International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 569–578 | Cite as

Exploring the role of renal pharmacists in outpatient dialysis centres: a qualitative study

  • Teresa M. Salgado
  • Rebekah Moles
  • Shalom I. Benrimoj
  • Fernando Fernandez-LlimosEmail author
Research Article


Background Pharmacists’ involvement in outpatient dialysis centres in Australia is currently limited, despite the positive contribution of pharmacists to renal patients’ medication management and health outcomes outlined in the literature. An expanded role for pharmacists in this setting may be required as a consequence of the increasing burden of renal disease in the population. Objective To explore renal-specialised hospital pharmacists’ intentions to implement pharmacy services in outpatient dialysis centres. Setting Australian renal-specialised hospital pharmacists. Method Semi-structured interviews were conducted with a purposeful sample of renal pharmacists recruited through the Society of Hospital Pharmacists of Australia Renal Special Interest Group. The interview guide was developed based on the theory of planned behaviour. To identify behavioural intention, the three components of the theory—attitudes, subjective norm, and perceived behavioural control—were explored. The interviews were recorded, transcribed verbatim, and thematically content analysed following a qualitative approach. Main Outcome Measures Pharmacists’ views on their potential involvement and perceived ease or difficulty in implementing pharmacy services in outpatient dialysis centres. Results Thirteen renal pharmacists were interviewed until data saturation achievement. The following services for this setting were suggested: medication reconciliation, medication review, patient education, promotion of compliance, involvement in protocol development with subsequent anaemia/phosphate management. Pharmacists demonstrated positive attitudes towards the implementation of the services. Outcomes expected included benefits to patients, the renal team, and the pharmacy profession, as well as economic savings due to dose optimisation and improvement of patients’ adherence. Subjective norm was favourable meaning that nephrologists, nurses and patients were expected to be receptive towards future pharmacy services. Barriers pointed out for the implementation comprised: funding, hospital administrators’ approval, time and staff shortage, academic training, relationship with physicians, and attitudes of pharmacists, renal team, and patients. Facilitators mentioned by respondents included: having an interview room with access to information sources, consent from the team, access to patients’ profiles, and a full-time pharmacist with a clearly defined role. Conclusion Pharmacists showed positive attitudes, favourable subjective norm and strong perceived behavioural control, which originated a clear behavioural intention to develop pharmacy services in outpatient dialysis centres. The potential barriers and enablers outlined should be taken into account, as well as the holistic approach for the successful implementation of cognitive pharmacy services.


Australia Haemodialysis centres Outpatients Pharmacists Qualitative research Theory of planned behaviour 



We would like to acknowledge the invaluable contribution of Dr. Eleonora Feletto in the development of the interview guide and pre-testing of the research instrument. In addition, we would like to thank all the renal pharmacists who participated in this study for sharing their views and experiences.


Financial support received from Fundaçao para a Ciencia e a Tecnologia, Ministry of Education and Science, Portugal (Doctoral Grant reference number SFRH/BD/43999/2008).

Conflicts of interests

None to declare.


  1. 1.
    Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687–94.PubMedCrossRefGoogle Scholar
  3. 3.
    Boudreau DM, Capoccia KL, Sullivan SD, Blough DK, Ellsworth AJ, Clark DL, et al. Collaborative care model to improve outcomes in major depression. Ann Pharmacother. 2002;36(4):585–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Pharmacists’ interventions in the management of patients with chronic kidney disease: a systematic review. Nephrol Dial Transplant. 2012;27(1):276–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Stemer G, Lemmens-Gruber R. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review. BMC Nephrol. 2011;12(1):35.PubMedCrossRefGoogle Scholar
  6. 6.
    Pai AB, Boyd A, Depczynski J, Chavez IM, Khan N, Manley H. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009;29(12):1433–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Leung WY, So WY, Tong PC, Chan NN, Chan JC. Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. Am J Med. 2005;118(12):1414.PubMedCrossRefGoogle Scholar
  8. 8.
    Yokum D, Glass G, Cheung CF, Cunningham J, Fan S, Madden AM. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in hemodialysis patients. J Ren Nutr. 2008;18(6):521–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Bucaloiu ID, Akers G, Bermudez MC, Mainali R, Brown BL, Roberts SS, et al. Outpatient erythropoietin administered through a protocol-driven, pharmacist-managed program may produce significant patient and economic benefits. Manag Care Interface. 2007;20(6):26–30.PubMedGoogle Scholar
  10. 10.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementing cognitive services in community pharmacy: a review of models and frameworks for change. Int J Pharm Pract. 2006;14(2):105–13.CrossRefGoogle Scholar
  11. 11.
    Gastelurrutia MA, Fernandez-Llimos F, Benrimoj SI, Castrillon CC, Faus MJ. Barriers for the implementation of cognitive services in Spanish community pharmacies. Aten Primaria. 2007;39(9):465–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Implementing cognitive services in community pharmacy: a review of facilitators used in practice change. Int J Pharm Pract. 2006;14(3):163–70.CrossRefGoogle Scholar
  13. 13.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Aslani P. Practice change in community pharmacy: quantification of facilitators. Ann Pharmacother. 2008;42(6):861–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Rossing C, Hansen EH, Krass I. Barriers and facilitators in pharmaceutical care: perceptions and experiences among Danish community pharmacies. J Soc Admin Pharm. 2001;19(2):55–64.Google Scholar
  15. 15.
    Saini B, Krass I, Armour C. Specialisation in asthma: current practice and future roles. J Soc Admin Pharm. 2000;18(5):169–77.Google Scholar
  16. 16.
    Farris KB, Schopflocher DP. Between intention and behavior: an application of community pharmacists’ assessment of pharmaceutical care. Soc Sci Med. 1999;49(1):55–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Feletto E, Wilson LK, Roberts AS, Benrimoj SI. Flexibility in community pharmacy: a qualitative study of business models and cognitive services. Pharm World Sci. 2010;32(2):130–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Roberts AS, Benrimoj SI, Chen TF, Williams KA, Hopp TR, Aslani P. Understanding practice change in community pharmacy: a qualitative study in Australia. Res Social Adm Pharm. 2005;1(4):546–64.PubMedCrossRefGoogle Scholar
  19. 19.
    Benrimoj SI, Feletto E, Gastelurrutia MA, Martinez Martinez F, Faus MJ. A holistic and integrated approach to implementing cognitive pharmaceutical services. Ars Pharm. 2010;51(2):69–87.Google Scholar
  20. 20.
    Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211.CrossRefGoogle Scholar
  21. 21.
    Herbert KE, Urmie JM, Newland BA, Farris KB. Prediction of pharmacist intention to provide Medicare medication therapy management services using the theory of planned behavior. Res Social Adm Pharm. 2006;2(3):299–314.PubMedCrossRefGoogle Scholar
  22. 22.
    Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, et al. Applying theory-driven approaches to understanding and modifying clinicians’ behavior: what do we know? Psychiatr Serv. 2007;58(3):342–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Gavaza P, Brown CM, Lawson KA, Rascati KL, Wilson JP, Steinhardt M. Examination of pharmacists’ intention to report serious adverse drug events (ADEs) to the FDA using the theory of planned behavior. Res Social Adm Pharm. 2010;7(4):369–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Rashidian A, Russell I. Intentions and statins prescribing: can the theory of planned behaviour explain physician behaviour in following guideline recommendations? J Eval Clin Pract. 2011;17(4):749–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Chisholm MA, Williamson GM, Lance CE, Mulloy LL. Predicting adherence to immunosuppressant therapy: a prospective analysis of the theory of planned behaviour. Nephrol Dial Transplant. 2007;22(8):2339–48.PubMedCrossRefGoogle Scholar
  26. 26.
    Patton MQ. Qualitative evaluation and research methods. 2nd ed. Newbury Park, CA: Sage; 1990.Google Scholar
  27. 27.
    Cohen D, Crabtree B. Qualitative research guidelines project. Available from: Cited 28 Dec 2011.
  28. 28.
    Bowen GA. Naturalistic inquiry and the saturation concept: a research note. Qual Res. 2008;8(1):137–52.CrossRefGoogle Scholar
  29. 29.
    Whiteley AM, Whiteley J. The familiarization study in qualitative research: from theory to practice. Qual Res J. 2006;6(1):69–85.CrossRefGoogle Scholar
  30. 30.
    Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.PubMedCrossRefGoogle Scholar
  31. 31.
    Commonwealth of Australia, The Pharmacy Guild of Australia. The fifth community pharmacy agreement between the Commonwealth of Australia and the Pharmacy Guild of Australia. 2010 [cited 7-Sep-2011]; Available from:$File/5CPA%20Agreement%2005%20August%202010.pdf.
  32. 32.
    Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Transplant. 2004;19(7):1842–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;47(2):117–21.PubMedGoogle Scholar
  34. 34.
    Manley HJ, Drayer DK, McClaran M, Bender W, Muther RS. Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center. Pharmacotherapy. 2003;23(2):231–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Mirkov S, Ball P. Design and pilot of a medication review clinic in a dialysis centre. J Pharm Pract. 2003;33(3):199–203.Google Scholar
  36. 36.
    Quercia RA, Abrahams R, White CM, D’Avella J, Campbell M. Cost avoidance and clinical benefits derived from a pharmacy-managed anemia program. Hosp Pharm. 2001;36(2):169–75.Google Scholar
  37. 37.
    Sulick JA, Pathak DS. The perceived influence of clinical pharmacy services on physician prescribing behavior: a matched-pair comparison of pharmacists and physicians. Pharmacotherapy. 1996;16(6):1133–41.PubMedGoogle Scholar
  38. 38.
    Hepler CD. A dream deferred. Am J Health Syst Pharm. 2010;67(16):1319–25.PubMedCrossRefGoogle Scholar
  39. 39.
    Tahaineh LM, Wazaify M, Albsoul-Younes A, Khader Y, Zaidan M. Perceptions, experiences, and expectations of physicians in hospital settings in Jordan regarding the role of the pharmacist. Res Social Adm Pharm. 2009;5(1):63–70.PubMedCrossRefGoogle Scholar
  40. 40.
    McGrath SH, Snyder ME, Duenas GG, Pringle JL, Smith RB, McGivney MS. Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis. J Am Pharm Assoc (2003). 2010;50(1):67–71.CrossRefGoogle Scholar
  41. 41.
    Brown CA, Bailey JH, Lee J, Garrett PK, Rudman WJ. The pharmacist-physician relationship in the detection of ambulatory medication errors. Am J Med Sci. 2006;331(1):22–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Makowsky MJ, Schindel TJ, Rosenthal M, Campbell K, Tsuyuki RT, Madill HM. Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. J Interprof Care. 2009;23(2):169–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Teresa M. Salgado
    • 1
  • Rebekah Moles
    • 2
  • Shalom I. Benrimoj
    • 3
  • Fernando Fernandez-Llimos
    • 4
    Email author
  1. 1.Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL), Faculty of PharmacyUniversity of LisbonLisbonPortugal
  2. 2.Faculty of PharmacyUniversity of SydneySydneyAustralia
  3. 3.Graduate School of HealthUniversity of Technology SydneySydneyAustralia
  4. 4.Department of Social Pharmacy, Faculty of Pharmacy, Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL)University of LisbonLisbonPortugal

Personalised recommendations