.

1. EstablishingandEvaluatingaPharmaceutical Care inRenal TransplantationClinicandthe Integrated
PharmaCloudService forPharmacistProfessionalPerformance
Authors Wang,Hue-Yu
http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0011-2411201600293900
KMUIR > College of Pharmacy > Graduate Institute of Pharmaceutical Sciences >Theses > Item
310902000/40198
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Background:To preventdrug-relatedproblemsinadvance andthusensure patientsafetyiscloselyrelated
to properpharmaceutical care andeffective model forpharmaceutical care.Atthe moment,OPD
pharmaceutical consultationisprovidedaccordingtophysicians’ordersandpatients’need.However,
proactive pharmaceutical care istobe initiatedandofferedbypharmaciststointerview face-to-face the
patients,discoverdrug-relatedproblems,provide withtherapyrecommendations,andinstructthe patients
howto take the medicinesproperly.Togetherwithwellrecordsof pharmaceutical care anddocumentsfor
drug-relatedproblems,greaterprofessionalismof pharmacistswouldbe demonstrated.
Objective:The studyaimstoestablishamodel of proactive pharmaceutical care basedondataon the NHI
PharmaCloudandhastwo objectives.First,toevaluate if persistentinfectiousdiarrheaisarisk factorfor
deteriorationof renal functioninkidneytransplantrecipients.Secondly,toanalyze the dataregarding the
prevalence andtypesof drug-relatedproblems(DRPs) andthe recommendationsforoptimizingmedication
providedbyclinical pharmacistsaftertwostages(Firststage (FS):pharmacistsreviewedthe datareal-time
and recordedthe DRPs;Secondstage (SS):pharmacistsreviewedandevaluatedthe pre-downloaded
patientprescriptiondataandrecordedall the DRPs) of implementationof NHIPharmaCloudSystem.
Methods:A cross-sectionalprospectivestudywasconductedata medical centerinSouthernTaiwan.In the

2. firstpart of the study,a retrospective andobservational studywasconductedusingHyperinDatabase of
the hospital.Patientswerecollectedaccordingtodiagnosesof diarrhea,diarrheaperiod≥3 days,use (or
not) of antibioticagents.Studentt-testsorANOVA were usedtoverifythe correlationamongthe serum
creatinine changesanddiarrheacauses,diarrheaperiods(continuousvariables).Inthe secondpartof the
study,data are presentedasmeanswithstandarddeviationsforcontinuousvariables andnumberswithfor
categorical variables.Drug-relatedproblemswereprobedandencodedwithAABBCCandrecorded
accordingto PCNE DRP v6.2 guideline (Pharmaceutical Care NetworkEurope WorkinggrouponDRPs).
Wilcoxonsigned-ranktestforcontinuousvariablesandPearson'sChi-square testorFisher'sexacttestfor
categorical variableswasusedtocompare the differencesbetweentwogroups.The logisticregressionwas
usedto estimate the associationbetweeneachdrug-relatedproblemsandstages.The multivariable logistic
regressioncalculatedthe oddsratios(ORs) and95% confidence intervals(CIs)afteradjustingpotential
confoundingfactors.Significance wassetatp< 0.05. All analyseswere presentedusingStatisticalAnalysis
System(SAS) statisticalsoftware (version9.4;SASInstitute,Inc,Cary,NC).
Resultsanddiscussion:The preliminaryresultsof the firstpartof the studyrevealedthatinkidney
transplantrecipients,patientswithinfectiousdiarrheademonstratedalargermeanserumcreatinine (Scr)
change than those withnon-infectiousdiarrhea(0.31±0.52 vs.0.1±0.27), and whentheirdiarrheapersisted
for more than 10 days,a significantlargermeanserumcreatinine change wouldbe observed(0.53±0.55 vs.
0.05±0.22; comparedwiththose withdiarrheaperiodof <10 days,p=0.0018), showingthatthe irreversible
kidneyallograftfunctionchange wasassociatedwithbothpersisteddiarrheaandinfectiousdiarrhea.
Besides,the immunosuppressive combinationof tacrolimus(TAC) andmycophenolate mofitil (MMF) might
be associatedwithanincreasedriskof noninfectiousdiarrhea.
The resultsof the secondpart of the studyrevealedthat“Treatmenteffectiveness”(Untreatedindication;
50.0%) was the mainprobleminthe FS groupand “Patient”(Patientforgetstouse/take drug;55.0%) inthe
SS group.Furtheranalysesof logisticregressionsrevealedthatpatientsinthe SSgrouphad a 2.7 timesof
riskto receive “Unnecessarydrug-treatment(P3.2)”than theydidinFS group(OR 2.7; p<0.0001) indicating
that the prescriptiondatadownloadedinbatchesfromthe PharmaCloudSystemcouldbe helpful for
clinical pharmaciststoidentifyDRPsmore efficientlywithsignificantclinicalbenefits.Onclassificationof
the drug-relatedproblems,“Treatmenteffectiveness”(41.3%) wasthe mostfrequentlyseenprobleminthe
FS groupand “Treatmentcost” (48.3%) in the SS group,and furtheranalysesdemonstratedthat
“Unnecessarydrugtreatment”wasthe mainproblemforall patients.Onthe cause of the problems,“Drug
selection”became the maincause forall the problems.
Thisstudydemonstratedthatthe PharmaCloudSystemallowedprescriptioninformationof patientstobe
sharedacross hospitalsandenabledpharmacistsandphysicianstoreview andevaluatemedicationsin
advance.The potential problemsof “Unnecessarydrugtreatment”andthe treatmentcostderivedfrom
that wouldbe resolvedefficiently.
Conclusion:Ourstudybringsnewdatainthe directionshowingthatinfectiousdiarrheadoesmore
damagesto renal functionthannon-infectiousonesinkidneytransplantrecipients,especiallywhenthe
diarrheapersistsformore than10 days.Our studyalso demonstratedthathigherefficiencyof the use of
the proactive model of pharmaceutical care waseasilyachievedtopreventand/orsolvedrug-related
problemsinadvance withPharmaCloudsystemessedNov11,2015