Evaluation of Clinical Pharmacy Services and Drug Use in Renal Impairment.

Summary

Clinical pharmacy services aim to optimise medication use, enhance patient outcomes, and reduce the risk of drug-related harm through patient-centred pharmaceutical care. In hospital settings, clinical pharmacists collaborate with physicians and other healthcare professionals as part of a multidisciplinary team to identify, prevent, and resolve drug-related problems (DRPs). Pharmacist interventions are defined as any action initiated by a pharmacist that directly contributes to patient management or results in a modification of medication therapy. The clinical and economic benefits of such interventions have been widely recognised in various healthcare environments.

This quasi-experimental study aims to investigate the impact of clinical pharmacy services on drug use and the management of DRPs in patients with renal impairment admitted to the general internal medicine ward. The study also evaluates the contribution of the clinical pharmacist to optimising the use of drugs that require renal dose adjustment.

The study was conducted in a university hospital and included three consecutive patient groups: observation (control), education, and intervention. In the observation group, no pharmacist intervention was performed. In the education group, physicians received a structured educational presentation on renal dose adjustment for commonly prescribed medications. In the intervention group, the clinical pharmacist actively participated in daily ward rounds, identified and resolved DRPs, and provided recommendations to physicians. DRPs were classified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1.

This study evaluates whether the integration of a clinical pharmacist into the healthcare team can improve the quality of pharmacotherapy, reduce DRPs-particularly those associated with renal dysfunction-and enhance patient safety and outcomes in hospitalised patients.

Conditions

• Renal Impairments
• Chronic Kidney Disease
• Acute Kidney Disease
• Medication Errors

Interventions

DRUG

Clinical Pharmacist-Led Pharmaceutical Care Service and Renal Dose Adjustment

Clinical pharmacist-led interventions were implemented to optimise medication therapy and ensure patient safety among hospitalised patients with renal impairment. The interventions included several integrated pharmaceutical care activities conducted during daily ward rounds. The clinical pharmacist assessed renal function and adjusted medication doses according to up-to-date dosing guidelines and renal pharmacotherapy principles. In cases where inappropriate doses or dosing intervals were identified, corrective recommendations were communicated to the treating physicians to prevent under- or overdosing. The pharmacist also evaluated each patient's medication profile for potential drug-drug interactions and provided strategies to avoid clinically significant interactions. Drug selection was reviewed for indication, therapeutic appropriateness, and safety, with substitution or discontinuation proposed when necessary. In addition to these direct patient care activities, the clinical pharm

BEHAVIORAL

Education for renal adjusments

The educational intervention consisted of regular training sessions delivered by the clinical pharmacist to physicians on renal dose adjustment principles, identification of nephrotoxic drugs, and prevention of drug-related problems in patients with renal impairment. The sessions aimed to improve physicians' knowledge and prescribing practices for medications requiring renal dose modification.

Sponsors & Collaborators

• Bezmialem Vakif University

  collaborator OTHER

• Istanbul University - Cerrahpasa

  lead OTHER

Principal Investigators

• Muhammed Yunus BEKTAY, PHD · Bezmialem Vakif University

Study Design

Allocation

NON_RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-10-31

Primary Completion

2023-10-31

Completion

2024-05-31

Countries

• Turkey (Türkiye)

Study Locations