Effects of a medication management system for inpatients with renal impairment at Rong Kwang Hospital, Phrae Province: A retrospective quasi-experimental study
Keywords:
Medication management system, Renal impairment, Appropriateness of drug prescribingAbstract
This study aimed to evaluate the effectiveness of a newly developed medication management system for hospitalized patients with renal impairment. The system comprised 1) a guideline and handbook for renal dose adjustment, 2) an alert system for monitoring and tracking medication use within the electronic medical record, 3) pharmacist review of medication orders to assess prescribing appropriateness, and 4) physician consultation when inappropriate prescribing was identified. Outcomes of patients managed using this system (intervention group, data collected from April to August 2024) were compared with those of patients treated before its implementation (historical control group, data collected from May to September 2023). The primary outcome was the appropriateness of medication prescribing, analyzed using logistic regression. The secondary outcome was the rate of appropriate dose adjustment, analyzed using Poisson regression. All analyses employed multivariable models adjusted for sex, age, estimated glomerular filtration rate (eGFR), and type of renal impairment. Data were collected from 220 patients (110 per group). Most participants were male (56.4%), with a mean age of 71.70 ± 11.99 years, and 51.4% had chronic kidney disease. After implementation, prescribing appropriateness significantly improved (adjusted odds ratio = 11.33, 95% CI 5.81–22.13; p < 0.001). The proportion of inappropriate prescriptions decreased from 53.7% (116 of 216 prescriptions) to 14.3% (28 of 196 prescriptions; p < 0.001). The rate of appropriate dose adjustment also significantly increased (adjusted incidence rate ratio = 2.20, 95% CI 1.67–2.89; p < 0.001). Although this study could not fully establish a causal relationship and residual confounding related to participants’ comorbidities remained, the analysis indicated that the developed medication management system has the potential to improve prescribing appropriateness among patients with renal impairment. Future research should assess clinical outcomes, monitor the severity and consequences of inappropriate prescribing, and explore healthcare providers’ perspectives as system users. In addition, long-term monitoring of system sustainability is warranted, particularly regarding the maintenance of prescribing appropriateness over time.
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