Study protocol: Effectiveness of patient centered pharmacist care in improving medication adherence, clinical parameters and quality of life among hemodialysis patients

Abstract

Background Patients requiring hemodialysis (HD) often have several chronic comorbidities, which necessitate the use of several medications and hence put them at high risk of polypharmacy. Medication-related problems (MRPs) among HD patients are a serious issue as they can increase morbidity and nonadherence with medications. To overcome this issue, a unique pharmacy practice model including medication review (MR) and motivational interviewing (MI) is needed to improve medication adherence, by reducing MRPs and optimizing therapeutic outcomes. The present study aims to assess the effectiveness of MR and MI in improving medication adherence, quality of life (QOL) and clinical outcomes among end-stage renal disease (ESRD) patients who are on dialysis. Method and design This pre-post study will be conducted prospectively among patients with ESRD who have been on dialysis at the Hemodialysis Unit, Hospital Kuala Lumpur and the Hemodialysis Affiliated Centers of the University Malaya Medical Centre, from August 2020 till August 2021. Medication adherence will be assessed using the General Medication Adherence Scale (GMAS), whilst patients’ HRQOL will be assessed using the Kidney Disease Quality of Life Short Form 36 (KDQOL-36). Clinical parameters such as blood glucose level, calcium, phosphate, hemoglobin and serum low-density lipoprotein (LDL) levels will be obtained from medical records. A total of 70 patients will be recruited. Discussion We hypothesize that the implementation of pharmacy-based MR and MI may expect an increase in medication adherence scores and increase in HRQOL scores from baseline as well as achieving the clinical lab parameters within the desired range. This would indicate a need for a pharmacist to be involved in the multidisciplinary team to achieve a positive impact on medication adherence among hemodialysis patients. Trial registration Ethical approval has been obtained from the National Medical Research and Ethics Committee NMRR: 20-1135-54435 and Medical Research Ethics Committee, University Malaya Medical Centre MREC ID NO: 202127-9811.

Analysis of influencing factors on quality of life in patients with chronic kidney disease undergoing maintenance haemodialysis

“…Factors affecting QoL vary and include physical conditions, such as anaemia and malnutrition [ 26 , 27 ], while mental and social environments, such as emotional and stress fluctuations, also play a significant role. Vazquez noted the profound impact of depression and anxiety on patients undergoing MHD [ 28 ]. The progression of treatment, escalating costs and the family's financial situation further decrease patients' QoL.…”

Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study

“…Actually, with the development of clinical pharmacy, pharmacists have gradually completed the transition from pharmacy to clinical practice. They made a lot of attempts in the process, including pharmacotherapy clinics (Shahrami et al, 2022), MTM service (Johnson et al, 2018), and patient centered pharmacist care (Paneerselvam et al, 2022). Those pharmacists with rich pharmacotherapy knowledge reserves, as irreplaceable partners of physicians, ensure rational drug use, improve patient medication compliance, and ultimately ameliorate patient outcomes (Marr et al, 2018).…”

Avaliação da adesão à farmacoterapia por pacientes em terapia hemodialítica atendidos em um hospital universitário

“…Tal fato exige do paciente maior atenção, memória e organização diante dos horários de administração dos medicamentos aos quais faz uso (Bampi et al, 2015;Paneerselvam et al, 2022). Por outro lado, um estudo (Albarelo et al, 2020) que avaliou a adesão ao tratamento da hipertensão arterial sistêmica de pacientes participantes do programa hiperdia de uma estratégia em saúde da família encontrou com o BMQ que 22,9% dos entrevistados têm efetivamente adesão ao tratamento medicamentoso da hipertensão e 47,8% têm provável adesão; enquanto 28,2% têm provável baixa adesão e 1,2% têm baixa adesão.…”

“…Destaca-se na literatura que a presença do farmacêutico no cuidado ao paciente com DRC em HD proporciona melhora na adesão aos medicamentos, reduz os Problemas Relacionados a Medicamentos (PRMs) e otimiza os resultados terapêuticos, sendo fundamental a presença deste profissional nas equipes multidisciplinares que acompanham pacientes renais (Bampi et al, 2015;Paneerselvam et al, 2022).…”