Assessment of a pharmaceutical interventional programme in patients on medications with renal risk

Álvarez Arroyo, L.; Climent Grana, E.; Bosacoma Ros, N.; Roca Meroño, S.; Perdiguero Gil, M.; Ordovás Baines, J.P.; Sánchez Payá, J.

doi:10.1016/S2173-5085(09)70080-2

Farmacia Hospitalaria

ISSN: 1130-6343

Farmacia Hospitalaria (Farm Hosp) is the official publication of the Spanish Society of Hospital Pharmacists (SEFH), a professional and scientific organization that currently has about 4.351 members.

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To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk.

Method

Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmaco-therapeutic profile. The study was designed to be carried out in 2 descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease.

Results

The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7% and 2.1%, representing a statistically significant reduction in nonadaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1939.63 euro over 2 months, the average saving per medication intervened amounting to 62.57 euro (95% CI, 23.99–101.14 euro; P=.02).

Conclusions

The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease.

Keywords:

Renal disease

Pharmaceutical care

Medications with renal risk

Dosage adjustment

Compliance

Resumen

Objetivo

Comparar la adecuación de las prescripciones médicas según las guías de dosificación, en pacientes con enfermedad renal, antes y después de aplicar un programa de intervención farmacéutica. Los objetivos secundarios fueron la elaboración de una guía de dosificación en enfermedad renal y medir la prevalencia de prescripción de fármacos con riesgo renal.

Método

Estudio experimental de intervención no aleatorizado (antes/después) realizado en un hospital general de 800 camas, que incluyó a pacientes ingresados, mayores de 18 años, con enfermedad renal y medicamentos con riesgo renal prescritos en su perfil farmacoterapéutico. El estudio se diseñó para realizarlo en dos fases: un corte transversal descriptivo (grupo control) y un estudio de intervención de cohortes prospectivo (grupo de intervención). La variable principal fue el porcentaje de inadecuación posológica según el grado de enfermedad renal.

Resultados

El estudio incluyó a 185 pacientes, 88 en el grupo control y 97 en el de intervención. En el grupo de intervención la prevalencia de incumplimiento antes y después de la intervención fue del 18,7 y el 2,1%, lo que supone una reducción estadísticamente significativa en la inadecuación posológica. El coste evitado con el programa de intervención farmacéutica fue de 1.939,63 euros en 2 meses; la media por cada medicamento en el que se intervino fue de 62,57 euros (intervalo de confianza del 95 %, 23,99–101,14 euros; p=0,02).

Conclusiones

Los resultados del estudio indican que la aplicación de un modelo de atención farmacéutica, basado en la validación prospectiva de los medicamentos con riesgo renal, mejora de forma muy significativa la adecuación de las pautas posológicas en enfermos renales.

Palabras clave:

Enfermedad renal

Atención farmacéutica

Medicamentos con riesgo renal

Ajuste posológico

Cumplimiento

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☆

The preliminary data from this study was presented to the 52nd Congress of the Spanish Society of Hospital Pharmacy held in Tenerife in September of 2007 as a poster: “Cumplimiento de las pautas posológicas en pacientes con enfermedad renal: estudio de prevalencia” (Compliance of dosage guidelines in patients with kidney disease: prevalence study).

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