Development of a seamless pharmaceutical care system for hemodialysis patients linking government hospitals and private clinics, Sisaket Province.
Keywords:
Seamless Pharmaceutical Care System, Dialysis Patients, Research and DevelopmentAbstract
This research and development have developed a seamless pharmaceutical care system for hemodialysis patients linking government hospitals with private clinics and hospitals in Sisaket Province. The study was divided into 3 phases. Phase 1 was a retrospective study and situation analysis. Data from 60 medical records were collected and 18 interdisciplinary personnel were interviewed. Interview forms and data recording forms were used to collect data. Descriptive statistics and content synthesis were used to analyze the data. Phase 2 developed the pharmaceutical care system, created the Hemodialysis SSK system, linked laboratory test results, and developed a set of 8 components: Policy, Provider, Materials, Revise CPG, Refer/Fast track, Tele-health, Risk management, and Monitoring. Data was collected from a questionnaire. Descriptive statistics and content analysis were used to analyze the data. Developed pharmaceutical care system model. It has potential for further implementation. Phase 3 The outcome study compared the experimental and control groups. The sample consisted of 30 interdisciplinary professionals, each with 30 medical records. Data were collected from the questionnaire developed in Phase 2 and expand using a t-test, with a significance level of 0.05.
Results showed that implementing the pharmaceutical care system (V2) in the outcome evaluation phase significantly increased healthcare professionals' knowledge after training (t = 15.78, p < .001), with satisfaction and feasibility levels exceeding 86%. Additionally, the proportion of DTPs at level E and above significantly decreased (Z = –2.09, p < .01), while eGFR values showed no significant difference between groups. Based on feedback, the pharmaceutical care system (V3) was developed and implemented in the scale-up phase. Results demonstrated significantly increased knowledge (t = 17.78, p < .001), satisfaction levels exceeding 94%, and DTPs proportion significantly decreased from 13.3% to 0% (Z = –2.68, p < .01).
References
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al.(2013). Chronic kidney disease: global dimension and perspectives. Lancet. 2013 Jul;382 (9888):260–72.
Webster AC, Nagler EV, Morton RL, Masson P.(2017). Chronic kidney disease. Lancet. 2017 Mar;389(10075):1238–52.
GBD 2015 Mortality and Causes of Death Collaborators.(2016). Global, regional, and national life expectancy, all- cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015. Lancet. 2016 Oct;388(10053):1459–544.
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al.(2016). Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One. 2016 Jul;11(7):e0158765.
สำนักงานหลักประกันสุขภาพแห่งชาติ.(2567). รายงานสถานการณ์โรคไตเรื้อรังในประเทศไทย [อินเทอร์เน็ต]. กรุงเทพฯ: สปสช.; 2567 [เข้าถึงเมื่อ 18 ก.ย. 2568]. เข้าถึงได้จาก: https://www.nhso.go.th/
กรมการแพทย์.(2567)> รายงานอาการไม่พึงประสงค์จากการใช้ยาในผู้ป่วยโรคไตเรื้อรัง จังหวัดศรีสะเกษ ปี 2567 [อินเทอร์เน็ต]. กรุงเทพฯ: กรมการแพทย์ กระทรวงสาธารณสุข; 2567 [เข้าถึงเมื่อ 18 ก.ย. 2568]. เข้าถึงได้จาก https://www.dms.moph.go.th/
Krediet RT.(2013). Peritoneal dialysis: from bench to bedside. Clin Kidney J. 2013 Jun;6(6):568–77.
Jha V.(2013). PD First: Peritoneal dialysis as initial renal replacement therapy. Kidney Int Suppl. 2013 May;3(2):154–6.
Tesfaye WH, Castelino RL, Wimmer BC, Jose MD, Zaidi STR.(2017). Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions. Int J Clin Pract. 2017 Jul;71(7):e12960.
Chang F, O’Hare AM, Miao Y, Steinman MA.(2015). Use of renally inappropriate medications in older adults with advanced chronic kidney disease. JAMA Intern Med. 2015 Dec;175(12):1968–75.
Al-Ramahi R.(2014). Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia. Saudi J Kidney Dis Transpl. 2014 Jan;25(1):95–9.
Nobelius D. (2020). Managing R&D processes-focusing on technology development, product development, and their interplay [Dissertation]. Göteborg: Department of Operations Management and Work Organization School of Technology Management and Economics, Chalmers University of Technology.
ณัฏฐพันธ์ เขจรนันทน์.(2545). การสร้างทีมงานที่มีประสิทธิภาพ. กรุงเทพฯ: เอ็กซเปอร์เน็ท.
Dwoaczyk, W.J.(1999). “Use of Stufflebeam’s CIPP Model to Assess a Change Effort in aDivision of a University Library,” Dissertation Abstracts International. 1999; 59(7) : 2382-A
Polit DF, Beck CT.(2017). Nursing research: generating and assessing evidence for nursing practice. 10th ed. Philadelphia: Wolters Kluwer Health; 2017.
Likert R.(1967). “The Method of Constructing and Attitude Scale,” in Attitude Theory and Measurement. New York: Wiley & Son.
Best JW.(1977). Research in Education. 3rd ed. Englewood Cliffs, New Jersey: Prentice Hall Inc.
Bloom BS, Madaus GF, Hasting JT.(1971). Handbook on formative and summative evaluation of student learning. New York: McGraw-Hill.
Cronbach LJ.(1951). Coefficient Alpha and the Internal structure of tests. Psychometrika; 1951,pp. 334 – 297.
Cohen, J. and Uphoff.(1977). Rural Development Participation : Concept and Measures for Project Design Implementation and Evaluation. London : Rural Development Center : Cornell University.1977.
Tavakol M, Dennick R.(2011). Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53–5.
Heale R, Twycross A.(2015). Validity and reliability in quantitative studies. Evid Based Nurs. 2015;18(3):66–7.
Nascimento YS, Foppa AA, Silva D, Pontarolo R.(2021). Pharmacist interventions to reduce medication errors and adverse drug events in hospital: a systematic review. Eur J Hosp Pharm. 2021;28(1):4–10.
Polit DF, Beck CT.(2021). Nursing research: Generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer.
DeVon HA, Block ME, Moyle-Wright P, Ernst DM, Hayden SJ, Lazzara DJ, et al.(2007). A psychometric toolbox for testing validity and reliability. J Nurs Scholarsh. 2007;39(2):155–64.
Souza AC, Alexandre NMC, Guirardello EB.(2017). Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude. 2017;26(3):649–59.
Basger BJ, Moles RJ, Chen TF.(2018). Development of an aggregated system for classifying causes of drug-related problems. Ann Pharmacother. 2018;52(1):23–32.
Bond CA, Raehl CL.(2007). Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481–93.
Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL.(2006). Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med. 2006;166(9):955–64.
Rotenstein LS, Sadun R, Jena AB.(2018). Virtualist models of care: physician staffing in the era of telemedicine. N Engl J Med. 2018;378(20):1895–7.
World Health Organization.(2019). Global strategy on digital health 2020–2025. Geneva: WHO; 2019.
Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al.(1995). Incidence of adverse drug events and potential adverse drug events. JAMA. 1995;274(1):29–34.
Classen DC, Resar R, Griffin F, Federico F, Frankel T, Kimmel N, et al.(2011). ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff. 2011;30(4):581–9.
Tsai D, Udy AA, Stewart PC, Robertson TA, Brett J, Boots RJ, et al.(2018). Pharmacist-led dose adjustment in patients with renal impairment: a systematic review. Br J Clin Pharmacol. 2018;84(5):934–45.
Dooley MJ, Singh S, Michael M.(2011). Implications of dose adjustments in patients with renal impairment. Cancer Forum. 2011;35(2):102–6.
