September 2008

Research Highlight

Ongoing quality improvement projects undertaken as part of Providence Health Care’s (PHC) renal program are helping enhance kidney patients’ anemia management and bone mineral metabolism as well as other medication-related aspects of their care.

"We do these types of studies to maximize our practice and ultimately optimize patient outcomes," says clinical pharmacy specialist Marianna Leung, who participates in the projects in addition to seeing pre-dialysis patients as part of the PHC Kidney Function Clinic healthcare team.

"My job is to ensure patients are on the most appropriate medications, and answer any questions they have," says Marianna, who completed a Bachelor’s degree in Pharmaceutical Science and a hospital pharmacy residency in the early ‘90s, and after working in psychiatry for seven years, went back to school for a Doctor of Pharmacy degree. "Medication management is hard for kidney patients – they can be on ten drugs or more if they have other concurrent diseases, and those can change frequently."

Projects completed by the PHC pharmacy team in collaboration with the renal team – aimed variously at maximizing the benefits and reducing the complexity of renal medication management - include:

A retrospective review of the charts of hemodialysis patients whose hemoglobin values were outside the target range, with a view to evaluating contributing factors. The study concluded that in patients with hemoglobin values outside the target range, the variations were closely related to iron management. The iron protocol was revised as a result.
An assessment of metabolic bone disease (MDB) in pre-dialysis patients attending the PHC Kidney Function Clinic. The study results showed serum phosphorus and calcium levels were well-controlled in most stage three and four patients, but only about half of stage five patients (with stages related to the progress of the kidney disease). The recommendation was a standardized approach among the health care providers to MDB management to optimize pre-dialysis patient care.

Projects currently underway include:

Determining the feasibility of using trained pharmacy technicians to conduct hemodialysis patient interviews to obtain the best possible medication history – which in turn will help pharmacists resolve discrepancies in medication therapy and identify drug-related problems.
Determining the effectiveness of the new BC Renal Agency guidelines for the management of catheter-related bacteremia (a condition in which bacteria are present in the bloodstream,)
Evaluating the current use of the drug midodrine in the management of intradialytic hypotension (a decrease in a specific aspect of blood pressure measurement during dialysis), a significant problem that complicates up to 20 percent of hemodialysis treatments.

For more information on these and other PHC studies, contact Marianna at MLeung@providencehealth.bc.ca.

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PHSA improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners. For more information, visit www.phsa.ca