Feasibility of point-of-care creatinine testing in community pharmacy to monitor drug therapy in ambulatory elderly patients

• Published in: Journal of clinical pharmacy and therapeutics Vol. 38; no. 5; pp. 416 - 422
• Main Authors: Geerts, A. F. J., De Koning, F. H. P., De Vooght, K. M. K., Egberts, A. C. G., De Smet, P. A. G. M., van Solinge, W. W.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-10-2013; Blackwell; Hindawi Limited
• Subjects: Adult; Aged; Ambulatory Care - methods; Biological and medical sciences; Community Pharmacy Services; creatinine; Creatinine - urine; Drug Monitoring - methods; elderly; Feasibility Studies; Female; General Practitioners; Humans; Male; Medical sciences; Middle Aged; monitoring; Pharmacies; Pharmacology. Drug treatments; point-of-care; Point-of-Care Systems; primary care; renal function; Human; Creatinine; Renal function; Primary health care; Pharmacotherapy; Medical screening; monitoring; Treatment; Surveillance; Point of care testing; primary care; Feasibility; Ambulatory; Drugstore; Elderly; point-of-care; renal function; creatinine; elderly
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12081

Summary
What is known and objective
It is often necessary to adjust drug therapy if renal function is impaired in elderly patients taking drugs for diabetes and/or cardiovascular disease that are cleared by the kidneys. Although clinical guidelines recommend regular monitoring of renal function in these patients, in practice adherence to these recommendations varies from 28% to 75%. To determine whether drug dosing is appropriate, pharmacists need have up‐to‐date information about patients' renal function. In this study, the feasibility of point‐of‐care creatinine testing (POCCT) in a community pharmacy was evaluated as part of monitoring the drug therapy of ambulatory elderly patients.
Methods
Elderly patients on maintenance therapy with renally excreted drugs for diabetes or cardiovascular disease were eligible for POCCT. After informed consent was obtained, POCCT was performed by trained personnel. A pharmacist assessed the clinical relevance of electronically generated drug alerts based on the patient's calculated renal function and the Dutch guidelines for adjusting drug dosage in patients with chronic kidney disease. If appropriate, the patient's general practitioner (GP) was consulted and adjustments to treatment were communicated to the patient. The feasibility of POCCT was evaluated by means of questionnaires completed by patients and healthcare professionals (GPs and pharmacists).
Results
Of 338 potentially eligible patients, 149 (44%) whose renal function was not known were asked, by letter, to participate in the study. Of these individuals, 46 (31%) gave their informed consent and underwent POCCT. Response rates for completing the patient and professional questionnaires were 87% and 100%, respectively. More than half of the patients who underwent POCCT had mild‐to‐moderate renal impairment. On the basis of information provided by patients and healthcare professionals, POCCT would appear to be feasible in community pharmacies.
What is new and conclusion
POCCT improves the management of drug therapy by community pharmacists and is feasible in daily practice.