title: Implementation of a pharmacist medication review clinic for haemodialysis patients.
abstract: OBJECTIVE
  To implement the Pharmacist Medication Review Clinic and establish a sustainable clinical pharmacy service.
  
  
  METHODS
  Prospective clinical medication review conducted by trained clinical pharmacists using standardised tools. Pharmacists' intervention included medication recommendation and patient education.
  
  
  RESULTS
  From December 2007 to July 2008, medication reviews were conducted with 64 haemodialysis patients. Patients were taking on average 13 medications. Drug-related problems (DRPs) were identified in 92% of medication reviews (a total of 278 DRPs). The major DRP was non-adherence with medication regimen (33%), followed by medication requiring dose decrease (9.3%) and indication requiring new medication (8.6%). The risk factors for multiple DRPs were ethnicity, length of time on dialysis and age. New Zealand (NZ) Maori and Pacific Peoples were more likely to have more than three DRPs compared to patients of European descent. (NZ Maori: OR 7.49, 95%CI 1.15-48.9, p=0.035; Pacific Peoples: OR 5.4, 95%CI 0.96-30.34, p=0.055) and patients who spent 3.5 to 6.3 years on dialysis (OR 7.48, 95%CI 1.45-38.76, p=0.016). Patients older than 55 were less likely to have more than three DRPs compared to younger patients (OR 0.14, 95%CI 0.03-0.69, p=0.016).
  
  
  CONCLUSIONS
  Pharmacist-led medication review clinic identified drug-related problems (DRPs) and risk factors for DRPs in haemodialysis patients.
authors: Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand. smirkov@middlemore.co.nz
authors: Sanja
authors: S
authors: Mirkov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010353:Patient Education as Topic; D004364:Pharmaceutical Preparations; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D019338:Polypharmacy; D011446:Prospective Studies; D006435:Renal Dialysis; D012380:Role; D019966:Substance-Related Disorders / Q000517:prevention & control
chemical_list: D004364:Pharmaceutical Preparations