The potential role of clinical pharmacist in the practice of heart transplantation
International Pharmacy Acta,
Vol. 5 No. 1 (2022),
Page e6: 1-7
Due to the complexity of heart transplant procedure and risk of organ rejection, most heart transplant patients receive multiple medications such as antibiotics, antifungals, and immunosuppressants. Since some medications have narrow therapeutic indexes, more attention is needed by the clinical pharmacists to solve and reduce medication-related problems. Pharmacists can play an essential role in assisting patients and physicians in receiving better treatment with the lowest risk of medication errors.
The purpose of this study was to investigate the types and quality of clinical pharmacist recommendations, the recommendations acceptance rate, and the outcomes related to clinical pharmacist interventions in heart transplant patients. The study was conducted at National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Dr.Masih Daneshvari Hospital, a university affiliated hospital, Tehran, Iran. Main outcome measures included determination of the quality of clinical pharmacist recommendations, physician acceptance rate and the effects of recommendations on patients’ clinical outcomes. Clinical pharmacist recommendations were divided into ten categories, and physicians’ acceptance rate for each recommendation was recorded. The quality of pharmacist recommendations was also classified into six categories.
The total number of recommendations that were recorded for 46 patients was 344, about 7.47 recommendations per patient. Dose adjustment recommendations were the most recommendations that were made (n=100, 29.06 %). However, this type of recommendation had the lowest physician acceptance rate (62%). Antibiotics had the least acceptance rate in dose adjustment recommendations (40%). Clinical pharmacist recommendations in the drug interaction category prevented 265 moderate and 28 severe interactions, respectively. Clinical pharmacist made 27 (7.84%) extreme significant recommendations and 88 (25.58%) significant recommendations.
Clinical pharmacists could have a critical role in optimizing medication regimens and minimizing drug interactions as well as adverse reactions in transplant patient care and their treatment programs.
- Heart Transplantation
- Patient Care
- Drug-Related Problems
How to Cite
Mangini S, Alves BR, Silvestre OM, et al. Heart transplantation: review. Einstein (São Paulo). 2015;13(2):310-318.
Hussain T, Nassetta K, O’Dwyer LC, et al. Adherence to immunosuppression in adult heart transplant recipients: A systematic review. Transplant Rev. 2021;35(4):100651.
Sirota M, Heyrend C, Ou Z, et al. Impact of tacrolimus variability on pediatric heart transplant outcomes. Pediatr Transplant. 2021; 25(7). doi:10.1111/petr.14043.
Tonsho M, Michel S, Ahmed Z, et al. Heart transplantation: Challenges facing the field. Cold Spring Harb Perspect Med. 2014; 4(5):a015636-a015636. doi:10.1101/cshperspect.a015636.
Kung M, Koschwanez HE, Painter L, et al. Immunosuppressant nonadherence in heart, liver, and lung transplant patients: Associations with medication beliefs and illness perceptions. Vol. 93, Transplantation. 2012; 93(9):958-963.
Repp KL, Hayes C, Woods TM, et al. Drug-Related Problems and Hospital Admissions in Cardiac Transplant Recipients. Annals of Pharmacotherapy. 2012; 46(10):1299-1307.
Chambord J, Couzi L, Merville P, et al. Benefit of a pharmacist-led intervention for medication management of renal transplant patients: a controlled before-and-after study. Ther Adv Chronic Dis. 2021;12:204062232110052. doi:10.1177/20406223211005275.
Park L, Kim JH, Waldman G, et al. Impact analysis of virtual ambulatory transplant pharmacists during COVID-19. JACCP. 2021; 4(8):978-987.
Trofe-Clark J, Kaiser T, Pilch N, et al. Value of Solid Organ Transplant-Trained Pharmacists in Transplant Infectious Diseases. Curr Infect Dis Rep. 2015;17(4). doi:10.1007/s11908-015-0475-8.
Yang H, Li L, Hu X, et al. Impact of pharmacist-led post-transplant medication management for kidney transplant recipients: A retrospective pre- and post-intervention study. J Clin Pharm Ther. 2019;44(4):603–10.
Ahmed KO, Taj Eldin I, Yousif M, et al. Clinical Pharmacist’s Intervention to Improve Medication Titration for Heart Failure: First Experience from Sudan. Integr Pharm Res Pract. 2021;10:135–43.
Maldonado AQ, Weeks DL, Bitterman AN, et al. Changing transplant recipient education and inpatient transplant pharmacy practices: a single-center perspective. AJHP. 2013; 70(10):900-904.
Martin JE, Zavala EY. The expanding role of the transplant pharmacist in the multidisciplinary practice of transplantation. Clin Transplant. 2004;18(s12):50-54.
Alsheikh R, Johnson K, Dauenhauer A, et al. Impact of transplant pharmacists on length of stay and 30-day hospital readmission rate: A single-centre retrospective cohort study. Eur J Hosp Pharm. 2020;28(e1):e146-e150. doi:10.1136/ejhpharm-2020-002421.
Foroughinia F, Tazarehie S, Petramfar P. Detecting and managing drug-related problems in the neurology ward of a tertiary care teaching hospital in Iran: A clinical pharmacist’s intervention. J Res Pharm Pract. 2016;5(4):285.
Gonzales HM, Fleming JN, Gebregziabher M, et al. Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial. Clin J Am Soc Nephrol. 2021;16(5):776-784.
Baniasadi S, Habibi M, Haghgoo R, et al. Increasing the number of adverse drug reactions reporting: the role of clinical pharmacy residents. Iran J Pharm Res. 2014; 13(1): 291-297.
Dashti-Khavidaki S, Sharif Z, Khalili H, et al. The use of pharmaceutical care to improve health-related quality of life in hemodialysis patients in Iran. Int J Clin Pharm. 2013; 35(2):260-267.
Sukkha S, Rattanavipanon W, Chamroenwit B, et al. Quality assessment and cost saving of renal dosing recommendation by clinical pharmacists at medical wards in Thailand. Int J Clin Pharm. 2020; 42(2):610–616.
Reinau D, Furrer C, Stämpfli D, et al. Evaluation of drug-related problems and subsequent clinical pharmacists’ interventions at a Swiss university hospital. J Clin Pharm Ther. 2019; 44(6):924-931.
Charra F, Philippe M, Herledan C, et al. Immunosuppression medication adherence after allogeneic hematopoietic stem cell transplant: Impact of a specialized clinical pharmacy program. J Oncol Pharm Pract. 2021:107815522110001. doi:10.1177/10781552211000115.
Einsfeld L, Hastenteufel LCT, Taber D, et al. Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action. J Clin Pharm Ther. 2021. doi:10.1111/jcpt.13577.
Wang HY, Chan ALF, Chen MT, et al. Effects of Pharmaceutical Care Intervention by Clinical Pharmacists in Renal Transplant Clinics. Transplant Proc. 2008; 40(7):2319-2323.
Vessal G. Detection of prescription errors by a unit-based clinical pharmacist in a nephrology ward. Pharm World Sci. 2010; 32(1):59–65.
Shafiekhani M, Tarighati S, Mirzaei E, et al. Evaluation and Management of Drug-Drug Interactions in Patients Hospitalized in Nephrology and Post-Transplant Wards in a Teaching Hospital. J Pharm Care. 2020. doi:10.18502/jpc.v8i1.2742.
Khalili H, Elyasi S, Hatamkhani S, et al. Adherence to empiric antibiotic therapy guideline in a referral teaching hospital, Tehran, Iran. Acta Med Iran. 2012; 50(1):47-52.
Stemer G, Lemmens-Gruber R. Clinical pharmacy services and solid organ transplantation: a literature review. Pharm World Sci. 2009; 32(1):7-18.
Dashti-Khavidaki S, Khalili H, Hamishekar H, et al. Clinical pharmacy services in an Iranian teaching hospital: a descriptive study. Pharmacy World & Science. 2009; 31(6):696-700.
Rivkin A, Yin H. Evaluation of the role of the critical care pharmacist in identifying and avoiding or minimizing significant drug-drug interactions in medical intensive care patients. J Crit Care. 2011; 26(1): 104.e1-104.e6. doi:10.1016/j.jcrc.2010.04.014.
Roblek T, Deticek A, Leskovar B, et al. Clinical-pharmacist intervention reduces clinically relevant drug-drug interactions in patients with heart failure: A randomized, double-blind, controlled trial. Int J Cardiol. 2016; 203:647-652.
Van De Beek D, Kremers WK, Del Pozo JL, et al. Effect of infectious diseases on outcome after heart transplant. Mayo Clin Proc. 2008; 83(3):304–8.
Duwez M, Chanoine S, Lepelley M, et al. Clinical evaluation of pharmacists’ interventions on multidisciplinary lung transplant outpatients’ management: results of a 7-year observational study. BMJ Open. 2020; 10(11):e041563.
Prom A, Ricciuti D, Walter K, et al. Impact of a clinical pharmacist in an outpatient heart transplant clinic. JACCP. 2021; 4(12):1511-1515.
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