title: A pharmacy medication alert system based on renal function in older patients.
abstract: BACKGROUND
  Patients with diabetes or cardiovascular disease are at risk of reduced renal function and frequently use drugs that interact with renal function. GPs monitor renal function in these patients. Computerised prescription systems produce alerts in patients labelled as having chronic kidney disease, but alerts are often ignored. If pharmacists use a pharmacy medication alert system (PMAS) based on renal function, they can provide the GP with therapeutic advice to optimise the medication. The extent of this advice and the feasibility in the clinical context are unknown.
  
  
  OBJECTIVE
  To assess the therapeutic advice formulated by pharmacists with help of a PMAS based on the renal function of patients aged ≥70 years with diabetes or cardiovascular disease.
  
  
  METHODS
  Observational study in primary health care in the Netherlands.
  
  
  METHODS
  GPs provided pharmacists with the renal function of older patients with diabetes or cardiovascular disease who were using target drugs, that is, drugs requiring therapeutic advice in patients with reduced renal function. With the help of a PMAS, pharmacists assessed the actual medication. The GP weighed the advice in relation to the clinical context of the individual patient.
  
  
  RESULTS
  Six hundred and fifty patients were prescribed 1333 target drugs. Pharmacists formulated 143 therapeutic recommendations (11% of target drugs) concerning 89 patients (13.7% of study population). In 71 recommendations in 52 patients (8.0% of study population), the GP agreed immediately.
  
  
  CONCLUSIONS
  The use of a PMAS resulted in therapeutic advice in 11% of the target drugs. After weighing the clinical context, the GP agreed with half of the advice.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands. a.f.j.geerts@uu.nl
authors.forename: Arjen F J
authors.initials: AF
authors.lastname: Geerts
authors.forename: Nynke D
authors.initials: ND
authors.lastname: Scherpbier-de Haan
authors.forename: Fred H P
authors.initials: FH
authors.lastname: de Koning
authors.forename: Tim M J W
authors.initials: TM
authors.lastname: van der Sterren
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Gerald M M
authors.initials: GM
authors.lastname: Vervoort
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: de Smet
authors.forename: Wim J C
authors.initials: WJ
authors.lastname: de Grauw
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D003376:Counseling; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000503:physiopathology; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D058006:General Practice; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007400:Interprofessional Relations; D008297:Male; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D009426:Netherlands; D010604:Pharmacy; D055553:Prescription Drugs / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D004232:Diuretics; D007004:Hypoglycemic Agents; D055553:Prescription Drugs