title: Development of a Predictive Model for Drug-Related Problems in Kidney Transplant Recipients.
abstract: 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 to predict which patients are at highest risk of DRPs to streamline pharmacists' workflow in a chronic kidney transplant clinic.
  
  
  
  Prospective observational study.
  
  
  
  Chronic kidney transplant clinic at a large, tertiary care, academic hospital.
  
  
  
  Two hundred thirty-seven adults seen in the kidney transplant clinic between September 16, 2015, and November 30, 2015, who were at least 90 days posttransplantation at the time of their clinic visit.
  
  
  
  Prospective data detailing DRPs and a survey assessing baseline characteristics and patient-related outcomes were used to generate a predictive model to identify patients at risk of having six or more DRPs; the cutoff of six DRPs provided a threshold for identifying a subset of high-risk patients on whom the transplant pharmacists could focus their efforts. DRPs were categorized as nonadherence, overdosing or underdosing, duplication of therapy, preventable adverse drug reaction, missing medication, erroneous medication, conflicting provider information, undermonitoring or lack of monitoring, and wrong medication received. In total, 865 unique DRPs were identified, and the most common were erroneous medication, missing medication, and nonadherence, accounting for 38%, 21%, and 16% of the DRPs, respectively. A nine-variable model with a sensitivity of 62.5% and specificity of 66.7% (area under the receiver operating characteristic curve of 0.720) was developed to identify patients at risk of having six or more DRPs. The model included the following variables: age, Medicaid for prescription insurance, current employment status, medication affordability, difficulty or lack of difficulty obtaining medications from the pharmacy, negative impact of medications on quality of life, medication nonadherence, poor rating of current health status, and moderate or poor medication understanding.
  
  
  
  These results demonstrated that a straightforward, 5-minute survey completed by renal transplant recipients prior to their clinic visit may be capable of effectively determining those at risk of having six or more DRPs, potentially allowing use as a screening tool for transplant pharmacists' workflow prioritization. External validation is needed before this tool can be used in the outpatient setting.
authors.affiliation: Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Covert
authors.affiliation: Transplant Service Line, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Caitlin R
authors.initials: CR
authors.lastname: Mardis
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: James N
authors.initials: JN
authors.lastname: Fleming
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Meadows
authors.affiliation: Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Mardis
authors.affiliation: Department of Transplant Nephrology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Prince
authors.initials: P
authors.lastname: Mohan
authors.affiliation: Department of Transplant Nephrology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Maria
authors.initials: M
authors.lastname: Posadas-Salas
authors.affiliation: Department of Transplant Nephrology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Titte
authors.initials: T
authors.lastname: Srinivas
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.|Department of Pharmacy, Ralph H. Johnson VAMC, Charleston, South Carolina.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D010595:Pharmacists / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D024382:Professional Role; D011446:Prospective Studies; D011788:Quality of Life; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D066027:Transplant Recipients; D057188:Workflow; D016903:Drug Monitoring
keywords: drug safety; outcomes; pharmacy practice; renal; transplant