Pharmaceutical care to improve medication knowledge among patient with chronic kidney disease.

Sir,

Chronic kidney disease (CKD) is a significant worldwide problem associated with an increased mortality, poor outcomes, various medical comorbidities, and exorbitant healthcare cost.[12] It is common for patient with CKD to receive complex medication regimes with an average of 12–19 prescribed medications a day.[3] Appropriate medication adherence is the key to the effective management of most chronic illnesses; however, more than 30% of patients have been shown not adhered to the prescribed medications which lead to poor treatment outcomes.[4] A similar trend is seen in Malaysia where the prevalence of nonadherence among hemodialysis patients to medication is 33.5%.[5] From the preliminary results of our study, the main cause of nonadherence is a lack of medication knowledge toward their complex medication regimen as well as the desired disease outcomes.

Medication knowledge encompasses patient's ability to fully understand the detailed information of safe and effective medication use, including knowledge of the drug indication, dose, frequency, and for certain medications and special instructions. Improving medication knowledge is vitally important because it has been associated with better medication adherence, fewer drug-related problems as well as fewer hospital visits, which reflects successful disease control and clinical outcomes. Patients with poor knowledge of their medication regimen are mainly caused by ineffective counseling, low health literacy, impaired cognition, or a higher number of medications.[6]

Ineffective counseling is directly related to pharmacist's role in providing appropriate, understandable, and relevant information to patients about their medication. This may be due to incomplete counseling tools to counsel patient, short counseling time, lack of counseling follow-up, lack of counseling skills, and unsystematic appointment system. In addition, time constraint during medication dispensing, inexperience pharmacists in detecting patient with poor medication knowledge, patient's education level, and language barrier that exists between pharmacist and patient can also be associated with poor medication knowledge. Therefore, interventions designed to engage and educate patients to improve patients’ knowledge of CKD and medications can be achieved through proper counseling and follow-up strategies which can ultimately delay the onsets of dialysis and improve medical outcome.[7]

Pharmaceutical Services Division, Ministry of Health Malaysia has developed the Renal Medication Therapy Adherence Clinic (MTAC) which managed by pharmacists as one of the strategies in optimizing patients’ knowledge by assessing potential barriers to medication knowledge and implementing comprehensive strategies to increase adherence. Renal MTAC enables selected patients to be followed up where proper education and counseling tailored for CKD patient can be provided individually to improve patient medication knowledge, adherence, and ability to manage their condition successfully. Counseling tools such as flip chart, drug album, and pamphlet specialized for CKD patients can facilitate patient in the knowledge their own disease and medications better. The pharmacist will review patient condition, medication, assess medication adherence, monitor laboratory data, and document all important information, and also interacts closely with other healthcare providers in promoting health, preventing disease complications, and assuring that patients receive rational, safe, and effective therapy regimens.[3]

Patient education is a part of effective kidney disease management in the Renal MTAC and a key element in the pharmaceutical care activities. Pharmacists with their in-depth knowledge of medications play a bigger role in patient care and have proven to benefit the patients and also the healthcare system in many ways. Pharmacists’ involvement can help patients to have better improvement on medication and treatment plan, enhance patient's medication knowledge, and understand in regards to their medication and treatment plan, retardation of disease progression, optimal management of disease complications, reduce drug-related problems, and optimal therapeutic drug monitoring.[7]

Although patients receive the optimum drug regimen, the desired therapy outcome will be achieved only when patient adhere to the medications as directed. Patients who are knowledgeable about their disease, treatment, and medication will have a better knowledge on the rational of drug therapy which will enable a better appreciation of medication counseling and promote adherence to therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.