Development of Pharmaceutical Care with Multidisciplinary Health Care Team for End-stage Renal Disease Patients Undergoing Hemodialysis at Hospital and Home

Abstract

Objective: To develop a pharmaceutical care model with multidisciplinary teams for patients with end-stage renal disease undergoing hemodialysis in order to link hospital cares and home cares. Method: The study is a mixed method study. Qualitative research employed focused group discussions in 13 medical professionals, including physicians, pharmacists and nurses, to gather their suggestions for the development of collaborative pharmaceutical care with a multidisciplinary team in taking care of patients at hospitals and their homes. The researchers implemented the derived model within a quantitative study conducted in 22 patients and evaluated the outcomes on patient knowledge, drug-related problems (DRPs), clinical outcomes and quality of life of patients at before and after the provision of pharmaceutical care. Results: The results from qualitative study revealed collaborative pharmaceutical care model with multidisciplinary teams in patient care at the hospital and at home should encompass patient education on the disease, drug use, water and food intakes, identifying and resolving DRPs, monitor patient's laboratory examination, communication of patient information and problems needed to follow up to primary care pharmacists for home visit with family care team. Quantitative research found that most of the subjects were men between the ages of 37-76 years. Most prevalent comorbidity was hypertension (11 patients). Average number of medication was 10.00±2.07 items per person. Knowledge of the subjects increased from 12.91±3.75 to 14.96±3.76 after intervention (P=0.007) (from the full score of 20). There were 101 DRPs before the provision of pharmaceutical care. There were 30 and 32 DRPs after the intervention at the first 1-3 months in the hospital, and at the 4th-6th months at home. Most common problem at all stages of the study was failure to receive prescribed medication or not receiving medication as prescribed. After intervention, most patients had hemoglobin, ferritin, TSAT, potassium and bicarbonate within normal range. However, numbers of patients with systolic blood pressure higher than threshold increased. Parathyroid hormone was lower than the normal value throughout the study. Phosphate level was higher than normal value. Calcium was lower than normal value. Quality of life before and after intervention did not reach statistically significant differences. Conclusion: The development of pharmaceutical care model in collaboration with a multidisciplinary team has resulted in increased knowledge of medication and reduction of DRPs. Pharmaceutical care development should be continued with