Development and implementation of a new method for medication monitoring of eGFR-signals in Dutch community pharmacies

Abstract

Introduction – An important aspect of optimising pharmacotherapy is correct dosing of drugs. Dose management is especially essential in people with chronic kidney disease (CKD), as an earlier study showed that 10% of medication-related hospital admissions were related to renal impairment and medication errors. Individual patient characteristics are currently insufficiently used in computerized generation of medication monitoring signals (classical monitoring, CM) for people with CKD. The objective of this study was to improve efficiency and specificity of medication monitoring in renal impaired patients. To achieve this, a new method of monitoring (reassessment-oriented monitoring, ROM) was compared to CM. Methods – ROM was implemented in three community pharmacies and consisted of two components: I. monitoring incoming renal function values (eGFR-values) of patients and II. an adapted signal list of CM. Over the period of October, November and December 2021 generated signals following both methods were collected and merged into one dataset. Possible overlaps were identified. Subsequently, all signals were assessed as "(potentially) actionable" or "not actionable". To avoid arbitrary classification, signals were classified based on eGFR-values linked to advisory texts for drugs requiring caution in case of reduced renal function. The results were then compared to the currently used system of CM. Results – In total 10,276 unique signals were generated. 9892 and 3158 signals were generated by CM and ROM, respectively. As a result, ROM has led to a reduction in the signal load of 68.1%. Sensitivity was determined at 98.9% for CM and 100.0% for ROM. For CM a specificity of 4.6% was calculated, as for ROM specificity was determined at 91.3%. Discussion – The introduction of ROM led to a substantial decrease in signal load. In this context it is important to note that sensitivity did not reduce, whereas specificity strongly improved from 4.6% up to more than 90%. Based on this data, ROM has added value for medication monitoring of renal function signals in Dutch community pharmacies. The level of impact does depend on several conditions, however, and further research into other aspects regarding this method of monitoring is recommended.