Evaluation of a training and communication-network nephrology program for community pharmacists
- 287 Downloads
Objectives To assess the feasibility and impact of implementing ProFiL program to optimize community-pharmacist management of drug-related problems among chronic kidney disease patients followed in a predialysis clinic. The program comprises a training workshop, communication-network program and consultation service. Setting Forty-two community pharmacies, 101 pharmacists, and 90 chronic kidney disease patients attending a predialysis clinic in Laval (Canada). Patients were followed-up for 6 months. Method In a six-month, pilot, open, cluster-randomized controlled trial, community pharmacies were assigned to ProFiL or the usual care. Chronic kidney disease patients of these pharmacies attending a predialysis clinic were recruited. ProFiL pharmacists attended a workshop, received patient information (diagnoses, medications, and laboratory-test results) and had access to a consultation service. Their knowledge and satisfaction were measured before and after the workshop. The mean numbers of pharmacists’ written recommendations to physicians (pharmaceutical opinions) and refusals to dispense a medication were computed. Results Of the ProFiL pharmacists, 84% attended the workshop; their knowledge increased from 52% to 88% (95% CI: 29–40%). Most ProFiL pharmacists rated workshop (95%), communication program (82%) and consultation service (59%) as “excellent” or “very good”; 82% said the program improved the quality of their follow-up. The consultation service received 21 requests. ProFiL and usual care pharmacists issued a mean of 0.50 and 0.02 opinion/patient, respectively, (95% CI of the adjusted difference: 0.28–1.01 opinion/patient). Conclusion The results of this pilot study suggest that ProFiL can be implemented and may help community pharmacists intervene more frequently to manage drug-related problems. However, a larger-scale study with longer follow-up is necessary to evaluate the impact of the program on management of drug-related problems and its clinical relevance.
KeywordsCanada Chronic kidney disease Cluster-randomized controlled trial Community pharmacy Drug-related problems Pharmaceutical care Pharmacist education
We thank all the pharmacists, physicians, and patients involved in this study, Nathalie Caron for her excellent work and constant support and Chantal Legris for her assistance in the preparation of this article.
Dr. Lyne Lalonde is a scientist supported by the Fonds de la recherche en santé du Québec. Unrestricted research grants were received from the Bourse du Cercle du Doyen (Faculty of pharmacy, University of Montreal), and Pfizer Canada Inc.; unrestricted educational grants were received from Amgen Canada Inc., Bristol-Myers Squibb/Sanofi-Synthelabo, Hoffmann-La Roche Limitée, LEO Pharma Inc., Merck Frosst Canada & Co, Pharmaceutical Partners of Canada Inc., Pro Doc Ltée, Sabex, and Shire BioChem Inc.
Conflicts of Interest
- 9.K/DOQI clinical practice guidelines for management of dyslipidemias in patients with kidney disease. Am J Kidney Dis. 2003;41:I-IV, S1–91.Google Scholar
- 10.K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1–201.Google Scholar
- 11.K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.Google Scholar
- 12.IV. NKF-K/DOQI clinical practice guidelines for anemia of chronic kidney disease: update 2000. Am J Kidney Dis. 2001;37:S182–238. doi: 10.1016/S0272-6386(01)70008-X.
- 13.Philipneri MD, Rocca Rey LA, Schnitzler MA, Abbott KC, Brennan DC, Takemoto SK, et al. Delivery patterns of recommended chronic kidney disease care in clinical practice: administrative claims-based analysis and systematic literature review. Clin Exp Nephrol. 2008;12:41–52. doi: 10.1007/s10157-007-0016-3.PubMedCrossRefGoogle Scholar
- 14.Zillich AJ, Saseen JJ, Dehart RM, Dumo P, Grabe DW, Gilmartin C, et al. Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy. Pharmacotherapy. 2005;25:123–43. doi: 10.1592/phco.220.127.116.11628.PubMedCrossRefGoogle Scholar
- 17.Rapports d’études et statistiques, Régie de l’assurance maladie du Québec. Available at: http://www.ramq.gouv.qc.ca/fr/statistiques/index.shtml. Accessed 14 July 2008.
- 21.Murray DM. Planning the analysis. In: Murray DM, editor. Design and analysis of group-randomized trials (ISBN 0–19-512036–1). UK: Oxford University Press; 1998. p. 77–130.Google Scholar
- 24.Pickrell L, Duggan C, Dhillon S. From hospital admission to discharge: an exploratory study to evaluate seamless care. Pharm J. 2001;267:650–3.Google Scholar
- 25.Duggan C, Feldman R, Hough J, Bates I. Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharm Pract. 1998;6:77–82.Google Scholar
- 27.McLean W. Experience with a new prescription and discharge note form to improve seamless care. Can J Hosp Pharm. 1997;50:257. letter.Google Scholar
- 31.Moore H, Summerbell C, Vail A, Greenwood DC, Adamson AJ. The design features and practicalities of conducting a pragmatic cluster randomized trial of obesity management in primary care. Stat Med. 2001;20:331–40. doi :10.1002/1097-0258(20010215)20:3<331::AID-SIM795>3.0.CO;2-K.Google Scholar