Document Type


Publication Date



Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Pharmacy

MeSH Headings

Humans, Renal Dialysis, Pharmacy Service, Hospital, Medication Errors, Medication Reconciliation, Pharmacists, Outpatients, Health Facilities


Purpose/Background: Patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) are a vulnerable population experiencing high pill burden, low medication adherence rates, multiple comorbidities, and frequent transitions of care. Clinical Pharmacists are highly trained members of the interdisciplinary team who possess the necessary skills to assess and improve drug-related problems in this population. The aim of this study was to evaluate clinical pharmacist integration into an outpatient dialysis center and to determine the impact of pharmacist intervention on medication list accuracy, patient education and adherence to medications used in the management of ESRD.

Methods/Approach: The project was conducted at an outpatient dialysis center in Southern Maine. The pharmacist provided clinical services once weekly for 6 months for all patients receiving dialysis. The pharmacist interacted with the patients on three separate, scheduled occasions. The first visit included medication reconciliation, a baseline assessment of adherence using an eight-item questionnaire, and assessment of phosphorus binder understanding using a five-item questionnaire. The second visit focused on education regarding phosphate binders and a review of patients’ other medications. During the third visit, the pharmacist conducted a post-intervention adherence and knowledge assessment of the education provided. Baseline patient demographic information was collected and pre- and post-intervention serum phosphorus levels were recorded along with medication list discrepancies. Patient scores on both the adherence and phosphorus binder understanding questionnaires were assessed. This project was deemed as quality improvement by the Maine Medical Center Institutional Review Board.

Results A total of 21 out of 28 eligible patients completed the entire pharmacist pilot program Majority of patients were white and male (88% and 56% respectively) and 48% of patients reported an educational level that was greater than high school. Common comorbid conditions observed included diabetes, hypertension and dyslipidemia. Median time on dialysis was 2 years (range 0.5-10 years). Medication list discrepancies were detected in 100% of patients who completed medication reconciliation by the pharmacist, with a median of 6 discrepancies per patient (range 2-13). For patients who completed the entire program, serum phosphorus levels decreased significantly by a median of -0.40 mg/dL at 1 month post pharmacist intervention (p=0.028). Additionally, the number of patients reporting “never” missing a dose of phosphorus binder in the past week significantly increased after pharmacist intervention (23.8% before and 57.1% after, p= 0.033). There was a statistically significant increase in phosphorus binder education scores after pharmacist intervention (pre median score of 2, post median score of 5, p<0.001).

Conclusion Patients receiving medication reconciliation services and medication education from the clinical pharmacist at an outpatient dialysis center experienced decreased serum phosphorus levels, improvements in self-reported phosphorus binder adherence and an improved understanding of their phosphorus binder therapy as evidenced by the improvement in their education scores. Medication list discrepancies were detected in all patients receiving medication reconciliation services by the pharmacist. The evaluation of this clinical pharmacist pilot program demonstrates the positive impact that a pharmacist can have on this patient population.


2020 Costas T. Lambrew Research Retreat, 2020 Maine Nephrology Associates Himmelfarb Research Prize and Award for Excellence in Quality Improvement Research Winner