Protecting people with vulnerable kidneys with medication reviews
Mrs Cathy Pogson from Portsmouth Hospitals NHS Trust has received an allied health professional fellowship of £290,000, funded by Kidney Research UK, Pharmacy Research UK and the UK Kidney Association. Cathy will develop a medication review system specific to patients with decreased kidney function who are taking multiple medications which can have harmful effects and be a burden for patients.
The problem
A medication review is an appointment focused on a patient’s wishes and needs for their medicines. The healthcare professional, often a pharmacist, together with the patient and/or their carer, review and optimise the medicines the patient is taking. Currently in the UK these appointments are offered yearly. The role of each medicine is discussed along with checking they are having a positive instead of a harmful effect. Individualised support is also provided to help patient take medicines as intended.
People with chronic kidney disease (CKD) are often prescribed several different medicines and managing these patients can be complex. As kidney function decreases, the number of medications prescribed increases to try and manage the disease and its symptoms. In addition, many medicines are processed by the kidneys. If kidney function is reduced this can cause problems with certain medicines or combinations of medicines.
Medication reviews in CKD: A gap in the research
Cathy recently published a paper in the British Journal of Clinical Pharmacology which found there is no existing research in the UK into medication reviews for patients with CKD stages 4-5.
“For people who take lots of medicines, called polypharmacy, it is important they know what the important medicines are, and that people are supported to take their medicines as intended. Pharmacists will work with patients to do this and will try to find ways of reducing any harmful effects of taking multiple medications. Coming into the kidney world, I have realised that this is not offered to kidney patients, and nobody knows how to do it. This has been highlighted by the paper that I have just published.” Mrs Cathy Pogson
The solution
Cathy will interview patients with decreased kidney function (less than 30%) and their relatives/carers to explore their experiences and needs for medicines and medication reviews. Healthcare professionals will also be interviewed on their experience of conducting medication reviews. Cathy and her team will use this and collaborate with kidney doctors and kidney pharmacists to develop a specific medication review for patients with decreased kidney function (less than 30%). Specialist kidney doctors and pharmacists have expertise which can help to manage medications for people with reduced kidney function. Patient's and/or carers are the experts on how the medicines affect their lives.
“Kidney pharmacists use their specialist knowledge to optimise medicine regimes for kidney patients and reduce the risk of harm. As well as working with patients they also provide advice for other healthcare professionals on a local level, this can be within hospitals, for GPs and community pharmacies, and on a regional and national level, such as in the development of clinical guidelines.” Mrs Cathy Pogson
Over several months, Cathy will look at patients with decreased kidney function (less than 30%) who are taking fourteen or more different medicines a day and will be offered this medication review. Cathy will look at the number of medicines patients are prescribed, the burden of patients’ medications, quality of life and the patients’ experience, which will be used to refine the medication review.
What could this mean for kidney patients?
A specialist medication review for people with reduced kidney function could improve safety and reduce harm from medicines, minimise the burden of taking many medicines and improve quality of life. If this review is shown to be effective, it could also inform future studies to trial the review more widely across different hospitals.
Meet the researcher
“From discussions I’ve had with patients and their relatives/carers, and the research I have done previously, there is a gap in the current service provision. Medication reviews are done in GP surgeries by pharmacists, however a more specialist service could be far more beneficial to patients and build trust, as some patients are avoiding these reviews because the knowledge is not specialist enough.” Mrs Cathy Pogson
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