Impact of clinical pharmacy services on renal transplant recipients’ adherence and outcomes

Abstract

The purpose of this article is to provide a description of a clinical pharmacy services program implemented in a renal transplant clinic to improve medication access and adherence as well as health and economic outcomes among renal transplant recipients (RTRs). Following a team-based planning process and an informal survey of RTRs, a clinical pharmacy service intervention was implemented in the Medical College of Georgia renal transplant clinic. As part of the intervention, a clinical pharmacist reviewed and optimized medication therapy, provided instructions on how to take medication, and assisted with enrollment into medication assistance programs. Significant differences were found between RTRs who did and did not receive clinical pharmacy services on measures of adherence, health, economics, and quality of life. Clinical pharmacy services, as described in this article, have a positive impact on renal transplant recipients’ medication adherence, health and economic outcomes, and health-related quality of life. The findings described here suggest that clinical pharmacy services are a viable and effective option for improving care for RTRs in an outpatient clinic setting.

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

“…First, patients picking up their medication from a pharmacy might receive extra adherence‐enhancing interventions compared to those receiving them at the physician's office. Pharmacies are increasingly augmenting their services with adherence support, an intervention proven effective in kidney transplant patients 52, 53. Alternatively, receiving medication at a physician's office, which allows especially close follow‐up, might reflect the physician's perception of a higher nonadherence risk.…”

Managing Specialty Medication Services Through a Specialty Pharmacy Program: The Case of Oral Renal Transplant Immunosuppressant Medications

“…Studies in Medicare and in tertiary care institution-based transplant specialty pharmacy programs indicate that patient education, adherence oversight, and clinical management services positively influence medication adherence, total health care costs, and patients' quality of life. In one study by Chisholm-Burns (2008), patients at a tertiary care institution after 1 year of followup with clinical pharmacy services versus control group had a higher mean adherence rate compared with those in the control group (96.1% vs. 81.6%; P < 0.001). Additionally, they had a mean total cost of $2,614 less per patient than the control group.…”

“…Unfortunately, nonadherence to immunosuppressive therapy has been reported in 20%-70% of the transplant population; this wide range is based on variation in adherence measures and study populations. [1][2][3][4][5][6][7] Nonadherence rates with immunosuppressive therapy increase over time since the transplant occurred. 8 Reasons for nonadherence include such patient-related components as understanding the need for immunosuppressive therapy, misunderstanding of the medication regimen, forgetfulness, lack of communication and follow-up with the medical team, and depression.…”

“…Medication-related components of nonadherence include a high pill burden, high frequency and severity of drug interactions, and adverse effects. 1,2,9,10 Nonadherence has been identified as a major risk factor for acute complications and allograft rejection, as well as for late graft rejection, complications, and even death. Complications due to nonadherence can result in increased physician visits and inpatient hospitalization stays and, in cases of kidney transplantation failures, re-initiation of dialysis, all culminating in increased overall health care costs.…”

“…18,19 Studies in Medicare and in tertiary care institution-based transplant specialty pharmacy programs indicate that patient education, adherence oversight, and clinical management services positively influence medication adherence, total health care costs, and patients' quality of life. 1,17 However, little is known about the costs and benefits of specialty pharmacy programs in the commercial transplant population. Accordingly, we compared the effectiveness of a transplant specialty pharmacy program implemented by a large commercial health plan through a designated specialty pharmacy to improve post-renal transplant care with the services provided through retail pharmacies in a similar population.…”