The Effects of a Pharmaceutical Care on Delaying Renal Impairment by using Case Management among Patients with Chronic Kidney Disease
Keywords:
Chronic Kidney Disease, , Pharmaceutical Care, Case ManagementAbstract
This randomized controlled trial research aimed to examine the effects of a pharmaceutical care on both clinical and process outcomes in patients with stage 3 or 4 chronic kidney disease. The study was carried out between November 2021 and July 2022. A total of 124 patients were enrolled and separated to intervention group (Structure Care, N = 62) and control group (Usual Care, N = 62). The intervention program (case management program) consisted of finding drug-related problems, adjusting dosage, conducting patient's education, using a referring system for multidisciplinary teams. The outcomes were measured as clinical outcomes (blood pressure and renal function test) and process outcomes (quality of life, knowledge score, compliance, identifying and resolving drug-related problems). Paired t-test and Independent t-test were used to compare before/after intervention of each group and compare between groups. Wilcoxon-signed ranks test was used in non-normal distribution data.
The study showed that the average age of patients was 67 years old; 59.68% were males. Most patients had stage 3a or 3b renal failure. For clinical outcomes, the renal function (eGFR) had been significantly improved in intervention group compared to control group (p<0.05). There was no difference in the Serum Creatinine (SCr) between groups. However, the SCr in the intervention group was decreased while significantly increased in control group in the end of intervention (p <0.05), reflecting lower renal function. Additionally, in process outcomes (medication and disease knowledge, adherence, and quality of life) were significantly improved in intervention group (p<0.001) and showed higher rates in detecting and solving medication problems compared to the control group.
Therefore, the pharmaceutical care by using case management can constitute an effective process to slow the deterioration rate of kidney function in patients with chronic kidney disease. Patients can improve their knowledge on kidney disease and decrease drug-related problems, which is likely to slow the deterioration of the kidney function and improve clinical outcomes.
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