Comprehensive medication management of kidney transplanted patients
DOI:
https://doi.org/10.33448/rsd-v11i2.26224Keywords:
Kidney transplantation; Pharmaceutical services; Medication therapy management; Patient satisfaction; Drug related problems.Abstract
Kidney transplant patients use several medications, which increases the risk of developing drug-related problems. This is a pre-post-intervention study, carried out in a transplant outpatient clinic in Belo Horizonte, Minas Gerais, Brazil, with post-transplant patients using tacrolimus. Pharmacy consultations were carried out in individual offices, and the initial and final status were measured between the first and the last consultation. Satisfaction with the pharmaceutical service was also assessed. Thirty-nine drug-related problems were identified, 64.3% of patients presenting at least one, of which 79.5% were resolved (p<0.001). The most frequent were “use of unnecessary medications” (26.5%), with omeprazole being the most prescribed medication for this situation. Polymedicated patients had more drug-related problems (p = 0.001). 49 interventions were performed, 51.02% were accepted. The most accepted interventions were recommendations for guidelines regarding the time of administration and reduction of adverse drug reactions (100%) and suspension of treatment (92.3%). In the end, the proportion of patients with stable clinical status increased from 35 .7% to 83.3% (p<0.001). Patients related the pharmaceutical service as very good, reporting the desire for its continuity. Comprehensive medication management positively impacted the patient's clinical situation, proved to be effective in solving drug-related problems, and was very well evaluated by the patients. It is recommended that polymedication is a priority criterion for this service.
References
Acosta, A. M., Marques, G. Q., Levandovski, P. F., Peralta, J. P., & Lima, M. A. D. D. S. (2016). Satisfação de usuários com cuidados de enfermagem em serviço de emergência: uma revisão integrativa. Reme: revista mineira de enfermagem. Vol. 20 (2016), e938.
American College of Clinical Pharmacy. Comprehensive medication management in team-based care. Available: https://www.accp.com/docs/positions/misc/CMM%20Brief.pdf. Acess in: 20 de maio de 2020.
Arruda, C. A. M., & Bosi, M. L. M. (2016). Satisfação de usuários da atenção primária à saúde: um estudo qualitativo no Nordeste do Brasil. Interface-Comunicação, Saúde, Educação, 21, 321-332.
Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: a systematic review. Perspectives in public health, 137(2), 89-101.
Berns, J. (2020). Patient education: dialysis or kidney transplantation—which is right for me?(Beyond the basics).
Bjerrum, L., Søgaard, J., Hallas, J., & Kragstrup, J. (1999). Polypharmacy in general practice: differences between practitioners. British Journal of General Practice, 49(440), 195-198.
Bonadiman, R. L., Santanna, A. F., Brasil, G. A., Lima, E. M. D., Lenz, D., Endringer, D. C., & Andrade, T. U. (2018). Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil. Ciência & Saúde Coletiva, 23, 627-638.
Brasil. Ministério da Saúde. Portaria SAES/SCTIE MS nº 1, de 05 de janeiro de 2021. Avaiable: https://www.gov.br/saude/pt-br/assuntos/protocolos-clinicos-e-diretrizes-terapeuticas-pcdt/arquivos/2021/imunossupressao-em-transplante-renal-pcdt.pdf>. Acess em: 20 de dezembro de 2021.
Brito, D. C. S. D., Marsicano, E. O., Grincenkov, F. R. D. S., Colugnati, F. A. B., Lucchetti, G., & Sanders-Pinheiro, H. (2015). Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study. Sao Paulo Medical Journal, 134, 292-299.
Chisholm-Burns, M. A., Spivey, C. A., Tolley, E. A., & Kaplan, E. K. (2016). Medication therapy management and adherence among US renal transplant recipients. Patient preference and adherence, 10, 703.
Cipolle, R. J., Strand, L. M., & Morley, P. C. (2012). Pharmaceutical care practice: the patient-centered approach to medication management. McGraw Hill Professional.
Correr, C. J., Pontarolo, R., Melchiors, A. C., Souza, R. A. D. P., Rossignoli, P., & Fernández-Llimós, F. (2009). Satisfação dos usuários com serviços da farmácia: tradução e validação do Pharmacy Services Questionnaire para o Brasil. Cadernos de Saúde Pública, 25, 87-96.
de Oliveira, I. D. G., dos Reis, P. M., Reis, E. A., Gomes, K. B., Mota, A. P. L., & Chemello, C. (2021). Integração da farmacogenética do tacrolimo ao gerenciamento da terapia medicamentosa em pacientes com transplante de rim. Research, Society and Development, 10(10), e52101018589-e52101018589.
Detoni, K. B., Oliveira, I. V., Nascimento, M. M., Caux, T. R., Alves, M. R., & Ramalho-de-Oliveira, D. (2017). Impact of a medication therapy management service on the clinical status of patients with chronic obstructive pulmonary disease. International journal of clinical pharmacy, 39(1), 95-103.
El Raichani, L., Du, Q., Mathieu, A., Almassy, S., Lalonde, L., Berbiche, D., & Cardinal, H. (2019). Development and validation of PART (Pharmacotherapy Assessment in Renal Transplant Patients) criteria to assess drug‐related problems in an outpatient renal transplant population: A cross‐sectional study. Pharmacology research & perspectives, 7(1), e00453.
Elaine, W. Y., Bauer, S. R., Bain, P. A., & Bauer, D. C. (2011). Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. The American journal of medicine, 124(6), 519-526.
Falcão Lima, L., Cardoso Martins, B. C., de Oliveira, F. R. P., de Andrade Cavalcante, R. M., Pinto Magalhães, V., Milen Firmino, P. Y., ... & Rabelo Néri, E. D. (2016). Orientação farmacêutica na alta hospitalar de pacientes transplantados: estratégia para a segurança do paciente. Einstein (16794508), 14(3).
Farrell, B., & Mangin, D. (2019). Deprescribing is an essential part of good prescribing. American family physician, 99(1), 7-9.
Farrell, B., Pottie, K., Thompson, W., Boghossian, T., Pizzola, L., Rashid, F. J., ... & Moayyedi, P. (2017). Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Canadian Family Physician, 63(5), 354-364.
Foppa, A. A. (2014). Qualificação do serviço farmacêutico clínico a partir dos dados de seguimento farmacoterapêutico a indivíduos com Doença de Parkinson.
Gnatta, D., Keitel, E., & Heineck, I. (2019). Interventions performed by clinical pharmacist in the renal transplant ambulatory care. Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 10(3), 355-355.
Gokoel, S. R., Gombert-Handoko, K. B., Zwart, T. C., van der Boog, P. J., Moes, D. J. A., & de Fijter, J. W. (2020). Medication non-adherence after kidney transplantation: a critical appraisal and systematic review. Transplantation Reviews, 34(1), 100511.
Ho, S. W., Teng, Y. H., Yang, S. F., Yeh, H. W., Wang, Y. H., Chou, M. C., & Yeh, C. B. (2017). Association of proton pump inhibitors usage with risk of pneumonia in dementia patients. Journal of the American Geriatrics Society, 65(7), 1441-1447.
Isetts, B. J., Schondelmeyer, S. W., Artz, M. B., Lenarz, L. A., Heaton, A. H., Wadd, W. B., ... & Cipolle, R. J. (2008). Clinical and economic outcomes of medication therapy management services: the Minnesota experience. Journal of the American Pharmacists Association, 48(2), 203-214.
Joost, R., Dörje, F., Schwitulla, J., Eckardt, K. U., & Hugo, C. (2014). Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study. Nephrology Dialysis Transplantation, 29(8), 1597-1607.
Jorge, M. S. B. (2007). Avaliação da qualidade do Programa Saúde da Família no Ceará: a satisfação dos usuários. Revista baiana de saúde pública, 31(2), 256-256.
Larson, L. N., Rovers, J. P., & MacKeigan, L. D. (2002). Patient satisfaction with pharmaceutical care: update of a validated instrument. Journal of the American Pharmaceutical Association (1996), 42(1), 44-50.
Lee, P. H., Fan, P. Y. W., & Kee, T. Y. S. (2016). Medication therapy management by pharmacists in a kidney transplant ambulatory clinic. Proceedings of Singapore Healthcare, 25(2), 117-121.
Leite, R. F., Silva, A. C. M., Oliveira, P. C. D., Silva, L. M. G. D., Pestana, J. M. D. A., Schirmer, J., & Roza, B. D. A. (2018). Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal. Acta Paulista de Enfermagem, 31, 489-496.
Loghman-Adham, M. (2003). Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. American Journal of Managed Care, 9(2), 155-173.
Manyama, T. L., Tshitake, R. M., & Moloto, N. B. (2020). The role of pharmacists in the renal multidisciplinary team at a tertiary hospital in South Africa: Strategies to increase participation of pharmacists. Health SA Gesondheid (Online), 25, 1-7.
Mendonça, S. D. A. M., Melo, A. C., Pereira, G. C. C., Santos, D. M. D. S. S. D., Grossi, E. B., Sousa, M. D. C. V. B., ... & Soares, A. C. (2016). Clinical outcomes of medication therapy management services in primary health care. Brazilian Journal of Pharmaceutical Sciences, 52, 365-373.
Modes, P. S. S. D. A., & Gaíva, M. A. M. (2013). Satisfação das usuárias quanto à atenção prestada à criança pela rede básica de saúdeª. Escola Anna Nery, 17, 455-465.
Molnar-Varga, M., Molnar, M. Z., Szeifert, L., Kovacs, A. Z., Kelemen, A., Becze, A., ... & Novak, M. (2011). Health-related quality of life and clinical outcomes in kidney transplant recipients. American Journal of Kidney Diseases, 58(3), 444-452.
Mourao, A. O. M., Ferreira, W. R., Martins, M. A. P., Reis, A. M. M., Carrillo, M. R. G., Guimaraes, A. G., & Ev, L. S. (2013). Pharmaceutical care program for type 2 diabetes patients in Brazil: a randomised controlled trial. International journal of clinical pharmacy, 35(1), 79-86.
Nascimento, Y. D. A., Carvalho, W. D. S., & Acurcio, F. D. A. (2009). Drug-related problems observed in a pharmaceutical care service, Belo Horizonte, Brazil. Brazilian Journal of Pharmaceutical Sciences, 45, 321-330.
Planas, L. G., Crosby, K. M., Mitchell, K. D., & Farmer, K. C. (2009). Evaluation of a hypertension medication therapy management program in patients with diabetes. Journal of the American Pharmacists Association, 49(2), 164-170.
Prates, D. S., Camponogara, S., Arboit, E. L., Tolfo, F., & Beuter, M. (2016). Kidney transplant: perceptions from patients and healthcare professionals about kidney transplants. Rev Enferm UFPE, 10(4), 1264-72.
Prudencio, J., Cutler, T., Roberts, S., Marin, S., & Wilson, M. (2018). The effect of clinical pharmacist-led comprehensive medication management on chronic disease state goal attainment in a patient-centered medical home. Journal of managed care & specialty pharmacy, 24(5), 423-429.
Ramalho de Oliveira, D. (2011). Atenção Farmacêutica: da filosofia ao gerenciamento da terapia medicamentosa. RCN Editora: São Paulo, Brazil.
Rodis, J. L., Sevin, A., Awad, M. H., Porter, B., Glasgow, K., Hornbeck Fox, C., & Pryor, B. (2017). Improving chronic disease outcomes through medication therapy management in federally qualified health centers. Journal of primary care & community health, 8(4), 324-331.
Santana A. Avaliação do sistema único de saúde (SUS): um estudo fundamentado na percepção de diferentes atores em um município do sul de Minas Gerais. [Dissertação de Mestrado]. Lavras. Universidade Federal de Lavras (UFLA), 2013.
Soeiro, O. M., Tavares, N. U. L., Nascimento Júnior, J. M., Guerra Junior, A. A., Costa, E. A., & Acurcio, F. A. (2017). Satisfação dos usuários com os serviços da assistência farmacêutica na atenção básica nos municípios brasileiros. Rev Saude Publica, 51(sSupl 2).
Stemer, G., & Lemmens-Gruber, R. (2010). Clinical pharmacy services and solid organ transplantation: a literature review. Pharmacy world & science, 32(1), 7-18.
Strand, L. M., Cipolle, R. J., Morley, P. C., & Frakes, M. J. (2004). The impact of pharmaceutical care practice on the practitioner and the patient in the ambulatory practice setting: twenty-five years of experience. Current pharmaceutical design, 10(31), 3987-4001.
Vankova, B., Mala-Ladova, K., Kubena, A. A., Maly, J., & Sulkova, S. D. (2018). Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients. Patient preference and adherence, 12, 2605.
Welch, E. K., Delate, T., Chester, E. A., & Stubbings, T. (2009). Assessment of the impact of medication therapy management delivered to home-based Medicare beneficiaries. Annals of Pharmacotherapy, 43(4), 603-610.
Wittayanukorn, S., Westrick, S. C., Hansen, R. A., Billor, N., Braxton-Lloyd, K., Fox, B. I., & Garza, K. B. (2013). Evaluation of medication therapy management services for patients with cardiovascular disease in a self-insured employer health plan. Journal of Managed Care Pharmacy, 19(5), 385-395.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Patrícia Mara dos Reis; Isabela Diniz de Oliveira; Pollyanne Lacerda Coelho ; Sílvia Novaes Dias ; Luana Kellen de Oliveira Silva ; Clarice Chemello
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
