Background: Due to the complexity of their therapeutic regimen, kidney transplant recipients (KTR) are at risk of experiencing adverse drug reactions. Community pharmacists interact with patients on a monthly basis and are uniquely poised to detect drug related problems (DRPs) in this population. Our aim was to develop and validate a list of explicit criteria that can be used by community pharmacists to assess DRPs in KTR.

Methods: Following a modified RAND appropriateness method, a panel of 12 experts (transplant nephrologists and pharmacists, community pharmacists and family physicians) established the PART (Pharmacotherapy Assessment in Renal Transplant Patient) criteria. Two independent pharmacy residents (PART evaluators) prospectively applied the PART list to 97 patients who had received a kidney transplant at least 1 year prior to recruitment. The inter-rater reliability was assessed using kappa statistics, while the conceptual validity was evaluated by comparing the PART list to DRPs identified by the implicit judgment of independent renal transplant pharmacists. We used multiple linear regression to determine characteristics associated with the number of DRPs.

Results: At least one DRP was identified in 68% (95% confidence interval (CI) 0.59, 0.77) of study participants using the PART list, which comprised 70 DRPs in 10 categories (immunosuppressive agents adverse effects, interactions, non-adherence, blood pressure control, diabetes, smoking, mineral bone disease, over the counter drug use, adjustment for graft function, other). The PART evaluators found an average of 1.19 (95% CI 0.97, 1.40) DRPs per patient, while this figure was 1.39 (95% CI 1.14, 1.65) based on the judgment of transplant pharmacist. The inter-rater reliability was excellent (κ: 0.88, 95% CI 0.84, 0.93). In multivariate analysis, the total number of medications taken was the only variable associated with the number of DRPs (β: 0.27 for an increase of 5 medications, 95% CI 0.005, 0.547).

Conclusion: The list of PART criteria is a reliable and valid tool that can help community pharmacists follow-up renal transplant patients' drug regimen in a systematic fashion with the hope of reducing DRPs and their adverse impact on patients.

CITATION INFORMATION: El Raichani L, Du Q, Mathieu A, Almassy S, Lalonde L, Boudreau N, Gélinas-Lemay E, Berbiche D, Cardinal H. Development and Validation of PART (Pharmacotherapy Assessment in Renal Transplant Patients) Criteria to Assess Drug Related Problems in Outpatient Renal Transplant Population. Am J Transplant. 2017;17 (suppl 3).

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