Clinical Pharmacy Service Improves Medication Adherence In Patients With Chronic Kidney Disease Of Uncertain Aetiology (ckdu) – A Randomized Controlled Trial From Sri Lanka

• By: DIAS WICKRAMASINGHE (Faculty of Health Sciences, The Open University of Sri Lanka, Sri Lanka)
• Abstract:

  Background
  Chronic kidney disease of uncertain aetiology (CKDu) is a major public health concern in Sri Lanka. Patients with CKDu are often prescribed 10-12 medications per day and poor medication adherence is common. Sri Lankan health sector lacks an established clinical pharmacy service.
  
  Purpose
  The aim of this study was to assess the impact of introducing clinical pharmacy services in improving medication adherence in out-patients with CKDu in Sri Lanka.
  
  Method
  A randomized controlled clinical trial was conducted in patients with pre-dialysis CKDu (stages 4 and 5) at an out-patient renal clinic in a tertiary hospital in Sri Lanka. Participants were randomized to control and intervention groups and demographic and medication adherence data were collected at baseline. The control group received usual clinic care. The intervention group received medication counseling by a clinical pharmacist 4 times over 12 months and a booklet which included information on the disease, lifestyle modification and drug information, in addition to usual clinic care. Medication adherence data were collected from both groups after 12 months. “The Brief Medication Questionnaire (BMQ): a tool for screening patient adherence and barriers to adherence” was used to assess medication adherence. Total BMQ scores and individual BMQ scores of its three screens (regimen, belief, recall) were calculated (lower scores denote better adherence). The Mann-Whitney U test was used to compare medication adherence between the groups.
  
  Results
  At baseline, there were 122 and 126 patients in control and intervention groups respectively. Baseline median total BMQ scores, regimen scores, belief scores and recall scores were similar in the two groups.
  After 12 months, there were 102 and 96 patients in control and intervention groups, respectively. The medians of total BMQ scores were 5 (4-5) and 3 (2-4) (p<0.05) in control and intervention groups respectively. The medians of regimen scores were 3 (2-3) and 1.5 (1-3) (p<0.05), and the medians of recall screen were 2 (1-2) and 1 (1-1) (p<0.05) in control and intervention groups respectively. The medians of belief scores were similar 0 (0-1) and 0 (0-0) (p=0.075) in control and intervention groups respectively. The medians of total BMQ scores, regimen scores and recall scores of the intervention group were significantly improved compared to control group at 12 months.
  
  Conclusion
  The results of the study provide evidence for the potential benefits of implementing clinical pharmacy services to improve medication adherence in stage 4 and 5 pre-dialysis patients with CKDu. A collaborative therapeutic management approach with the addition of a clinical pharmacist to the existing renal health care team is a worthwhile addition in a resource-limited setting like Sri Lanka.