Development of a Predictive Model for Drug‐Related Problems in Kidney Transplant Recipients

• DOI: 10.1002/phar.1886
• Publication Date: 2016-12-20T20:06:54Z
• Authors: Kelly L. Covert; Caitlin R. Mardis; James N. Fleming; Nicole A. Pilch; Holly B. Meadows; Benjamin A. Mardis; Prince Mohan; Maria Posadas‐Salas; Titte Srinivas; David J. Taber
• Keywords: Male; drug safety; Drug-Related Side Effects and Adverse Reactions; outcomes; Pharmacists; Sensitivity and Specificity; Medication Adherence; Workflow; Tertiary Care Centers; 03 medical and health sciences; Professional Role; 0302 clinical medicine; 616; 617; Humans; Medication Errors; transplant; Prospective Studies; Models, Statistical; Middle Aged; pharmacy practice; Kidney Transplantation; Transplant Recipients; 3. Good health; Quality of Life; renal; Female; Pharmacy Service, Hospital

Study Objective Drug‐related problems (DRPs) are associated with increased rates of infection, rejection, and graft loss in kidney transplant recipients. This study aimed to develop a model predict which patients at highest risk DRPs streamline pharmacists’ workflow chronic clinic. Design Prospective observational study. Setting Chronic clinic large, tertiary care, academic hospital. Patients Two hundred thirty‐seven adults seen the between September 16, 2015, November 30, who were least 90 days posttransplantation time their visit. Measurements Main Results data detailing survey assessing baseline characteristics patient‐related outcomes used generate predictive identify having six or more DRPs; cutoff provided threshold for identifying subset high‐risk on whom pharmacists could focus efforts. categorized as nonadherence, overdosing underdosing, duplication therapy, preventable adverse drug reaction, missing medication, erroneous conflicting provider information, undermonitoring lack monitoring, wrong medication received. In total, 865 unique identified, most common accounting 38%, 21%, 16% DRPs, respectively. A nine‐variable sensitivity 62.5% specificity 66.7% (area under receiver operating characteristic curve 0.720) was developed DRPs. The included following variables: age, Medicaid prescription insurance, current employment status, affordability, difficulty obtaining medications from pharmacy, negative impact quality life, poor rating health moderate understanding. Conclusion These results demonstrated that straightforward, 5‐minute completed by renal recipients prior visit may be capable effectively determining those potentially allowing use screening tool prioritization. External validation is needed before this can outpatient setting.