D WATSON1,2, S KUO2, A GRAVER2, G KIRKLAND2, MD JOSE2,3
1Pharmacy, Royal Hobart Hospital, Tasmania; 2Renal Unit, Royal Hobart Hospital, Tasmania; 3School of Medicine, University of Tasmania
Aim: To investigate renal patients’ current medication management and their reflections on how this might be improved.
Background: Chronic kidney disease (CKD) patients have complex medication regimens with a high likelihood of medication misadventure. Our hospital has introduced a full-time renal pharmacist, with the aim of improving medication management with a patient-centred focus.
Methods: This review invited all patients under the care of a single renal unit to participate. A 10-question survey was administered to all who consented. Questions covered both quantitative and qualitative aspects of medication management.
Results: Of the 190 invited, 95 consented (50% response rate) to participate, including CKD4/5 (20%), home dialysis (22%), satellite dialysis (33%) and kidney transplants (25%). Education level for the majority (56%) was Grade 10 or less. Most people (92%) took ³4 medications, with 38% taking ³10 medications daily. Self-management was the most commonly employed strategy (82%) with 92% happy with their medication management. However, more information was desired around indications for medications (30%) and side-effects (35%), preferably in written form (25%). Many (26%) felt they took too many medications.
There was consistent agreement in the usefulness of health professionals as sources of medication information, including the nephrologist (97% agree), general practitioner (92%), community pharmacist (87%) and hospital pharmacist (85%). Suggestions to help self-management included consistent prescribing by generic or brand name, universally available dosette boxes, prescribing at the dialysis unit and greater access to the hospital pharmacy.
Conclusions: People with CKD are self-managing multiple medications with confidence, but desire improved access to information, prescriptions and dispensing. This should be further reviewed and compared to an assessment of patients’ medication competence from the treating team’s perspective.