Patient-Centered Pharmacist Care in the Hemodialysis Unit: A Quasi-Experimental Interrupted Time Series Study
- Conditions
- Medication Adherence
- Interventions
- Other: Patient-Centered Pharmacist Care
- Registration Number
- NCT03576404
- Brief Summary
Nonadherence to medications by patients requiring hemodialysis (HD) leads to unfavorable clinical outcomes.Limited data exist on the influence of pharmacists on pharmacoadherence by patients requiring HD. Therefore, we assessed the impact of patient-centered pharmacist care through the implementation of concepts of Medication Therapy Management (MTM) and motivational interview (MI) on pharmacoadherence and its outcomes in patients requiring HD.
- Detailed Description
Patients were assessed at baseline for baseline characteristics, dialysis-related factors, and medications records
1. Pharmacists conducted brief monthly interview for patients to assess the medications they are receiving
2. A comprehensive interview for patients occurred at month 3 and 5 including concepts of MTM and MI
3. MTM included a review of each participant's medications and personal medication record to identify the use of any over-the-counter medications, design of their medication-related action plan, formulation of specific therapeutic interventions, and referrals for discussion with their physician and subsequent documentation and follow-up. The therapeutic interventions accepted by the physician were further discussed with each patient/caregiver using the MI technique to encourage adherence and this discussion was documented in each patient's medication record.
4. MI incorporated the main components reported in the literature: rolling with resistance; expressing empathy; avoiding argumentative behavior; highlighting the discrepancy between patients' current attitudes compared with the desired therapeutic goals; and empowering patients' self-efficacy
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 72
- Patients (≥18 years of age)
- Outpatient HD for at least 3 months before the study period
- Patients who refused to participate in the study
- Patients without the capacity to understand or take responsibility for their medications
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Eligible participants Patient-Centered Pharmacist Care The intervention of patient-centered pharmacist care included a comprehensive interview patients conducted at month 3 and 5 ,which included and reviewing all their medications using concepts of MTM and MI All study participants were assessed at baseline and on monthly basis for the changes in the study outcomes.
- Primary Outcome Measures
Name Time Method Changes in pharmacoadherence of patients requiring HD using electronic medication refill from baseline Monthly and up to 6 months Comparing changes in self-reporting of number of medications with electronic prescribing during each of the six interviews
Changes in pharmacoadherence of patients requiring HD through the control of serum phosphate level (mmol/L) from baseline Monthly and up to 6 months Changes in surrogate laboratory pre-HD serum phosphate level (mmol/L) from baseline
- Secondary Outcome Measures
Name Time Method Changes in Systolic blood pressure (SBP) control in mmHg from baseline as a independent surrogate marker for administration of medications Monthly and up to 6 months Changes in Systolic blood pressure (SBP) control in mmHg from baseline and on a monthly basis
Changes in serum low-density lipoprotein (LDL) levels in mmol/L from baseline as an independent surrogate marker for the administration of medications Monthly and up to 6 months Changes in serum low-density lipoprotein (LDL) levels in mmol/L from baseline and on a monthly basis
Changes in Number of Medication-related problems (MRPs) from baseline at month 3 and month 5 At month 3 and month 5 of the study Number
Types of Medication-related problems (MRPs) Total study duration: from month 1 to month 6 Types of Medication-related problems included in the study as identified in literature: improper drug dosing or selection; initiation of medication without indication; adverse drug events; failure to receive drugs; indication without treatment; suggested alternative therapeutic options; and inappropriate monitoring or laboratory tests required
Number of accepted therapeutic interventions by the pharmacist Monthly and up to 6 months Number of Therapeutic interventions suggested by the pharmacists to alter medication regimen suggested by pharmacist based on discussion and approval of prescribing physicians