Yao Wenjie, Ye Xiaolan, Zhang Guobing, Ren Yan, Gao Qilong, Ren Xinfeng, Liu Yao, Huang Ping, Zheng Jianlan
Department of Pharmacy, Center for Clinical Pharmacy, Cancer Center, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
Department of Clinical Pharmacy, Huzhou Nanxun People's Hospital, Huzhou, Zhejiang, China.
Front Pharmacol. 2024 Oct 1;15:1183118. doi: 10.3389/fphar.2024.1183118. eCollection 2024.
Chronic kidney disease (CKD) stages 3-4 present a significant clinical challenge due to the absence of a systematic approach to managing associated medication-related problems (MRPs). This lack of a structured framework hinders the timely identification and effective intervention for these complications, potentially compromising patient safety and prognosis.
This study aims to leverage the Delphi method to establish an evaluation index for a rational drug use evaluation system dedicated to CKD patients in stages 3-4. This system will function as a platform for the continuous identification and management of MRPs, ultimately contributing to improved medication safety and patient outcomes.
This research uses the modified Delphi technique to develop an evaluation system for rational drug use in patients with chronic kidney disease. The initial questionnaire was developed by literature review for patients with chronic kidney disease. Twenty-six senior experts formed a panel in order to evaluate items across two Delphi rounds. Consensus was defined as at least 95% agreement (first round) and 85% agreement (second round), agreeing with an average score of at least 4.5 (first round) and 4.0 (second round). Items that fulfill the stipulated criteria are eligible for inclusion in the consensus list.
All experts participated in both rounds (100% response rate). Consensus was achieved on three patient-related items in the first round of 34 items. Based on expert feedback, 18 revised items were included in the second round after refining, restructuring, and removing some elements. Following two rounds of consultation, 20 items achieved consensus, encompassing aspects such as drug selection, dosage assessment, treatment duration, prescription and dispensing practices, patient-related factors, and other relevant considerations.
This study has successfully identified 20 key evaluation indicators for a rational drug use evaluation system specifically designed for CKD patients in stages 3 and 4. This system will serve as a tool for continuous MRP identification and timely intervention, ultimately enhancing medication safety and patient prognosis.
由于缺乏管理相关药物相关问题（MRP）的系统方法，慢性肾脏病（CKD）3-4期带来了重大的临床挑战。这种缺乏结构化框架的情况阻碍了对这些并发症的及时识别和有效干预，可能会危及患者安全和预后。
本研究旨在利用德尔菲法建立一个针对3-4期CKD患者的合理用药评价系统的评价指标。该系统将作为一个持续识别和管理MRP的平台，最终有助于提高用药安全性和患者预后。
本研究采用改良德尔菲技术开发慢性肾脏病患者合理用药评价系统。初始问卷通过对慢性肾脏病患者的文献回顾制定。26名资深专家组成一个小组，对两轮德尔菲法中的项目进行评估。共识定义为至少95%的同意率（第一轮）和85%的同意率（第二轮），平均得分至少为4.5（第一轮）和4.0（第二轮）。符合规定标准的项目有资格纳入共识清单。
所有专家都参与了两轮（回复率100%）。在第一轮的34个项目中，有3个与患者相关的项目达成了共识。根据专家反馈，经过细化、重组和删除一些元素后，18个修订项目被纳入第二轮。经过两轮咨询，20个项目达成共识，涵盖药物选择、剂量评估、治疗持续时间、处方和配药实践、患者相关因素以及其他相关考虑等方面。
本研究成功确定了20个关键评价指标，用于专门为3-4期CKD患者设计的合理用药评价系统。该系统将作为持续识别MRP和及时干预的工具，最终提高用药安全性和患者预后。
