S. C. Vranian1, K. L. Covert2, C. R. Mardis3, J. W. McGillicuddy1, K. D. Chavin1, D. Dubay1, D. J. Taber1 1Medical University Of South Carolina,Divison Of Transplant Surgery,Charleston, SC, USA 2Medical University Of South Carolina,Department Of Pharmacy Services,Charleston, SC, USA 3Medical University Of South Carolina,Transplant Service Line,Charleston, SC, USA
Introduction: There are limited studies seeking to identify patients at high risk for medication errors and subsequent adverse clinical outcomes in transplant. This study aimed to identify significant risk factors for deleterious outcomes in kidney transplant recipients based on drug-related problems (DRPs) and self-administered surveys.
Methods: This was a prospective observational study. Adult kidney transplant recipients with a clinic visit at our facility between Sept. and Nov. 2015 were eligible to participate. Patients were surveyed for self-reported demographics, medication adherence and health status/outlook. We assessed for associations between survey results, pharmacist-derived DRPs and health resource utilization over an 8-month follow-up period. Based on significant associations, two patient risk cohorts were identified and compared for health care utilization using Poisson regression analysis.
Results: 237 patients completed the survey and were included with mean follow-up of 8 months. For the patient-reported data, those that receive Medicaid insurance or rated their health as poor (M/PHS) were identified as a significant risk cohort. For pharmacist assessment, patients that were receiving an incorrect medication or did not have appropriate follow-up meidcation monitoring were identified as a significant risk cohort (pharmacy errors [PE]). The M/PHS cohort experienced 11.4 encounters per patient year and the PE cohort experienced 34.2 encounters per patient year, while the non-risk cohorts experienced 8.8 and 9.0 encounters per patient year, respectively. Poisson regression demonstrated that the M/PHS cohort experienced 43% more total encounters (p<0.05), 31% more admissions and 35% more outpatient transplant clinic visits (p<0.05). The PE cohort experienced 4.2 times more total encounters (p<0.05), 4.1 times more admissions (p<0.05) and 2.3 times more outpatient transplant clinic visits (p<0.05). A composite cohort comprising of either M/PHS or PE patients experienced 56% more total encounters (p<0.05), 58% more admissions (p<0.05) and 41% more outpatient transplant clinic visits (p<0.05).
Conclusions: This prospective observational study identified both patient-reported and pharmacist-derived risk factors that were associated with a significant increase in health care encounters; these risks included Medicaid insurance, poor self-reported health status, medication errors and lack of proper medication monitoring. These factors increased the rate of health care encounters by 30 to 400% during an 8-month follow-up period. Further research is warranted to validate these risks, determine their impact on graft and patient survival and develop risk-mitigation strategies to improve patient care and outcomes.
