Impact of clinical pharmacy services on renal transplant patients' compliance with immuno suppressive medications

Background: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-tra nsplant care. This randomized, controlled trial evaluates the impact of cli nical pharmacy services on renal transplant patients' compliance with immun osuppressive a gents. Methods: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the int ervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histo ries and review of patients' medications with an emphasis on optimizing med ication therapy to achieve desired outcomes and minimizing adverse medicati on events. The clinical pharmacist also provided recommendations to the nep hrologists with the goal of achieving desired outcomes. To promote medicati on compliance by using compliance enhancement strategies, the clinical phar macist counseled patients concerning their medication therapy and instructe d them how to properly take their medications. Patients in the control grou p received the same routine clinic services as the intervention group excep t that they did not have any clinical pharmacist interaction. Compliance ra te (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month , and the mean time patients were compliant were compared between groups. W hether there was a difference in the frequency of patients achieving 'targe t' immunosuppressive levels in the control and study groups was evaluated. Results: The mean CR for patients who had clinical pharmacist intervention (n = 12) was statistically higher than the control group's (n = 12) mean CR (p < 0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients i n the control group (p < 0.05). Additionally, patients who had clinical pha rmacy services had a greater achievement of 'target' levels than patients w ho did not receive these services (p < 0.05). Conclusions: Patients who received clinical pharmacy services with traditio nal patient care services had better compliance with immunosuppressants tha n patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharma cist as part of the care for post-transplant patients is beneficial for, en hancing medication compliance.