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Multidisciplinary education approach to optimize phosphate control among hemodialysis patients.
Int J Clin Pharm. 2019 Oct; 41(5):1282-1289.IJ

Abstract

Background Hyperphosphatemia is a common consequence in end stage renal disease. It is associated with increased cardiovascular risk and mortality, also development of hyperparathyroidism and mineral bone disease. A patient educational program involving physician, pharmacist and dietician was developed to manage hyperphosphatemia among hemodialysis patients. Objective To investigate the efficacy of the program in optimal phosphate control among hemodialysis patients. Setting Kuala Lipis Hospital, Malaysia. Method This was a non-randomized, single-arm community trial running for a period of 6 months. The program consisted of a small group seminar and individual counseling sessions. Two individual counseling sessions were conducted for each patient, focusing on diet and medication adherence, by an accredited dietician and pharmacist respectively. The group seminar was delivered by a multidisciplinary team involving a physician, pharmacist and dietician. Topics included basic knowledge of hyperphosphatemia, phosphate binder and dietary phosphate control. Eligible and consented patients had knowledge and medication adherence assessment, measurement of pre-dialysis serum calcium, albumin, phosphate, haemoglobin and alkaline phosphatase before and after the educational program. Main outcome measure Phosphate level, knowledge and medication adherence assessment. Results Fifty-seven patients completed the program and were included into final data analysis. The median (IQR) phosphate level (mmol/L) was 1.86 (1.45-2.24) before and decreased to 1.47 (1.21-1.91) and 1.49 (1.28-1.81) 3 months and 6 months after PEP (p < 0.001). The percentage of patients with uncontrolled phosphate level was reduced from 59.3 to 35.6% and 42.1% after the PEP (p = 0.003). The mean knowledge score almost doubled after the intervention, with a mean pre-score of 8.61 (95% CI 7.85-9.37) to mean post-score of 15.31 (95% CI 14.85-15.76). The adherence to phosphate binder also improved from 17.2 to 41.4% after PEP (p = 0.007). Conclusion A multidisciplinary patient education program is an effective approach to manage hyperphosphatemia among hemodialysis patients in Malaysia.

Authors+Show Affiliations

Department of General Medicine, Kuala Lipis Hospital, 27200, Kuala Lipis, Pahang, Malaysia.Department of Pharmacy, Kuala Lipis Hospital, 27200, Kuala Lipis, Pahang, Malaysia. hueymiin@moh.gov.my. Department of Pharmacy, Sultan Haji Ahmad Shah Hospital, Jalan Maran, 28000, Temerloh, Pahang, Malaysia. hueymiin@moh.gov.my.Department of Dietary and Nutrition, Kuala Lipis Hospital, 27200, Kuala Lipis, Pahang, Malaysia.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

31302884

Citation

Chan, Meei Wah, et al. "Multidisciplinary Education Approach to Optimize Phosphate Control Among Hemodialysis Patients." International Journal of Clinical Pharmacy, vol. 41, no. 5, 2019, pp. 1282-1289.
Chan MW, Cheah HM, Mohd Padzil MB. Multidisciplinary education approach to optimize phosphate control among hemodialysis patients. Int J Clin Pharm. 2019;41(5):1282-1289.
Chan, M. W., Cheah, H. M., & Mohd Padzil, M. B. (2019). Multidisciplinary education approach to optimize phosphate control among hemodialysis patients. International Journal of Clinical Pharmacy, 41(5), 1282-1289. https://doi.org/10.1007/s11096-019-00878-4
Chan MW, Cheah HM, Mohd Padzil MB. Multidisciplinary Education Approach to Optimize Phosphate Control Among Hemodialysis Patients. Int J Clin Pharm. 2019;41(5):1282-1289. PubMed PMID: 31302884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multidisciplinary education approach to optimize phosphate control among hemodialysis patients. AU - Chan,Meei Wah, AU - Cheah,Huey Miin, AU - Mohd Padzil,Madihah Binti, Y1 - 2019/07/13/ PY - 2019/01/17/received PY - 2019/07/03/accepted PY - 2019/7/16/pubmed PY - 2020/3/12/medline PY - 2019/7/15/entrez KW - Education KW - Hemodialysis KW - Malaysia KW - Mineral bone disease KW - Multidisciplinary KW - Phosphate SP - 1282 EP - 1289 JF - International journal of clinical pharmacy JO - Int J Clin Pharm VL - 41 IS - 5 N2 - Background Hyperphosphatemia is a common consequence in end stage renal disease. It is associated with increased cardiovascular risk and mortality, also development of hyperparathyroidism and mineral bone disease. A patient educational program involving physician, pharmacist and dietician was developed to manage hyperphosphatemia among hemodialysis patients. Objective To investigate the efficacy of the program in optimal phosphate control among hemodialysis patients. Setting Kuala Lipis Hospital, Malaysia. Method This was a non-randomized, single-arm community trial running for a period of 6 months. The program consisted of a small group seminar and individual counseling sessions. Two individual counseling sessions were conducted for each patient, focusing on diet and medication adherence, by an accredited dietician and pharmacist respectively. The group seminar was delivered by a multidisciplinary team involving a physician, pharmacist and dietician. Topics included basic knowledge of hyperphosphatemia, phosphate binder and dietary phosphate control. Eligible and consented patients had knowledge and medication adherence assessment, measurement of pre-dialysis serum calcium, albumin, phosphate, haemoglobin and alkaline phosphatase before and after the educational program. Main outcome measure Phosphate level, knowledge and medication adherence assessment. Results Fifty-seven patients completed the program and were included into final data analysis. The median (IQR) phosphate level (mmol/L) was 1.86 (1.45-2.24) before and decreased to 1.47 (1.21-1.91) and 1.49 (1.28-1.81) 3 months and 6 months after PEP (p < 0.001). The percentage of patients with uncontrolled phosphate level was reduced from 59.3 to 35.6% and 42.1% after the PEP (p = 0.003). The mean knowledge score almost doubled after the intervention, with a mean pre-score of 8.61 (95% CI 7.85-9.37) to mean post-score of 15.31 (95% CI 14.85-15.76). The adherence to phosphate binder also improved from 17.2 to 41.4% after PEP (p = 0.007). Conclusion A multidisciplinary patient education program is an effective approach to manage hyperphosphatemia among hemodialysis patients in Malaysia. SN - 2210-7711 UR - https://www.unboundmedicine.com/medline/citation/31302884/Multidisciplinary_education_approach_to_optimize_phosphate_control_among_hemodialysis_patients_ L2 - https://dx.doi.org/10.1007/s11096-019-00878-4 DB - PRIME DP - Unbound Medicine ER -