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Year : 2016 | Volume : 8 | Issue : 3 | Page : 263-264
Manan WW
Pharmaceutical care to improve medication knowledge among patient with chronic kidney disease
Wei FC
Rahman FA
Wan Zanariah W. A. Manan1, Fong Chui Wei2, Firdaus Abd Rahman1, Long Chiau Ming3
Ming LC
1 Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
2 Department of Pharmacy, Hospital Kemaman, Kemamam, Terengganu, Malaysia Access Statistics
3 Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, University of Tasmania, Email Alert *
Hobart, Australia Add to My List *
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Date of Web Publication 22-Jun-2016

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DOI: 10.4103/0975-7406.175976
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How to cite this article:


Manan WW, Wei FC, Rahman FA, Ming LC. Pharmaceutical care to improve medication knowledge among patient with
chronic kidney disease. J Pharm Bioall Sci 2016;8:263-4

How to cite this URL:


Manan WW, Wei FC, Rahman FA, Ming LC. Pharmaceutical care to improve medication knowledge among patient with
chronic kidney disease. J Pharm Bioall Sci [serial online] 2016 [cited 2017 Oct 2];8:263-4. Available
from: http://www.jpbsonline.org/text.asp?2016/8/3/263/175976

Sir,

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Pharmaceutical care to improve medication knowledge among patient with... http://www.jpbsonline.org/article.asp?issn=0975-7406;year=2016;volum...

Chronic kidney disease (CKD) is a significant worldwide problem associated with an increased mortality, poor outcomes,
various medical comorbidities, and exorbitant healthcare cost.[1],[2] It is common for patient with CKD to receive
complex medication regimes with an average of 1219 prescribed medications a day.[3] Appropriate medication
adherence is the key to the effective management of most chronic illnesses; however, more than 30% of patients have
been shown not adhered to the prescribed medications which lead to poor treatment outcomes.[4] A similar trend is seen
in Malaysia where the prevalence of nonadherence among hemodialysis patients to medication is 33.5%.[5] From the
preliminary results of our study, the main cause of nonadherence is a lack of medication knowledge toward their complex
medication regimen as well as the desired disease outcomes.

Medication knowledge encompasses patient's ability to fully understand the detailed information of safe and effective
medication use, including knowledge of the drug indication, dose, frequency, and for certain medications and special
instructions. Improving medication knowledge is vitally important because it has been associated with better medication
adherence, fewer drug-related problems as well as fewer hospital visits, which reflects successful disease control and
clinical outcomes. Patients with poor knowledge of their medication regimen are mainly caused by ineffective counseling,
low health literacy, impaired cognition, or a higher number of medications.[6]

Ineffective counseling is directly related to pharmacist's role in providing appropriate, understandable, and relevant
information to patients about their medication. This may be due to incomplete counseling tools to counsel patient, short
counseling time, lack of counseling follow-up, lack of counseling skills, and unsystematic appointment system. In
addition, time constraint during medication dispensing, inexperience pharmacists in detecting patient with poor
medication knowledge, patient's education level, and language barrier that exists between pharmacist and patient can also
be associated with poor medication knowledge. Therefore, interventions designed to engage and educate patients to
improve patients' knowledge of CKD and medications can be achieved through proper counseling and follow-up
strategies which can ultimately delay the onsets of dialysis and improve medical outcome.[7]

Pharmaceutical Services Division, Ministry of Health Malaysia has developed the Renal Medication Therapy Adherence
Clinic (MTAC) which managed by pharmacists as one of the strategies in optimizing patients' knowledge by assessing
potential barriers to medication knowledge and implementing comprehensive strategies to increase adherence. Renal
MTAC enables selected patients to be followed up where proper education and counseling tailored for CKD patient can
be provided individually to improve patient medication knowledge, adherence, and ability to manage their condition
successfully. Counseling tools such as flip chart, drug album, and pamphlet specialized for CKD patients can facilitate
patient in the knowledge their own disease and medications better. The pharmacist will review patient condition,
medication, assess medication adherence, monitor laboratory data, and document all important information, and also
interacts closely with other healthcare providers in promoting health, preventing disease complications, and assuring that
patients receive rational, safe, and effective therapy regimens.[3]

Patient education is a part of effective kidney disease management in the Renal MTAC and a key element in the
pharmaceutical care activities. Pharmacists with their in-depth knowledge of medications play a bigger role in patient care
and have proven to benefit the patients and also the healthcare system in many ways. Pharmacists' involvement can help
patients to have better improvement on medication and treatment plan, enhance patient's medication knowledge, and
understand in regards to their medication and treatment plan, retardation of disease progression, optimal management of
disease complications, reduce drug-related problems, and optimal therapeutic drug monitoring.[7]

Although patients receive the optimum drug regimen, the desired therapy outcome will be achieved only when patient
adhere to the medications as directed. Patients who are knowledgeable about their disease, treatment, and medication will
have a better knowledge on the rational of drug therapy which will enable a better appreciation of medication counseling
and promote adherence to therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1. Wang SM, Hsiao LC, Ting IW, Yu TM, Liang CC, Kuo HL, et al. Multidisciplinary care in patients with chronic
kidney disease: A systematic review and meta-analysis. Eur J Intern Med 2015;26:640-5.

2. Tomson C, Taylor D. Management of chronic kidney disease. Medicine (Baltimore) 2015;43:454-61.

3. Pharmaceutical Services Division, Ministry of Health, Malaysia. Renal Pharmacy Service Guideline 2011. Available
from: http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/renal-guideline.pdf. [Last accessed on

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Pharmaceutical care to improve medication knowledge among patient with... http://www.jpbsonline.org/article.asp?issn=0975-7406;year=2016;volum...

2015 Dec 18].

4. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in
chronic physical illness. J Psychosom Res 1999;47:555-67.

5. Chan YM, Zalilah MS, Hii SZ. Determinants of compliance behaviours among patients undergoing hemodialysis in
Malaysia. PLoS One 2012;7:e41362.

6. Marvanova M, Roumie CL, Eden SK, Cawthon C, Schnipper JL, Kripalani S. Health literacy and medication
understanding among hospitalized adults. J Hosp Med 2011;6:488-93.

7. Ghimirey A, Sapkota B, Shrestha S, Basnet N, Shankar PR, Sapkota S. Evaluation of pharmacist counseling in
improving knowledge, attitude, and practice in chronic kidney disease patients. SAGE Open Med 2013. p. 1.
2050312113516111. doi:10.1177/2050312113516111.

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