• Lyne Lalonde, Patricia Quintana-Bárcena, Anne Lord, Robert Bell, Valérie Clément, Anne-Marie Daigneault, Marie-Ève Legris, Sara Letendre, Marie Mouchbahani, Ghaya Jouini, Joëlle Azar, Élisabeth Martin, Djamal Berbiche, Stephanie Beaulieu, Sébastien Beaunoyer, Émilie Bertin, Marianne Bouvrette, Noémie Charbonneau-Séguin, Jean-François Desrochers, Katherine Desforges, Ariane Dumoulin-Charette, Sébastien Dupuis, Maryame El Bouchikhi, Roxanne Forget, Marianne Guay, Jean-Phillippe Lemieux, Claudia Morin-Bélanger, Isabelle Noël, Stephanie Ricard, Patricia Sauvé, and François Ste-Marie Paradis.
• Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Hôpital Cité de la Santé de Laval, Quebec, Canada. Electronic address: lyne.lalonde@umontreal.ca.
• Am. J. Kidney Dis. 2017 Sep 1; 70 (3): 386-396.

BackgroundAppropriate training for community pharmacists may improve the quality of medication use. Few studies have reported the impact of such programs on medication management for patients with chronic kidney disease (CKD).Study DesignMulticenter, cluster-randomized, controlled trial.Setting & ParticipantsPatients with CKD stage 3a, 3b, or 4 from 6 CKD clinics (Quebec, Canada) and their community pharmacies.InterventionEach cluster (a pharmacy and its patients) was randomly assigned to either ProFiL, a training-and-communication network program, or the control group. ProFiL pharmacists completed a 90-minute interactive web-based training program on use of medications in CKD and received a clinical guide, patients' clinical summaries, and facilitated access to the CKD clinic.OutcomesDrug-related problems (primary outcome), pharmacists' knowledge and clinical skills, and patients' clinical attributes (eg, blood pressure and glycated hemoglobin concentration).MeasurementsDrug-related problems were evaluated the year before and after the recruitment of patients using a validated set of significant drug-related problems, the Pharmacotherapy Assessment in Chronic Renal Disease (PAIR) criteria. Pharmacists' questionnaires were completed at baseline and after 1 year. Clinical attributes were documented at baseline and after 1 year using available information in medical charts.Results207 community pharmacies, 494 pharmacists, and 442 patients with CKD participated. After 1 year, the mean number of drug-related problems per patient decreased from 2.16 to 1.60 and from 1.70 to 1.62 in the ProFiL and control groups, respectively. The difference in reduction of drug-related problems per patient between the ProFiL and control groups was -0.32 (95% CI, -0.63 to -0.01). Improvements in knowledge (difference, 4.5%; 95% CI, 1.6%-7.4%) and clinical competencies (difference, 7.4%; 95% CI, 3.5%-11.3%) were observed among ProFiL pharmacists. No significant differences in clinical attributes were observed across the groups.LimitationsHigh proportion of missing data on knowledge and clinical skills questionnaire (34.6%) and clinical attributes (11.1%).ConclusionsProviding community pharmacists with essential clinical data, appropriate training, and support from hospital pharmacists with expertise in nephrology increases pharmacists' knowledge and reduces drug-related problems in patients with CKD who are followed up in clinics incorporating a multidisciplinary health care team.Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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