Project overview
This research aims to address the knowledge gap in how to deliver a structured medication review in nephrology secondary care, to improve quality of life and reduce harm from medication.
In the UK, over 60,000 adult nephrology patients have chronic kidney disease stage G4 and G5, to include dialysis (CKD G4-5D). Almost 48,500 (82%) of these people are prescribed five or more different regular medicines each day (polypharmacy). Over 24,000 (40%) are prescribed 10 or more different regular medicines each day (hyper-polypharmacy). These prescribing levels are associated with risk. Increases are seen in all-cause mortality, kidney failure and a faster eGFR decline for this polypharmacy population. Quality of life is significantly reduced when daily tablet burden exceeds fourteen. Nonadherence, adverse drug reactions, and the prescribing of potentially inappropriate medications are higher. Half of the people experiencing polypharmacy are not taking their medicines as intended. A medication review offers a solution to polypharmacy.
The KDIGO CKD Guideline update (2024) recommend medication reviews should be completed periodically and at transitions of care. In the UK, they are offered in NHS primary care. Patients with CKD G4-5D describe avoiding these reviews as they trust nephrology with their prescribing needs. A scoping review of such medication review interventions identified 21 studies, 18 (86%) were quantitative, 17 (81%) enrolled nephrology out-patients and 17 (81%) involved a kidney specialist pharmacist. Only 2 of these studies were from Europe (France and Norway). No such studies have been conducted in the United Kingdom. A specialist medication review may improve outcomes for people with CKD G4-5D.
Aim:
To develop a medication review for patients with CKD G4-5D using the person-based approach to intervention design, to improve quality of life and reduce harm from medicines, before evaluating the feasibility in nephrology secondary care clinics.
Objectives:
1. To co-design the medication review intervention using the person-based approach integrated with evidence and theory (Study 1)
2. To refine the medication review to determine if amendment or refinement is required before progression to a future multi-centre feasibility study. (Study 2)
Study Design:
A person-based approach to medication review development, using qualitative data collection with behaviour analysis, designed with experts (nephrologists, pharmacists, patients and carers).
Study 1:
•A qualitative study to understand the needs, views and experiences of medication and a medication review in patients with CKD G4-5D held by key stakeholders (patients/carers, nephrologists/kidney pharmacists, GP’s/primary care pharmacists) (Phase 1)
•To develop the guiding principles (the overarching behaviour components) required to improve experience of medication and a medication review. (Phase 2)
A qualitative study to co-design to the medication review, to improve engagement and uptake of the intervention. (Phase 3)
Study 2
An initial feasibility and acceptability study to evaluate and refine components of the medication review from the user perspective before progression to evaluation in a future multi-centre feasibility trial.
Funded by Kidney Research UK Nephrotoxicity Allied Health Professional Fellowship awarded to Mrs Cathy Pogson.
Supervisors - Associate Professor Kinda Ibrahim, Dr Rosalynn Austin, Dr Jignesh Patel, Professor David Wheeler.
In the UK, over 60,000 adult nephrology patients have chronic kidney disease stage G4 and G5, to include dialysis (CKD G4-5D). Almost 48,500 (82%) of these people are prescribed five or more different regular medicines each day (polypharmacy). Over 24,000 (40%) are prescribed 10 or more different regular medicines each day (hyper-polypharmacy). These prescribing levels are associated with risk. Increases are seen in all-cause mortality, kidney failure and a faster eGFR decline for this polypharmacy population. Quality of life is significantly reduced when daily tablet burden exceeds fourteen. Nonadherence, adverse drug reactions, and the prescribing of potentially inappropriate medications are higher. Half of the people experiencing polypharmacy are not taking their medicines as intended. A medication review offers a solution to polypharmacy.
The KDIGO CKD Guideline update (2024) recommend medication reviews should be completed periodically and at transitions of care. In the UK, they are offered in NHS primary care. Patients with CKD G4-5D describe avoiding these reviews as they trust nephrology with their prescribing needs. A scoping review of such medication review interventions identified 21 studies, 18 (86%) were quantitative, 17 (81%) enrolled nephrology out-patients and 17 (81%) involved a kidney specialist pharmacist. Only 2 of these studies were from Europe (France and Norway). No such studies have been conducted in the United Kingdom. A specialist medication review may improve outcomes for people with CKD G4-5D.
Aim:
To develop a medication review for patients with CKD G4-5D using the person-based approach to intervention design, to improve quality of life and reduce harm from medicines, before evaluating the feasibility in nephrology secondary care clinics.
Objectives:
1. To co-design the medication review intervention using the person-based approach integrated with evidence and theory (Study 1)
2. To refine the medication review to determine if amendment or refinement is required before progression to a future multi-centre feasibility study. (Study 2)
Study Design:
A person-based approach to medication review development, using qualitative data collection with behaviour analysis, designed with experts (nephrologists, pharmacists, patients and carers).
Study 1:
•A qualitative study to understand the needs, views and experiences of medication and a medication review in patients with CKD G4-5D held by key stakeholders (patients/carers, nephrologists/kidney pharmacists, GP’s/primary care pharmacists) (Phase 1)
•To develop the guiding principles (the overarching behaviour components) required to improve experience of medication and a medication review. (Phase 2)
A qualitative study to co-design to the medication review, to improve engagement and uptake of the intervention. (Phase 3)
Study 2
An initial feasibility and acceptability study to evaluate and refine components of the medication review from the user perspective before progression to evaluation in a future multi-centre feasibility trial.
Funded by Kidney Research UK Nephrotoxicity Allied Health Professional Fellowship awarded to Mrs Cathy Pogson.
Supervisors - Associate Professor Kinda Ibrahim, Dr Rosalynn Austin, Dr Jignesh Patel, Professor David Wheeler.
