Investigation of drug use and evaluation of clinical pharmacy services in patients with renal impairment

This study aims to assess drug use, identify, and resolve drug-related problems (DRPs) and evaluate clinical pharmacy services in patients with renal impairment who are admitted to the internal medicine ward. Additionally, the study aims assess the involvement and education provided by the clinical pharmacist in the use of drugs that require renal dose adjustment. The study is a prospective, quasi-experimental study conducted in the General Internal Medicine ward of a university hospital between November 2021 and November 2022. The study was conducted with patient groups taken in three consecutive periods, and the patients were evaluated regarding the DRPs, and the use of drugs that require renal dose adjustment. In the first group, the clinical pharmacist did not make any interventions. However, in the second group, patients were included in the study after an educational presentation about renal dose adjustments in the frequently used drug groups to the physicians responsible for the care of the patients. In the third group, the clinical pharmacist played an active role in the ward by identifying and resolving DRPs through direct interventions. DRPs were classified according to PCNE (Pharmaceutical Care Network Europe) V9.1. In this study, 160 patients with an average age of 73,1±10,3; 75,6±8,49 and 74,5±10,1 in control, education, and intervention groups respectively. The most common comorbidities observed in patients were hypertension, diabetes, coronary artery disease, atrial fibrillation, and heart failure, respectively. A total of 238, 195, and 169 DRPs were detected in three groups, respectively. During the study, the clinical pharmacist made 156 recommendations for 80 DRPs in the intervention group. Of these recommendations, 154 (98.71%) were accepted by the physicians. Numeric differences were observed between the groups in terms of the total number of DRPs and DRPs related to renal dysfunction; however, no significant difference was found statistically (p>0.05). However, there was a statistically significant difference in the number of patients with DRPs associated with renal dysfunction between the control and intervention groups (p<0.05). The high acceptance rate of DRPs and interventions detected in our study shows that the clinical pharmacist contributes to the improvement of patients' drug use and patient outcomes. Numerical reductions in total DRPs and DRPs associated with renal dysfunction were observed between groups. There was a significant difference between the control and intervention groups in the number of patients associated with renal dysfunction. According to these results, it is thought that the clinical pharmacist's involvement in the healthcare team, especially in the treatment of patients with kidney dysfunction, will contribute to improving patient outcomes.