Outcomes of pharmacist-provided medication review in collaborative care for adult Singaporeans receiving hemodialysis
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Background Patients receiving hemodialysis are predisposed to drug related problems (DRPs). While collaborative care (CC) models with pharmacist involvement can reduce DRP occurrence, few have examined its impact on clinical and economic outcomes. Objective To determine whether a CC model with pharmacist-provided medication review can reduce unplanned admissions and healthcare utilization in patients receiving hemodialysis, compared to usual care (UC). Setting Outpatient nephrology clinic of a tertiary hospital in Singapore. Method In this retrospective observational study, patients who were taking more than 10 medications or had prior unplanned admissions were included. Patients were identified as being managed under CC (n = 134) if they received comprehensive pharmacist-provided review, or under the UC (n = 190) if they did not. Those perceived to be at greater risk were given priority for receiving CC. All outcomes analyses were adjusted for covariates. Main outcome measure The primary outcome was incidence of unplanned admissions within 6 months post index visit. Secondary outcomes included length of stay (LOS), mortality and healthcare utilization cost. Results CC reduced unplanned admissions by 27% (IRR 0.73, 95% CI 0.54–0.99, p = 0.047) and shortened mean LOS by 1.3 days [6.7 (2.6) vs. 8.0 (3.2), p < 0.001] compared to UC. There were no significant differences in mortality (p = 0.189) or mean healthcare utilization cost (p = 0.165) between groups. Pharmacists identified 515 DRPs with 429 (83.3%) resolved after review. Conclusion The CC model with pharmacist-provided medication review reduced unplanned admissions and LOS in patients receiving hemodialysis. Further studies are warranted to confirm reductions in mortality and healthcare utilization.
KeywordsCollaborative care Cost analysis Hemodialysis Hospital admissions Medication review Pharmacist Singapore
The authors would like to thank Ms. Cheryl Lim Yu Ling for her valuable comments, and Mr. Asfak Mundayadankandy Puthiyapurayil for his assistance in acquiring the data necessary for this study.
Conflicts of interest
All authors declare that they have no conflicts of interest.
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