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The effect of inpatient pharmaceutical care on nephrotic syndrome patients after discharge: a randomized controlled trial

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Abstract

Background Clinical pharmacists can play an important role in chronic diseases management, but limited attention has been given to the pharmaceutical care of nephrotic syndrome patients. Objective To evaluate the impact of inpatient pharmaceutical care on medication adherence and clinical outcomes in nephrotic syndrome patients. Setting A tertiary first-class hospital in Shanxi, China. Method We conducted a randomized controlled trial on 61 patients with nephrotic syndrome. The intervention consisted of medication reconciliation, pharmacist visits every day, discharge counseling and education by 2 certificated pharmacist, while the control group received usual care. Assessments were performed at baseline, month-1, month-3 and month-6 after hospital discharge. Main outcome measure medication adherence and patients’ clinical outcomes. Results 61 patient completed the trial. Baseline variables were comparable between the two groups. The decline in medication adherence of patients in the intervention group after hospital discharge was restrained effectively at month-6 (p < 0.05). However, the groups did not differ in clinical outcomes, medication discrepancies, adverse drug events and readmission rate. The rate of return visits of the pharmaceutical care group was higher at month-1 and month-6 after discharge (p < 0.05). Conclusion Pharmaceutical inpatient care improved adherence in patients with nephrotic syndrome after hospital discharge, the effect of the intervention on clinical outcomes, medication discrepancies, adverse drug events or readmission was insignificant. These results are promising but should be tested in other settings prior to broader dissemination.

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References

  1. Kodner C. Diagnosis and management of nephrotic syndrome in adults. Am Fam Physician. 2016;93(6):479–85.

    PubMed  Google Scholar 

  2. He YN, Zhang WW. Current epidemiology of nephrotic syndrome. Chin J Kidney Dis Invest (Electron Edn). 2017;6(4):149–53.

    Google Scholar 

  3. KDIGO Glomerulonephritis Work Group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl. 2012;2:139–274.

    Article  Google Scholar 

  4. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.

    Article  PubMed  Google Scholar 

  5. Van Der Luit CD, De Jong IR, Ebbens MM, Euser S, Verweij SL, Van Den Bemt PM, et al. Frequency of occurrence of medication discrepancies and associated risk factors in cases of acute hospital admission. Pharm Pract (Granada). 2018;16(4):1301–5.

    Article  Google Scholar 

  6. Qian L, Yafang J. Bliefs about medicine and adherence among nephritic syndrome patients: a survey study. J Nurs Sci. 2012;27(5):48–50.

    Google Scholar 

  7. Morgado MP, Morgado SR, Mendes LC, Pereira LJ, Castelo-Branco M. Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: review and meta-analysis. Am J Health Syst Pharm. 2011;68(3):241–53.

    Article  PubMed  Google Scholar 

  8. Jeong S, Lee M, Ji E. Effect of pharmaceutical care interventions on glycemic control in patients with diabetes: a systematic review and meta-analysis. Ther Clin Risk Manag. 2018;14:1813–29.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Parajuli DR, Franzon J, McKinnon RA, Shakib S, Clark RA. Role of the pharmacist for improving self-care and outcomes in heart failure. Curr Heart Fail Rep. 2017;14(2):78–86.

    Article  PubMed  Google Scholar 

  10. Van Driel ML, Morledge MD, Ulep R, Shaffer JP, Davies P, Deichmann R. Interventions to improve adherence to lipid-lowering medication. Cochrane Database Syst Rev. 2016;12:CD004371.

    PubMed  Google Scholar 

  11. Galo JS, Mehat P, Rai SK, Avina-Zubieta A, De Vera MA. What are the effects of medication adherence interventions in rheumatic diseases: a systematic review. Ann Rheum Dis. 2016;75(4):667–73.

    Article  CAS  PubMed  Google Scholar 

  12. Felton MA, van Londen GJ, Marcum ZA. Medication adherence to oral cancer therapy: the promising role of the pharmacist. J Oncol Pharm Pract. 2016;22(2):378–81.

    Article  PubMed  Google Scholar 

  13. Jokanovic N, Tan EC, Sudhakaran S, Kirkpatrick CM, Dooley MJ, Ryan-Atwood TE, et al. Pharmacist-led medication review in community settings: an overview of systematic reviews. Res Social Adm Pharm. 2017;13(4):661–85.

    Article  PubMed  Google Scholar 

  14. Li J, Li ZP. Differences and similarities in clinical pharmacy practice in China and the United States: a narrative review. Eur J Hosp Pharm. 2017;25:2–5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. National health commission of the People’s Republic of China. China’s health statistical yearbook 2018. Beijing: Peking Union Medical College Press; 2018.

    Google Scholar 

  16. Qato DM, Zenk S, Wilder J, Harrington R, Gaskin D, Alexander GC, et al. The availability of pharmacies in the United States: 2007–2015. PLoS ONE. 2017;12(8):e0183172.

    Article  PubMed  PubMed Central  Google Scholar 

  17. WHO collaborating centre for drug statistics methodology. Complete ATC index. https://www.whocc.no/atc_ddd_index. Accessed 17 July 2019.

  18. Lee GKY, Wang HHX, Liu KQL, Cheung Y, Morisky DE, Wong MCS. Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky medication adherence scale. PLoS ONE. 2013;8(4):e62775.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10:348–54.

    Article  Google Scholar 

  20. Expert committee on the immunosuppressive therapy of Chinese adult nephrotic syndrome. Expert consensus on the immunosuppressive therapy of Chinese adult nephrotic syndrom. Chin J Nephrol. 2014; 30(6): 467–74.

  21. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.

    Article  PubMed  Google Scholar 

  22. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.

    Article  CAS  PubMed  Google Scholar 

  23. Skjøt-Arkil H, Lundby C, Kjeldsen LJ, Skovgårds DM, Almarsdóttir AB, Kjølhede T, et al. Multifaceted pharmacist-led interventions in the hospital setting: a systematic review. Basic Clin Pharmacol Toxicol. 2018;123(4):363–79.

    Article  PubMed  Google Scholar 

  24. Presley B, Groot W, Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: a systematic review and meta-analysis. Res Social Adm Pharm. 2018;15:1057.

    Article  PubMed  Google Scholar 

  25. Wooldridge K, Schnipper JL, Goggins K, Dittus RS, Kripalani S. Refractory primary medication nonadherence: prevalence and predictors after pharmacist counseling at hospital discharge. J Hosp Med. 2016;11(1):48–51.

    Article  PubMed  Google Scholar 

  26. Cohen MJ, Shaykevich S, Cawthon C, Kripalani S, Paasche-Orlow MK, Schnipper JL. Predictors of medication adherence post-discharge: the impact of patient age, insurance status and prior adherence. J Hosp Med. 2012;7(6):470–5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mulhem E, Lick D, Varughese J, Barton E, Ripley T, Haveman J. Adherence to medications after hospital discharge in the elderly. Int J Fam Med. 2013;2013:901845.

    Google Scholar 

  28. Krousel-Wood M, Joyce C, Holt E, Muntner P, Webber LS, Morisky DE, et al. Predictors of decline in medication adherence: results from CoSMO. Hypertension. 2011;58(5):804–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Benner JS, Glynn RJ, Mogun H, Neumann PJ, Weinstein MC, Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002;288:455–61.

    Article  PubMed  Google Scholar 

  30. Farley TM, Shelsky C, Powell S, Farris KB, Carter BL. Effect of clinical pharmacist intervention on medication discrepancies following hospital discharge. Int J Clin Pharm. 2014;36(2):430–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vinluan CM, Wittman D, Morisky D. Effect of pharmacist discharge counselling on medication adherence in elderly heart failure patients: a pilot study. J Pharm Health Serv Res. 2015;6(2):103–10.

    Article  Google Scholar 

  32. Mohd MMMAH, Phung H, Sun J, Morisky DE. Improving adherence to medication in adults with diabetes in the United Arab Emirates. BMC Public Health. 2016;16(1):857–67.

    Article  Google Scholar 

  33. Tsilimingras D, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, et al. Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study. J Gen Intern Med. 2015;30(8):1164–71.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Al-Rashoud I, Al-Ammari M, Al-Jadhey H, Alkatheri A, Poff G, Aldebasi T, et al. Medication discrepancies identified during medication reconciliation among medical patients at a tertiary care hospital. Saudi Pharm J. 2017;25(7):1082–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden SK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Miller DE, Roane TE, McLin KD. Reduction of 30-day hospital readmissions after patient-centric telephonic medication therapy management services. Hosp Pharm. 2016;51(11):907–14.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rebello KE, Gosian J, Salow M, Sweeney P, Rudolph JL, Driver JA. The rural PILL program: a post discharge telepharmacy intervention for rural veterans. J Rural Health. 2017;33(3):332–9.

    Article  PubMed  Google Scholar 

  38. Bethishou L, Herzik K, Fang N, Abdo C, Tomaszewski DM. The impact of the pharmacist on continuity of care during transitions of care: a systematic review. J Am Pharm Assoc. 2019;S1544–3191(19):30327–9.

    Google Scholar 

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Acknowledgments

The authors would like to thank all patients who participated in this study. Acknowledgment also goes to the physicians and staff nurses of the Second. Hospital of Shanxi Medical University for their assistance in data collection.

Funding

This study was funded by the Health Commission of Shanxi Province, Shanxi, China (201601055).

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Correspondence to Jinju Duan.

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Yin, D., Guo, Q., Geng, X. et al. The effect of inpatient pharmaceutical care on nephrotic syndrome patients after discharge: a randomized controlled trial. Int J Clin Pharm 42, 617–624 (2020). https://doi.org/10.1007/s11096-020-00975-9

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  • DOI: https://doi.org/10.1007/s11096-020-00975-9

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