
Haematocrit, Tsat, ferritin, haemoglobin | Health-related quality of life |
SBP, DBP | Medication-related knowledge |
Phosphorus, calcium-phosphorus product | Renal quality of life |
Drug dosages (e.g., EPO dosage or ferrous dosage) | Patient satisfaction survey |