Medication-related problems in liver transplant patients in the Netherlands: the role of the clinical pharmacist in the outpatient setting

M.B. Mulder, S.D. Borgsteede, S. Darwish Murad, H.J. Metselaar, N.G.M. Hunfeld

Thursday 5 march 2020

13:40 - 13:50h at Leo Franssen zaal

Parallel session: Parallel sessie XIV– Klinische abstracts

Background: After livertransplantation (LTx), adherence to immunosuppressive medication and avoidance of contra-indicated drugs is essential for long-term survival. Therefore, signalling and treatment of medication-related problems (MRPs) in LTx recipients opens opportunities to improve medication safety. This study aimed to investigate the prevalence and types of MRPs and interventions initiated by a clinical pharmacist (CP) in a cohort of stable LTx recipients in the outpatient setting.

Methods: This study was a prospective, observational study conducted between September–December 2018 in LTx recipients that visited the outpatient clinic for an annual extensive check-up. A 20-minutes face-to-face consultation with a CP was part of this check-up and consisted of medication reconciliation and a structured conversation about medication, adherence, adverse drug reactions (ADRs) and drug use. Potential interventions were discussed with the patient and hepatologist and initiated by the CP. The MRPs and interventions were registered by the CP and categorized into predefined categories. Analysis was performed using descriptive statistics.

Results: The CP consulted 64 LTx recipients with a median age of 59.5 years (IQR: 47-66) and a median of seven medications. Frequent comorbidities were chronic kidney disease (n=26), cardiovascular disease (n=26), and diabetes mellitus (n=19). In 57.8% of the patients, one or more discrepancies were found in the medication registered in the hospital and actually used by the patient. Most discrepancies (60.4%) were missing medications.

In total, 98 MRPs were identified in 53 patients, with a median of 2 MRPs per patient. Most frequent MRPs were: ADRs (22.4%), nonadherence (19.3%), unnecessary drugs (16.3%) and untreated indications (12.2%). Interventions most frequently proposed were: optimizations in dosage regimen (21.2%), medication compliance advises (16.8%) and stopping of medication (12.4%). Most interventions proposed by the CP (93.6%) were followed by both patients and hepatologists.

Conclusions: In this cohort, LTx recipients experience a median of 2 MRPs of which ADRs, nonadherence and unnecessary drugs are most frequently reported. An outpatient monitoring program of a CP for LTx recipients can signal MRPs and lead to interventions that are accepted by both patients as hepatologists and hence contribute to medication safety in LTx recipients.