Pharmacist + application that cuts errors, hospitalization after transplantation


A new pharmacist-led intervention that involves using a smartphone app with home control significantly reduces medication errors, adverse events, and hospitalizations among kidney transplant patients.

“To our knowledge, this is the first large-scale randomized controlled trial demonstrating improved drug safety outcomes in organ transplantation using health-based mobile technology, along with a pharmacist-led intervention.” , report Haley M. Gonzales, PharmD, the Medical University of South Carolina, Charleston, South Carolina, and colleagues in a study published online April 29 al Clinical Journal of the American Society of Nephrology.

“Based on our results, we believe that physicians should consider integrating these technologies into established clinical treatment pathways to improve drug safety-related outcomes,” they write.

The authors of a accompanying editorial Keep in mind that the intervention is unique in the relationship of patients to providers.

“This study goes beyond other research, which has shown different results on medication adherence, blood pressure control, and post myocardial infarction the results using applications that only involve patients unilaterally, ”write Wendy St. Peter, PharmD, University of Minnesota, Minneapolis, Minnesota, and Timothy D. Aungst, Pharm D, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts.

“This study adds to a growing understanding that improving patient outcomes, such as medication adherence, as well as reducing hospitalizations in transplant patients, requires a multifaceted approach and two-way communication between patients and healthcare providers. health that promote therapeutic relationships of trust “. add

Post-transplant medication errors Common, harmful

Advances in immunosuppressive drugs have substantially decreased rates of acute rejection in kidney transplant patients. However, regimens can be complex and present with toxicities that often lead to non-adherence or medication errors.

According to recent research, two-thirds of kidney transplant recipients experience medication errors. Between 1 in 8 patients, errors lead to hospitalization.

Smartphone apps seem like an ideal solution. However, several challenges have prevented their integration into various medical settings.

The authors note that clinical pharmacists are experts in drug safety and are in an ideal position to facilitate application-based intervention. They developed an application intervention led by a pharmacist called TRANSAFE Rx for the treatment of kidney transplant patients.

To evaluate the intervention, 136 patients with kidney transplantation were enrolled who went from 6 to 36 months after transplantation. The mean age of the patients was 51 years; 57% were male and 64% were black.

Patients were randomly assigned to groups of 68 patients each to receive 12 months of regular or routine care plus intervention. The intervention consisted of the management and monitoring of medications by a clinical pharmacist through the application. This management was integrated with risk-guided TVs and home blood pressure and glucose monitoring.

Error reductions, significant adverse events

Over the twelve months, those in the intervention group showed a 61% reduction in medication errors (risk rate [RR], 0.39; Pg <.001) and a 45% lower incidence of grade 3 or higher adverse events (RR, 0.55; Pg = .048).

It is important to note that the hospitalization rate was significantly lower among those who received the intervention compared to the usual care group (RR, 0.46; Pg = .005).

“The key to the success of this intervention was probably the use of technology along with telemonitoring and control of pharmacist-led patients,” the authors note.

“This intervention can be used in other centers, but both components are important to implement,” they point out.

Mobile health technologies integrated with clinical pharmacy

Using the intervention in conjunction with a HIPAA-compliant web-based portal, pharmacists could identify patients at high risk and establish clinical interventions and follow-up telepharmacy visits accordingly.

Patients ’medication regimens were automatically updated from the electronic health record (EHR). The mobile app included timely medication reminders, automated messages triggered by missed doses or a scheduled health check-up and surveys of patients ’side effects.

Pharmacists were able to respond to non-adherence alerts by sending messages to the patient and healthcare team and were able to update the EHR if necessary.

Encouraging findings underscore that “mobile health technologies have emerged as a new tool to complement current health practices and improve outcomes,” the author said in a press release David J. Taber, author of Pharmacy University of South Carolina Medical School.

“Identifying innovative strategies to help manage drug safety issues and the integration of mobile-based health interventions and the leadership of clinical pharmacists represents a promising opportunity,” he said.

Editorialists point out that key future steps in using mobile apps involve evaluating their cost-benefit profiles.

“We are looking forward to the economic analysis that determines the return on investment for incorporating these new approaches to the value-based care of these patients,” they write.

The study was supported by a grant from the Agency for Health Research and Quality. Taber has not disclosed any relevant financial relationship. Disclosures by other authors are detailed in the original article.

Clin J Am Soc Nephrol. Published online April 29, 2021. Summary, Editorial

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