Nephrology Clinic, Grenoble University Hospital, Grenoble, France.
J Nephrol. 2012 Jul-Aug;25(4):558-65. doi: 10.5301/jn.5000033.
Clinical pharmacists (CPs) specifically manage lab-test follow-up, adapt drug dosage according to guidelines and evaluate cardiovascular risk factors and decline in renal function. The aim of this study was to assess the impact of clinical pharmacy services in outpatient nephrology clinics.
For each patient, medical history and current treatment were obtained. Each intervention was classified according to the Act-IP document of the French Society of Clinical Pharmacy. This tool contains identifications and guidelines for prevention and resolution of drug-related problems (DRPs).
From January 2008 until April 2009, 42 patients seen by the CP on at least 2 visits were included in the study. We observed 350 pharmaceutical consultations and 263 interventions. The pharmaceutical interventions concerned: untreated indication (30%), underdosage (25.9%) and overdosage (18.3%). The CP interventions consisted of: adapting doses (42.2%) and adding treatments (31.9%). The main drugs involved concerned the cardiovascular (33.1%), digestive-metabolic (28.6%) and hematopoietic (21.6%) systems.
The inclusion of a CP in the management of chronic kidney disease (CKD) patients is necessary for identification and prevention of DRPs. Besides the medical improvement of CKD patients, the CP participates in the development of prescription recommendations and therapeutic education programs for patients. Moreover, redefining roles and practices of members of a clinical team proved its efficiency in optimizing the medical care of CKD patients. Furthermore, patient entry into dialysis is postponed, which leads to a reduction in costs for health care insurance.
临床药师专门负责管理实验室检测的随访，根据指南调整药物剂量，评估心血管危险因素和肾功能下降情况。本研究旨在评估临床药学服务在门诊肾脏病学中的影响。
为每位患者获取病史和当前治疗情况。根据法国临床药学学会的 Act-IP 文件对每项干预措施进行分类。该工具包含识别和预防及解决药物相关问题（DRPs）的指南。
从 2008 年 1 月至 2009 年 4 月，有 42 名患者至少接受过 2 次 CP 就诊，被纳入研究。我们观察到 350 次药物咨询和 263 次干预措施。药物干预涉及：未治疗的适应证（30%）、剂量不足（25.9%）和剂量过大（18.3%）。CP 干预措施包括：调整剂量（42.2%）和添加治疗（31.9%）。主要涉及的药物系统包括心血管系统（33.1%）、消化代谢系统（28.6%）和血液系统（21.6%）。
在慢性肾脏病（CKD）患者的管理中纳入 CP 对于识别和预防 DRPs 是必要的。除了改善 CKD 患者的医疗状况外，CP 还参与处方建议和患者治疗教育计划的制定。此外，重新定义临床团队成员的角色和实践证明了其在优化 CKD 患者医疗护理方面的有效性。此外，患者进入透析的时间推迟，从而降低了医疗保险的成本。
