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1.
Pharm World Sci ; 30(6): 924-33, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18802782

ABSTRACT

OBJECTIVES: To assess the feasibility and impact of implementing ProFiL program to optimize community-pharmacist management of drug-related problems among chronic kidney disease patients followed in a predialysis clinic. The program comprises a training workshop, communication-network program and consultation service. SETTING: Forty-two community pharmacies, 101 pharmacists, and 90 chronic kidney disease patients attending a predialysis clinic in Laval (Canada). Patients were followed-up for 6 months. METHOD: In a six-month, pilot, open, cluster-randomized controlled trial, community pharmacies were assigned to ProFiL or the usual care. Chronic kidney disease patients of these pharmacies attending a predialysis clinic were recruited. ProFiL pharmacists attended a workshop, received patient information (diagnoses, medications, and laboratory-test results) and had access to a consultation service. Their knowledge and satisfaction were measured before and after the workshop. The mean numbers of pharmacists' written recommendations to physicians (pharmaceutical opinions) and refusals to dispense a medication were computed. RESULTS: Of the ProFiL pharmacists, 84% attended the workshop; their knowledge increased from 52% to 88% (95% CI: 29-40%). Most ProFiL pharmacists rated workshop (95%), communication program (82%) and consultation service (59%) as "excellent" or "very good"; 82% said the program improved the quality of their follow-up. The consultation service received 21 requests. ProFiL and usual care pharmacists issued a mean of 0.50 and 0.02 opinion/patient, respectively, (95% CI of the adjusted difference: 0.28-1.01 opinion/patient). CONCLUSION: The results of this pilot study suggest that ProFiL can be implemented and may help community pharmacists intervene more frequently to manage drug-related problems. However, a larger-scale study with longer follow-up is necessary to evaluate the impact of the program on management of drug-related problems and its clinical relevance.


Subject(s)
Community Pharmacy Services/organization & administration , Education, Pharmacy, Continuing , Kidney Diseases/drug therapy , Pharmacists/organization & administration , Aged , Aged, 80 and over , Attitude of Health Personnel , Chronic Disease , Communication , Community Pharmacy Services/standards , Drug-Related Side Effects and Adverse Reactions , Female , Follow-Up Studies , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Pharmacists/psychology , Pharmacists/standards , Pilot Projects , Professional Role , Quality Assurance, Health Care/methods , Referral and Consultation
2.
Am J Kidney Dis ; 49(2): 245-56, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17261427

ABSTRACT

BACKGROUND: Use of over-the-counter medications and natural products may be associated with drug-related problems among patients with chronic renal insufficiency. The aim of this study is to describe the use of nonprescription medications in patients attending a predialysis clinic and identify drug-related problems associated with the use of these products. METHODS: In a 6-month cluster randomized controlled trial, patients with moderate (n = 46) and severe (n = 41) chronic renal insufficiency were interviewed over the telephone at baseline by a community pharmacist to document their use of over-the-counter medications and natural products. The safety of each product was assessed, and drug-related problems were identified independently by 2 pharmacists. RESULTS: Overall, 83% (95% confidence interval [CI], 72 to 94) of patients with moderate chronic renal insufficiency and 68% (95% CI, 54 to 83) with severe chronic renal insufficiency reported using at least 1 over-the-counter medication. Contraindicated over-the-counter medications were reported by 9% of patients. Natural products were used by 22% (95% CI, 10 to 34) and 29% (95% CI, 15 to 43) of patients with moderate and severe chronic renal insufficiency, respectively. Similarly, 3% of patients reported using at least 1 contraindicated natural product. Patients had consulted a health professional for 49% of over-the-counter medications and 19% of natural products. Overall, 65 drug-related problems were identified. CONCLUSION: The use of over-the-counter medications and natural products is highly prevalent in patients with chronic renal insufficiency and often is associated with a drug-related problem. These results emphasize the importance for community pharmacists to closely monitor the use of these products in patients with chronic renal insufficiency.


Subject(s)
Biological Products/administration & dosage , Nonprescription Drugs/administration & dosage , Renal Insufficiency, Chronic/epidemiology , Self Medication , Aged , Aged, 80 and over , Biological Products/adverse effects , Community Pharmacy Services , Drug Interactions , Female , Humans , Male , Middle Aged , Nonprescription Drugs/adverse effects , Renal Insufficiency, Chronic/drug therapy , Self Medication/adverse effects , Severity of Illness Index
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