(117) Effectiveness of pharmacist intervention in patients with pre-end-stage renal disease (pre-ESRD): A prospective study

Background: In 2006, Taiwan initiated a multidisciplinary care program for pre-end-stage renal disease patients, with team members including nephrologists, nurses, and dietitians, but challenges like high usage of potentially nephrotoxic non-steroidal anti-inflammatory drug (NSAID) and uncertain medication adherence persisted. Pharmacists joined the program in October 2021, yet their long-term impact remains uncertain.

Objectives: To evaluate the impact of pharmacist interventions on medication adherence and NSAID usage among pre-ESRD patients in Taiwan.

Methods: This multicenter, prospective pre-post intervention study included patients with stage 3b-5 chronic kidney disease (CKD) from seven medical centers across northern and southern Taiwan to enhance generalizability. At pharmacist-managed clinics, patients' adherence and NSAID usage were assessed during initial and follow-up visits. The Adherence to Refills and Medications Scale (ARMS) was used to measure adherence, with a score of 12 signified full adherence, whereas scores above 12 indicated increasing non-adherence (maximum=48). Patients with an ARMS score >12 were defined as poorly adherent. Pharmacists tracked NSAID usage through Electronic Medical Records (EMR) and the National Health Insurance (NHI) MediCloud System. The proportion of poor adherence (ARMS score >12), the decrease of ARMS scores among initially non-adherent patients and the changes in NSAID usage rates were evaluated at the 6th and 12th month post-intervention. Categorical and continuous variables were analyzed using McNemar's test and generalized estimating equations(GEE), respectively, with a significance threshold set at p< 0.05.

Results: A cohort of 374 patients was enrolled in this study, consisting of 58.15% male, 38.41% CKD stage 3b, 42.06% CKD stage 4, and 19.53% CKD stage 5. The proportion of poor adherence significantly decreased from 37.97% to 28.07% at the 6th month (p=0.0001) among these 374 patients and from 36.61% to 20.08% at the 12th month (p <0.0001) among 254 patients with available data. Additionally, the average decreased ARMS scores among initially non-adherent patients was 2.06 points (p < 0.0001) at 6th month and 3.45 points (p < 0.0001) at the 12th month. NSAID usage declined from 22.73% to 13.37% at the 6th month (p=0.0002) among 374 patients and from 18.11% to 6.3% at the 12th month among 254 patients with available data (p < 0.0001).

Conclusions: Pharmacist interventions positively and durably impacted medication adherence in pre-ESRD patients, affirming the essential role of pharmaceutical care in multidisciplinary approaches.