Evaluation of a training and communication-network nephrology program for community pharmacists

ProFiL (Programme de Formation et de Liaison) is a training and communication-network program designed to facilitate pharmaceutical care by community pharmacists. It comprises: 1) a training workshop; 2) a communication network to facilitate transfer of clinical information between a predialysis clinic and community pharmacies; and 3) a consultation service by hospital pharmacists with nephrology expertise. Between September and November 2004, all Laval (Canada) community pharmacies were asked to participate and randomly assigned to the ProFiL or usual-care (UC) group. ProFiL pharmacists attended a training workshop in November or December 2004. Patients of participating pharmacies attending a predialysis clinic were recruited between January and May 2005 and evaluated at baseline and six months. A three-hour workshop was developed by pharmacists and nephrologists. The objectives were to: 1) update basic knowledge on drug therapy in CKD to facilitate detection, prevention and management of DRPs; 2) familiarize pharmacists with ProFiL; 3) review administrative rules governing pharmaceutical opinions; and 4) meet the predialysis health care professionals. The workshop was offered on three occasions in November 2004 and December 2004. Pharmacists received 5.4 continuing education credits from the Quebec Order of Pharmacists. By the end of the workshop, it was expected that pharmacists would be able to: 1) identify nephrotoxic medications and propose alternatives to avoid their use; 2) adjust medication dosage in CKD; 3) write a pharmaceutical opinion; and 4) provide counselling on over-the-counter medications. The workshop included lecture presentations on: 1) clinical presentation of CKD (15 minutes) by a nephrologist; 2) management of DRPs in CKD (15 minutes) by a hospital pharmacist with expertise in nephrology; 3) writing of pharmaceutical opinions (15 minutes) by a community pharmacist; and 4) presentation of the ProFiL clinical tools (10 minutes by a pharmacist, including medication dosage adjustment tables for prescribed medications, over-the-counter medications and natural products. Two case studies (60 minutes) on the management of moderate and severe CKD were discussed in group of three or four pharmacists and within the entire group. Pharmacists had to use the information provided on the ProFiL clinical tools to identify DRPs and write a pharmaceutical opinion. If needed pharmacists responsible for the consultation service were available to answer questions.