Drug Utilization Pharmacist & Pharmacy Research Coordinator Nova Scotia Health Halifax, Canada
Background: Chronic Kidney disease (CKD) is common, and medications require adjustment to avoid adverse outcomes. Despite the availability of kidney drug dosing resources, CKD patients are at risk of inappropriate drug prescribing. Community pharmacists are in the ideal position to mitigate harm from inappropriate prescribing in this population.
Objectives: The objectives of this qualitative study were: 1) to ascertain community pharmacists’ perspectives on conducting kidney function assessment and dose-adjustment of high-risk medications in advanced CKD using the theoretical domains framework version 2 (TDFv2) and 2) to determine the education tool requirements needed for community pharmacists to effectively assess kidney function and provide dose adjustments or avoidance of high-risk medications in this patient population.
Methods: In this qualitative study, community pharmacists were interviewed on their perspective on kidney function assessment and dose-adjustment in advanced CKD patients (eGFR < 30 ml/min/1.73m2). The theoretical domains framework, a framework for targeting behavioral change was used to inform the interview guide and analysis. Purposeful sampling was employed until data saturation. Semi-structured virtual interviews were audio-recorded, transcribed verbatim, and uploaded into NVIVO 12 Pro to facilitate thematic analysis. Deductive and inductive iterative coding approaches were employed to determine categories and themes.
Results: Twelve pharmacists were interviewed with a mean age of 42 years and 16 years of experience. Four themes comprised of ten categories were identified to influence kidney function assessment and dosing including resources (information access, technology, references), environment (pharmacy infrastructure, practice setting), reflection (triggers, experience and training, collaboration), and leadership and governance (pharmacist role, advocacy). Feedback on an optimal CKD tool was collected and enabling themes (categories) for implementation included knowledge and skills (education, training) and reflection (role, support, integration).
Conclusions: Findings will inform the interventions needed to improve implementation of kidney assessment and dosing of high-risk medications in patients with kidney impairment into community pharmacy practice.
