A Qualitative Assessment of the Saskatchewan Medication Assessment Program in Patients with Renal Failure or Renal Replacement

Abstract

Background: The Saskatchewan Medication Assessment Program (SMAP) is a provincially funded service enabling community pharmacists to perform medication reviews for eligible Saskatchewan residents, with the goal of optimizing patient care. Individuals with renal failure, and/or those requiring renal replacement therapy have unique needs and receive specialized care provided by nephrologists and renal pharmacists. Little is known about the benefits and/or challenges of performing community based medication assessments in complex populations. Objective: A qualitative analysis was undertaken to examine the perceptions of health care providers involved in the SMAP process in complex patients (i.e. renal patients). Methods: All nephrologists, renal pharmacists, and community pharmacies in Saskatoon and Regina were sent an invitation to participate in the study. A semi-structured interview was completed with interested participants, and the interviews were audio-recorded and transcribed verbatim. Coding was performed using NVIVO qualitative software to identify common themes. Results: Ten renal pharmacists, eight nephrologists, and nine community pharmacists were interviewed. Community pharmacists had mixed levels of comfort providing SMAPs for renal patients, but expressed the desire to provide the best care possible. Some themes were consistent amongst all participant groups including ‘the importance of collaboration/communication’, ‘challenges’ and ‘suggestions for improvements’. Specific themes such as ‘unique needs of renal patients’ and ‘duplication of service’ were common amongst both renal pharmacists and nephrologists. The nephrologists had very little knowledge of the program and of the role of the community pharmacist, indicating the need for improved education and communication. Conclusion: Despite some negative experiences, none of the participants believed the program should be eliminated. Several recommendations, however, are suggested to improve the SMAP process in renal patients.