Hospital-community care coordination and therapeutic optimization in patients receiving maintenance hemodialysis
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Aurélie David1, Émilie Prevost1, Audrey Martin1
1Centre hospitalier mémorial de Saint-Lô, pharmacie, Saint-Lô, France.
Abstract:
Patients undergoing maintenance hemodialysis are frequently exposed to polypharmacy due to multiple comorbidities, increasing the risk of adverse drug events and medication discrepancies between hospital and community care. The objectives were to identify prescribing discrepancies and characterize therapeutic optimizations in patients receiving maintenance hemodialysis. A retrospective single-center study was conducted. Medication reconciliation and clinical pharmacy reviews were performed to identify discrepancies and therapeutic optimization proposals, reviewed with the nephrologist and, when applicable, with the general practitioner. The study included 76 patients. Medication discrepancies were identified in 33% of patients receiving follow-up care from their general practitioner. According to the CLEO scale, 75% of discrepancies had at least a minor clinical impact. Therapeutic optimization proposals were made for 69 patients, with a nephrologist acceptance rate of 93%. The proportion of potentially inappropriate medications decreased significantly after intervention (p < 0.05). Integrating clinical pharmacists into a structured therapeutic optimization process may improve prescribing appropriateness and medication safety in patients on maintenance hemodialysis.
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