Flamme-Obry Fabienne, Belaiche Stéphanie, Hazzan Marc, Ramdan Nassima, Noël Christian, Odou Pascal, Décaudin Bertrand
Pharmacie, CH d'Arras, 62022 Arras, France.
Institut de pharmacie, CHRU de Lille, rue Philippe-Marache, 59000 Lille, France; EA 7365, GRITA, groupe de recherche sur les formes injectables et les technologies associées, University Lille, 59000 Lille, France.
Nephrol Ther. 2018 Apr;14(2):91-98. doi: 10.1016/j.nephro.2017.04.004. Epub 2018 Feb 22.
Drug related problems (DRP) can lead to severe consequences in kidney recipients. The aim of the study was to assess the impact of the clinical pharmacist interventions on the incidence of DRP.
The number of DRP were evaluated according to 3periods: Without intervention, with medication reconciliation at admission, and with medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge.
Patients concerned were mainly men, 55years old (median age), stage3 of CKD, transplanted for less than 3months or more than 1year, with cardiovascular risk factors and receiving an average of 9drugs/day. Among the DRP, 20% were avoidable and severe in most cases. In period1, 27.7% patients had at least 1DRP, in period2, 21.3% patients had at least 1DRP, and in period3, 17.4% of patients had at least 1DRP (P=0.03). One hundred and ten patients had medication reconciliation at admission with a mean of 0.6unintentional discrepancies per patient (omission in 81% of cases). The main drugs involved concerned the digestive-metabolic (24.5%), cardiovascular (23%), and nervous (23%) system. Sixty-eight interviews at discharge were realized and revealed self-medication habits.
Our study shows that medication reconciliation at admission associated with an interview with the clinical pharmacist at discharge can help to reduce DRP in kidney recipients. Further studies are needed to confirm our results.
药物相关问题（DRP）可在肾移植受者中导致严重后果。本研究的目的是评估临床药师干预对DRP发生率的影响。
根据三个阶段评估DRP的数量：无干预阶段、入院时进行用药核对阶段、入院时进行用药核对并在出院时与临床药师面谈阶段。
相关患者主要为男性，年龄中位数为55岁，处于慢性肾脏病3期，移植时间少于3个月或超过1年，有心血管危险因素，平均每天服用9种药物。在DRP中，20%是可避免的，且在大多数情况下较为严重。在第一阶段，27.7%的患者至少有1个DRP；在第二阶段，21.3%的患者至少有1个DRP；在第三阶段，17.4%的患者至少有1个DRP（P=0.03）。110名患者在入院时进行了用药核对，平均每名患者有0.6个无意差异（81%的情况为遗漏）。主要涉及的药物与消化代谢系统（24.5%）、心血管系统（23%）和神经系统（23%）有关。出院时进行了68次面谈，发现了自我用药习惯。
我们的研究表明，入院时进行用药核对并在出院时与临床药师面谈有助于减少肾移植受者的DRP。需要进一步研究来证实我们的结果。
