A Preliminary Review of the Medication Management Service Conducted by Pharmacists in Haemodialysis Patients of Singapore General Hospital

Background: Patients with end-stage renal disease (ESRD) are at risk of developing drug-related problems (DRPs) due to polypharmacy, multiple co-morbidities and frequent medication changes. Objective: To evaluate the prevalence of DRPs identified and the types of interventions made by Medication Management Service (MMS) pharmacists. Methodology: Renal MMS was set up to conduct comprehensive medication review and medication reconciliation in haemodialysis patients. A pharmacist review was arranged for selected patients prior to the renal physician's appointment. A written report on the findings and proposed recommendations after the pharmacist's review was submitted to the referring physician to aid clinical decision making. This acted as a method of communication between the patient's dialysis centre, pharmacist and attending renal physician. Results: A total of 30 patients were enrolled into the service within a period of five months. Each patient had, on average, 3.1 DRPs. The three most common DRPs were non-adherence (41.5%), untreated indications (14.9%) and adverse drug reactions (11.7%). A total of 54 interventions were performed and almost half of them involved suggestions to modify dosing regimens (51.9%), followed by suggestions to add new drugs (16.7%) and to discontinue drugs (13.0%). Conclusion: The high prevalence of DRPs in renal patients warranted a multidisciplinary team approach. MMS conducted by pharmacists may help to address the gap in information when patients transfer between healthcare settings.