Orals in the Bundle: Meds Matter

Patients with ESRD are the most medication-burdened of all the chronically ill. They take an average of 8 to 10 different medications, consuming more than 20 pills per day. It is not surprising, therefore, that the ability of nephrologists, dialysis facilities and patients to manage these medications is a challenge. Patients often do not know what medications they are on, and the monthly “pill check”—usually a shoebox filled with medication bottles—is notoriously inaccurate (1). More importantly, it has been estimated that up to a third of hospitalizations among the frail elderly (which includes a significant number of ESRD patients), and nearly half of re-hospitalizations in this population, are related to medication errors or adverse reactions. Finally, because of the large pill burden, the high costs of some medications and the significant occurrence of adverse events, adherence to prescribed medications is suboptimal (2).

Integrated pharmacy services can help resolve many of these issues for ESRD patients, as recently demonstrated by Weinhandl et al (3). This study compared nearly 9,000 patients enrolled in the DaVita Rx full-service pharmacy program to more than 40,000 control patients not in the program. Read more…