A pharmacy medication alert system based on renal function in older patients

Authors: Geerts, Arjen FJ1; Scherpbier-de Haan, Nynke D2; de Koning, Fred HP3; van der Sterren, Tim MJW2; van Weel, Chris2; Vervoort, Gerald MM2; de Smet, Peter AGM4; de Grauw, Wim JC2

Source: British Journal of General Practice, 1 August 2012, vol. 62, no. 601, pp. e525-e529(5)


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Patients with diabetes or cardiovascular disease are at risk of reduced renal function and frequently use drugs that interact with renal function. GPs monitor renal function in these patients. Computerised prescription systems produce alerts in patients labelled as having chronic kidney disease, but alerts are often ignored. If pharmacists use a pharmacy medication alert system (PMAS) based on renal function, they can provide the GP with therapeutic advice to optimise the medication. The extent of this advice and the feasibility in the clinical context are unknown.


To assess the therapeutic advice formulated by pharmacists with help of a PMAS based on the renal function of patients aged ≥70 years with diabetes or cardiovascular disease.

Design and setting:

Observational study in primary health care in the Netherlands.


GPs provided pharmacists with the renal function of older patients with diabetes or cardiovascular disease who were using target drugs, that is, drugs requiring therapeutic advice in patients with reduced renal function. With the help of a PMAS, pharmacists assessed the actual medication. The GP weighed the advice in relation to the clinical context of the individual patient.


Six hundred and fifty patients were prescribed 1333 target drugs. Pharmacists formulated 143 therapeutic recommendations (11% of target drugs) concerning 89 patients (13.7% of study population). In 71 recommendations in 52 patients (8.0% of study population), the GP agreed immediately.


The use of a PMAS resulted in therapeutic advice in 11% of the target drugs. After weighing the clinical context, the GP agreed with half of the advice.

Keywords: aged; medication alert systems; medication errors; primary health care; renal insufficiency

Document Type: Research Article

DOI: http://dx.doi.org/10.3399/bjgp12X653561

Affiliations: 1: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, the Netherlabds; Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands 2: Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands 3: Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands 4: Departments of Clinical Pharmacy and IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

Publication date: August 1, 2012


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