Collaborative Pharmacist–physician Medication Management for the Elderly With Chronic Kidney Disease and Polypharmacy

Background: Inappropriate polypharmacy is likely in older adults with chronic kidney disease owing to the considerable burden of comorbidities. We aimed to evaluate the impact of a collaborative pharmacist–physician geriatric medication management service on the quality of medication use. Methods: We retrospectively reviewed the medical records of patients who received the geriatric medication management service in ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The quality of medication use was evaluated based on the numbers of medications and potentially inappropriate medications. We also evaluated the types of drug-related problems identified during medication management service and pharmacists’ interventions. Results: Drug use quality was assessed in 87 of 95 patients who received the service. After the provision of medication management service, the total numbers of medications and potentially inappropriate medications decreased from 13.5 ± 4.3 to 10.9 ± 3.8 (p < 0.001) and from 1.6 ± 1.4 to 1.0 ± 1.2 (p<0.001), respectively. Furthermore, the numbers of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped” (111, 31.4%).Conclusions: Polypharmacy and potentially inappropriate medications were prevalent in older adults with chronic kidney disease, and geriatric medication management service involving a collaboration between pharmacists and physicians improved the quality of medication use in this population.