International Journal of Advances in Nephrology Research

Introduction: Clinical pharmacy is a branch of pharmacy that is patient centred. It was born in the Western world and is well established in countries like USA, Canada, United Kingdom and France. In Cameroon, it was recently (2022) introduced in the medical training programme as a specialization in pharmacy. Its objectives include but are not limited to; the safe, effective and rational use of health products. Healthcare providers may prioritize which hospital services may require clinical pharmacists according to medical needs, budget and other constrains. Effective medication therapy management may result in reduced risk of drug interactions, adverse drug events and optimisation of drug therapy leading to lower health care costs. The organ which is most involved in the excretion of drugs and/or metabolites from the body is the kidney and patients with impaired kidney may be at risk of adverse drug reactions and drug interactions. Therefore, the haemodialysis unit was chosen to conduct this study to investigate medication therapy management in patients with end stage renal kidney disease at the Yaoundé University Teaching Hospital.

Material and Methods: A cross-sectional study was carried out in the haemodialysis unit at the Yaoundé University Teaching Hospital for a period of 8 months from October 2023 to May 2024. The study populations were patients with end-stage renal disease on haemodialysis and medical personnel following these patients. The study tools were questionnaires addressed to patients and medical personnel as well as data collection sheets. Administrative and research authorisations were obtained. Data collected were medical personnel’s knowledge and attitude towards medication therapy management, number of drugs prescribed per patient, therapeutic classes of drugs prescribed, patient medication-taking behaviour, non-prescription drugs and herbal remedies use. Data were analysed using the software Epi info 7.2.5.0 and interpreted as either low, medium or high risk of adverse drug reaction and/or drug interaction. Data were reported as frequencies (n) and percentages (%) and displayed using tables and figures.

Results: 2 clinicians were recruited as those being involved in the drug therapy of patients; and 100 patients were recruited with a clinician to patient ratio of 2:100.  One out of two clinicians had basic knowledge of medication therapy management and both had an unsatisfactory attitude towards medication therapy management.

Risk of drug interaction was medium to high; 76% of patients were prescribed between 4-12 medications, 63% buy their medications from multiple pharmacies, 16% consume herbal medicines and 17% non-prescribed drugs. The risk of adverse drug reaction was low to medium. 23% of patients experienced hypotension, 33% were not taking their medications as prescribed and 54% were not reviewed for their medications routinely. 

Conclusion: This study showed that clinicians in the haemodialysis unit have basic knowledge of medication therapy management but are resistant to the input of another healthcare professional, without realising that this aspect of care falls within the clinical pharmacy services. Patients on haemodialysis with end stage renal disease have poor medication-taking habits, consume herbal medicines and non-prescription drugs which exposes them to medium to high risk of drug interactions and low to medium risk of adverse drug reactions. These risks can be further lowered by the counselling and management of the medications of these patients by a clinical pharmacist.