Community pharmacist intervention in patients with renal impairment
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Background In France, community pharmacists do not have free access to patients’ lab results, and it is therefore impossible for them to identify patients with renal impairment. Objective (1) to evaluate the ability of community pharmacists (CPs) to identify drug related problems (DRP) in patients at risk for or suffering from renal impairment; (2) to evaluate the proportions of recommendations by CPs that lead to a modification by GP. Setting A prospective and observational study involving 24 community pharmacists in France. Methods Following special training, community pharmacists were asked to select 52 patients with the following characteristics: ≥65 years of age; prescribed at least two diabetic and/or antihypertensive drugs. Serum creatinine value was obtained for each patient and glomerular filtration rate estimated (eGFR) with the aMDRD formula. Those with a eGFR 60 ml/min/1.73 m² were considered having chronic kidney disease (CKD). Data was collected concerning whether the community pharmacists identified drug related problems and tried to inform the GP who prescribed the medications. Identified DRP were reviewed by a team of nephrologists and hospital clinical pharmacists. Primary outcome The proportion of CKD patients and those without serum creatinine monitoring, the number of drug related problems identified by community pharmacists, and the proportion of drug related problems resolved by the community pharmacists intervention to the GP. Results Of the total 791 patients identified, 180 (22.8 %) exhibited CKD, and 57 (7.2 %) had not undergone serum creatinine monitoring. Among the 1297 drugs prescribed, 260 had to be adapted to eGFR. The proportion of DRP was 21.5 % (56/260), of which 40 % (20) were identified by community pharmacists. Once the GP was informed, 33.3 % (6/18) of DRP were resolved. Conclusion Community pharmacists identified 40 % of DRP related to CKD prescriptions, leading to prescription modification by GPs in a third of the cases. These interventions are likely to decrease drug-related morbidity and mortality.
KeywordsChronic kidney disease Community pharmacist Drug-related problem France General practitioner Serum creatinine
The study had been financed by the URPS Pharmacists of Center region.
Conflicts of interest
The authors declare no conflicts of interest.
- 1.HAS December 2011. Evaluation du débit de filtration glomérulaire et du dosage de la créatininémie dans le diagnostic de la maladie rénale chronique chez l’adulte [Glomerular filtration rate evaluation and serum creatinine in the diagnosis of chronic kidney disease in adults]. ISBN: 978-2-11-128508-8. http://www.has-sante.fr/portail/upload/docs/application/pdf/2011-12/rapport_dfg_creatininemie.pdf. Accessed 14 Feb 2014.
- 3.HAS février 2012 guide du parcours de soins. Maladie Rénale Chronique de l’adulte [Internet]. ISBN: 978-11-128521-7. http://www.has-sante.fr/portail/upload/docs/application/pdf/2012-4/guide_parcours_de_soins_mrc_web.pdf. Accessed 14 Feb 2014.
- 4.Cogneau J, Blanchecotte F, Halimi J. BIRD: base de données sur la fonction rénale en région Centre [BIRD: database on renal function in the Centre Region]. Ann Biol Clin. 2008;66(3):285–90.Google Scholar
- 6.Bouattar T, Benasila S, Mattous M, Ezzaitouni F, Ouzeddoun N, Rhou H, et al. L’atteinte rénale chez le diabétique âgé [Renal disease in elderly diabetic]. NPG. 2010;10(55):43–9.Google Scholar
- 11.Rapport de l’Académie nationale de Pharmacie: Bonnes pratiques de dispensation du médicament par le pharmacien d’officine [Report of the National Academy of Pharmacy: Good practices for drug dispensing by the pharmacist]. http://www.acadpharm.org/dos_public/Rapport_Bonnes_pratiques_de_dispensation__adoptEpar_le_Conseil_du_27_11_2013_VF.pdf. Accessed 22 Feb 2015.
- 15.National Kidney Foundation. Guidelines and commentaries. https://www.kidney.org/professionals/guidelines/guidelines_commentaries. Accessed 07 Jul 2015.
- 16.Prat L, Caille A, Sautenet B, Merieau E, Leger J, Giraudeau B, et al. L’insuffisance rénale en milieu hospitalier: est-ce fréquent? Est-ce grave? Chez qui? Etude Néphrovigilance [Renal failure in hospital: is it common? Is it serious? For whom? Nephrovigilance study]. Soc Néphrol Brux Ther. 2010;5(6):462–468.Google Scholar
- 18.Pozuelos Estrada G, Molina Martínez L, Romero Perera JJ, Díaz Herrera N, Cañón Barroso L, Buitrago Ramírez F. Prevalence of hidden renal failure calculated through formulas on the degree of renal function in hypertense patients over 60 referred to out-patients for blood pressure monitoring. Aten Prim. 2007;39(5):247–53.CrossRefGoogle Scholar
- 22.Lefèvre T. Analyse des interventions pharmaceutiques réalisées lors de la validation des prescriptions médicales, au sein d’une officine de pharmacie [Analysis of pharmaceutical interventions during the review of medical prescriptions in a community pharmacy]. J Pharm Clin. 2011;30(3):155–8.Google Scholar
- 24.Schlecht-Bauer D, Sautenet B, Emonet M, Hay N, Guegan F, Rosset P, et al. Insuffisance rénale et médicaments: suivis patients coordonnés entre pharmaciens officinaux et hospitaliers [Renal impairment and drugs: coordination between community pharmacists and hospital pharmacists]. Pharm Hosp Clin. 2012;47(2):123–6.Google Scholar