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Pharmacy World & Science

, Volume 32, Issue 1, pp 7–18 | Cite as

Clinical pharmacy services and solid organ transplantation: a literature review

  • G. StemerEmail author
  • R. Lemmens-Gruber
Review Article

Abstract

Aim of the review Organ transplantation represents the therapy of choice for most types of end-stage organ failure, and post-transplant patient care warrants great attention. The aim of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services in the care of solid organ transplant patients. Methods A search of the literature was conducted using the MEDLINE, EMBASE and IPA databases to identify studies relevant to our investigation of the impact of clinical pharmacists’ interventions. Results Only five out of nineteen of the included studies were randomised controlled trials; eleven studies were descriptive, and three were before-after studies. Interventions performed in these studies consisted of routine clinical pharmacy services with a focus on identifying, resolving and preventing drug-related problems; clinical pharmacy services with a focus on therapeutic drug monitoring; and those with a focus on compliance enhancement and educational interventions. The number and type of interventions and the physicians’ acceptance rates were assessed in the majority of the included studies. Acceptance rates were generally above 95%, and most studies reported that clinical pharmacy services had a positive impact on the care of solid organ transplant patients. Positive perceptions of patients and health care professionals are also reported. In two of the studies, patients’ compliance rates and drug knowledge were assessed following counselling by a pharmacist. Dosing-related interventions were the most common interventions proposed. Immunosuppressants, cardiovascular drugs and antimicrobials were the drug classes most affected by the clinical pharmacists’ interventions. Conclusions High quality evidence that supports the benefit of clinical pharmacy services in the care of solid organ transplant patients is rare. Nevertheless, all of the included studies showed that clinical pharmacy services had a positive impact. Furthermore, all included studies showed that patients and physicians appreciated clinical pharmacists. The various outcome measures used in these studies were improved by interactions with clinical pharmacists. More randomised controlled trials are needed to contribute to the paucity of the existing evidence.

Keywords

Clinical pharmacy services Immunosuppressant medications Literature review Solid organ transplantation 

Notes

Acknowledgements

The authors wish to thank the staff of the pharmacy department of the General Hospital of Vienna for their continual support during the review and the manuscript preparation process.

Funding

This literature review was carried out as part of a clinical pharmacy project that was funded by Amgen.

Conflicts of interest

None declared.

References

  1. 1.
    Müller-Ruchholtz W. Glances at the history of transplantation immunology. Transpl Proc. 1999;31(3):1443–51.CrossRefGoogle Scholar
  2. 2.
    Lauchart W, Gubernatis G, Blümke M. Transplantation medicine. Intensivmedizin. 2005;42(6):481–8.CrossRefGoogle Scholar
  3. 3.
    Lee MA. Transplantation: drug aspects of immunosuppression. Hosp Pharmacist. 2003;10:201–7.Google Scholar
  4. 4.
    Caillard S, Moulin B. Transplant patient monitoring. Rev Prat. 2007;57(3):299–308.PubMedGoogle Scholar
  5. 5.
    Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102(3):275–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Bond CA, Raehl CL. 2006 national clinical pharmacy services survey: clinical pharmacy services, collaborative drug management, medication errors, and pharmacy technology. Pharmacotherapy. 2008;28(1):1–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. Pharm World Sci. 2007;29(3):146–63.CrossRefGoogle Scholar
  9. 9.
    Burge KL, Simonson DH. Documentation of clinical interventions on a solid organ transplant service. Poster presented at: ASHP Midyear Clinical Meeting. 1992;27(Dec):P-328D.Google Scholar
  10. 10.
    Chisholm MA, Bagby TR, DiPiro JT, May JR. Provision of pharmaceutical care services in a renal transplant clinic. Poster presented at: ASHP Midyear Clinical Meeting. 1998;33(Dec):FGF-3.Google Scholar
  11. 11.
    Chisholm MA, Reinhardt BO, Vollenweider LJ, Martin BC, DiPiro JT, et al. Effect of pharmaceutical care services on renal transplant patients’ blood glucose levels. Poster presented at: ASHP Midyear Clinical Meeting. 1999;34(Dec):P-148E.Google Scholar
  12. 12.
    Chisholm MA, Vollenweider LJ, Reinhardt BO, Rogers HE, DiPiro JT, May JR. Provision of pharmaceutical care services in a renal transplant clinic. Poster presented at: ASHP Midyear Clinical Meeting. 1999;34(Dec):P-149E.Google Scholar
  13. 13.
    Chisholm MA, Vollenweider LJ, DiPiro JT. Provision of pharmaceutical care services in a renal transplant clinic. Poster presented at: ASHP Midyear Clinical Meeting. 2000;35(Dec):P-168E.Google Scholar
  14. 14.
    Chisholm MA, Vollenweider LJ, Mulloy LL, Jagadeesan M, Wade WE, DiPiro JT. Direct patient care services provided by a pharmacist on a multidisciplinary renal transplant team. Am J Health Syst Pharm. 2000;57(21):1994–6.PubMedGoogle Scholar
  15. 15.
    Chisholm MA, Mulloy LL, Jagadeesan M, Martin BC, DiPiro JT. Effect of clinical pharmacy services on the blood pressure of African-American renal transplant patients. Ethn Dis. 2002;12(3):392–7.PubMedGoogle Scholar
  16. 16.
    Marek TM, Wiland AM, Weidle PJ. Introduction of a clinical pharmacist into a transplant clinic. Poster presented at: ASHP Midyear Clinical Meeting. 1994;29(Dec):P-254(D).Google Scholar
  17. 17.
    Mathis AS, Lew L, Adamson RT. Renal transplant faculty documentation of clinical activities using a web-based program and handheld device. ASHP Midyear Clinical Meeting. 2003;38(Dec):P-288(D).Google Scholar
  18. 18.
    Oji VU, Okpara AU, Egbunike IG. Implementation of pharmaceutical care with a renal transplant service. Poster presented at: ASHP Midyear Clinical Meeting. 1994;29(Dec):P-367(D).Google Scholar
  19. 19.
    Prowse A, Scott D. An evaluation of a clinic-based pharmacist and a medicines home delivery service from a transplant outpatient department. Pharm J. 2004;272:547–51.Google Scholar
  20. 20.
    Ptachcinski RJ. Impact of clinical pharmacy services in a liver transplant clinic. Poster presented at: ASHP Midyear Clinical Meeting. 1991;26(Dec):P-263D.Google Scholar
  21. 21.
    Wang HY, Chan AL, Chen MT, Liao CH, Tian YF. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics. Transpl Proc. 2008;40(7):2319–23.CrossRefGoogle Scholar
  22. 22.
    Lee KL, Peng YL, Chou JL, Lee KT, Chung HM. Economic evaluation of therapeutic drug monitoring services in renal transplant recipients treated with cyclosporine. Transpl Proc. 2000;32(7):1801–6.CrossRefGoogle Scholar
  23. 23.
    Mishima K, Makino K, Shimada M, Suehiro T, Oishi R, et al. Roles of pharmacists as a member of the liver transplant team in controlling tacrolimus whole blood concentrations and monitoring adverse drug events such as convulsion. Jpn J Pharm Health Care Sci. 2002;28(4):393–400.Google Scholar
  24. 24.
    Chisholm MA, Mulloy LL, Jagadeesan M, DiPiro JT. Impact of clinical pharmacy services on renal transplant patients’ compliance with immunosuppressive medications. Clin Transpl. 2001;15(5):330–6.CrossRefGoogle Scholar
  25. 25.
    Klein A, Kramer I. Influence of a pharmaceutical care program on liver transplant patients’ compliance with immunosuppressive therapy: a prospective, randomized, controlled trial. Krankenhauspharmazie. 2007;28(12):458–68.Google Scholar
  26. 26.
    Monnier G, Charpiat B, Serratrice F, Bossaert S, Fourcade N, Ducerf C. Evaluation of drug therapy knowledge in liver transplant patients after pharmacy counseling. Therapie. 2003;58(4):305–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Partovi N, Chan W, Nimmo CR. Evaluation of a patient education program for solid organ transplant patients. Can J Hosp Pharm. 1995;48(2):72–8.PubMedGoogle Scholar
  28. 28.
    Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24(11):1093–7.PubMedGoogle Scholar
  29. 29.
    Schaefer M. Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc. Pharm World Sci. 2002;24:120–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Hatoum HT, Hutchinson RA, Witte KW, Newby GP. Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988;22(3):252–9.PubMedGoogle Scholar
  31. 31.
    Martin JE, Zavala EY. The expanding role of the transplant pharmacist in the multidisciplinary practice of transplantation. Clin Transpl. 2004;18(Suppl 12):50–4.CrossRefGoogle Scholar
  32. 32.
    Burckart GJ. Transplant pharmacy: 30 years of improving patient care. Ann Pharmacother. 2007;41(7):1261–3.CrossRefPubMedGoogle Scholar
  33. 33.
    Ohler L, Lo A. Transplant pharmacists: key to a successful transplant program. Prog Transpl. 2004;14(2):80–1.Google Scholar
  34. 34.
    Poveda Andres JL, Font Noguera I, Monte Boquet E. Pharmacist’s contribution to transplant patient care. Farm Hosp. 2006;30(5):269–71.CrossRefPubMedGoogle Scholar
  35. 35.
    Shaefer MS. Current topics in immunotherapy and the role of the pharmacist on a solid organ transplant service. Pharmacotherapy. 1991;11(6):136S–41S.PubMedGoogle Scholar
  36. 36.
    Wells H. Promoting adherence in renal transplant patients. Hosp Pharmacist. 2004;11:69–71.Google Scholar
  37. 37.
    Eurotransplant International Foundation. Annual data reports. Available online at: http://www.eurotransplant.nl/?id=annual_report. Accessed 16 Feb 2009.
  38. 38.
    Organ Procurment and Transplantation Network. Data reports. Available online at: http://www.optn.org/data/. Accessed 16 Feb 2009.

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Pharmacy DepartmentGeneral Hospital ViennaViennaAustria
  2. 2.Department of Pharmacology and ToxicologyUniversity of ViennaViennaAustria

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