A Preliminary Review of the Medication Management Service Conducted by Pharmacists in Haemodialysis Patients of Singapore General Hospital

Abstract

background: Patients with end-stage renal disease (ESRD) are at risk of developing drug-related problems (DRPs) due to polypharmacy, multiple co-morbidities and frequent medication changes.Objective: To evaluate the prevalence of DRPs identified and the types of interventions made by Medication Management Service (MMS) pharmacists. Methodology:Renal MMS was set up to conduct comprehensive medication review and medication reconciliation in haemodialysis patients. A pharmacist review was arranged for selected patients prior to the renal physician's appointment. A written report on the findings and proposed recommendations after the pharmacist's review was submitted to the referring physician to aid clinical decision making. This acted as a method of communication between the patient's dialysis centre, pharmacist and attending renal physician. Results:A total of 30 patients were enrolled into the service within a period of five months. Each patient had, on average, 3.1 DRPs. The three most common DRPs were non-adherence (41.5%), untreated indications (14.9%) and adverse drug reactions (11.7%). A total of 54 interventions were performed and almost half of them involved suggestions to modify dosing regimens (51.9%), followed by suggestions to add new drugs (16.7%) and to discontinue drugs (13.0%). Conclusion:The high prevalence of DRPs in renal patients warranted a multidisciplinary team approach. MMS conducted by pharmacists may help to address the gap in information when patients transfer between healthcare settings.

Impact of pharmacist‐provided medication therapy management service on reducing unplanned readmissions in adult patients in Singapore

“…Of all the different categories of DRPs identified in MTM sessions, nonadherence to medications (80.1%) had the highest occurrence, likely contributed by the high pill burden and complexity of medication regimen 16 . A study on renal patients from Singapore General Hospital also found nonadherence to be the most common DRP, 17 whereas another study by Yeoh et al 18 found nonadherence to be the third most common DRPs in their study on MTM for oncology patients in Singapore, concurring with these observed findings. This is significant as non‐adherence has been found to account for a significant number of avoidable hospitalizations and treatment failures 19 .…”