Medication Management Led to Improvements in Older Adults With CKD, Study Shows

A pharmacist-led collaborative medication management service reduced problems associated with polypharmacy in older adults with chronic kidney disease (CKD).

Older adults with chronic kidney disease (CKD) who present with several comorbidities are more likely to endure polypharmacy, but a pharmacist-led geriatric medication management service (MMS) can improve the quality of medicine use among affected patients, a study showed.

Results from the study, conducted in the Republic of Korea, were published in the International Journal of Environmental Research and Public Health.

The single-center, retrospective, descriptive study recruited 95 patients who had received MMS, which aims to improve the appropriateness of medication use, reduce medication-related harm, and improve clinical outcomes. The study population had received MMS in an ambulatory care nephrology clinic at a teaching hospital between May 2019-December 2019.

On average, patients were aged 74.9 [7.3] years. About 38 patients (40%) had advanced CKD (stage 4 or 5); the most common comorbidities were hypertension, diabetes, and cardiovascular disease.

Patients undergoing MMS received weekly counseling from designated pharmacists. During these sessions, pharmacists recommended general precautions for patients to follow during medication use and encouraged patients to consult their prescribing physicians about deprescribing inappropriate or unnecessary medications.

In addition, pharmacists also interacted with physicians and patients to intervene and resolve drug-related problems (DRPs) throughout the course of the sessions.

Researchers measured several factors to evaluate the overall impact of MMS on the quality of medicine usage, including the number of medications, the number of potentially inappropriate medications (PIMs), and the proportion of patients on PIMs. Researchers also measured the number of central nervous system (CNS)-active drugs, strong anticholinergic agents, and anticholinergic burden among patients. The frequencies and types of DRPs observed were used to evaluate pharmacist interventions.

After evaluating the impact of MMS on the quality of medication use in 87 patients, findings showed:

  • The total number of medications and PIMs decreased from 13.5 [4.3] to 10.9 [3.8] and 1.6 [1.4] to 1.0 [1.2] (both P < .001), respectively.
  • The number of patients who received 3 or more central nervous system-active drugs and strong anticholinergic drugs decreased.
  • Among 354 drug-related problems, the most common ones were missing patient documentation, adverse effects, or the drug wasn’t indicated.
  • The overall acceptance rate for recommended interventions was 81.7%; interventions included stopping therapy, starting therapy, adjusting the dosage, or substituting a therapy.
  • Stopping therapy was the most frequent (40.7%) method of intervention.

The reduction of excessive polypharmacy, PIM use, CNS-active drug use, and anticholinergic burden supported the finding that a pharmacist-led collaborative geriatric MMS for older adults with polypharmacy contributed significantly to the improvement of the quality of medication use, concluded the authors.

Reference

Kim, A J., Lee, H., Shin, E., et al. Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy. Int. J. Environ. Res. Public Health. 2021;18(8):4370; doi: 10.3390/ijerph18084370