Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands.
J Clin Pharm Ther. 2013 Oct;38(5):416-22. doi: 10.1111/jcpt.12081. Epub 2013 Jun 28.
It is often necessary to adjust drug therapy if renal function is impaired in elderly patients taking drugs for diabetes and/or cardiovascular disease that are cleared by the kidneys. Although clinical guidelines recommend regular monitoring of renal function in these patients, in practice adherence to these recommendations varies from 28% to 75%. To determine whether drug dosing is appropriate, pharmacists need have up-to-date information about patients' renal function. In this study, the feasibility of point-of-care creatinine testing (POCCT) in a community pharmacy was evaluated as part of monitoring the drug therapy of ambulatory elderly patients.
Elderly patients on maintenance therapy with renally excreted drugs for diabetes or cardiovascular disease were eligible for POCCT. After informed consent was obtained, POCCT was performed by trained personnel. A pharmacist assessed the clinical relevance of electronically generated drug alerts based on the patient's calculated renal function and the Dutch guidelines for adjusting drug dosage in patients with chronic kidney disease. If appropriate, the patient's general practitioner (GP) was consulted and adjustments to treatment were communicated to the patient. The feasibility of POCCT was evaluated by means of questionnaires completed by patients and healthcare professionals (GPs and pharmacists).
Of 338 potentially eligible patients, 149 (44%) whose renal function was not known were asked, by letter, to participate in the study. Of these individuals, 46 (31%) gave their informed consent and underwent POCCT. Response rates for completing the patient and professional questionnaires were 87% and 100%, respectively. More than half of the patients who underwent POCCT had mild-to-moderate renal impairment. On the basis of information provided by patients and healthcare professionals, POCCT would appear to be feasible in community pharmacies.
POCCT improves the management of drug therapy by community pharmacists and is feasible in daily practice.
在服用通过肾脏清除的糖尿病和/或心血管疾病药物的老年患者中，如果肾功能受损，通常需要调整药物治疗。尽管临床指南建议这些患者定期监测肾功能，但实际上，这些建议的依从率从 28%到 75%不等。为了确定药物剂量是否合适，药剂师需要掌握患者肾功能的最新信息。在这项研究中，评估了社区药房中即时检测肌酐（POCCT）在监测门诊老年患者药物治疗中的可行性。
正在接受肾排泄药物治疗糖尿病或心血管疾病的维持治疗的老年患者有资格进行 POCCT。在获得知情同意后，由经过培训的人员进行 POCCT。药剂师根据患者计算出的肾功能和荷兰调整慢性肾脏病患者药物剂量的指南，评估电子生成的药物警报的临床相关性。如果合适，咨询患者的全科医生（GP）并将治疗调整告知患者。通过患者和医疗保健专业人员（GP 和药剂师）填写的问卷评估 POCCT 的可行性。
在 338 名潜在合格的患者中，通过信函邀请了 149 名（44%）肾功能未知的患者参加研究。在这些人中，有 46 人（31%）表示同意并接受了 POCCT。患者和专业人员完成问卷的回复率分别为 87%和 100%。接受 POCCT 的患者中，超过一半的人有轻度至中度肾功能损害。根据患者和医疗保健专业人员提供的信息，POCCT 似乎在社区药房可行。
POCCT 通过社区药剂师改善了药物治疗管理，在日常实践中是可行的。
