A study to scope structures, processes and related outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease.

Chronic kidney disease (CKD) is a complex health-related comorbidity with an enormous economic burden on any healthcare system globally. Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. However, published literature shows there is a lack of robust evidence for the role of clinical pharmacists in providing care to patients with CKD. The overall aim of this doctoral research was to investigate the structures, processes and related outcomes of clinical pharmacy practice in the care of patients with CKD. This doctoral research was undertaken under two stages. Stage 1 was a systematic review to appraise, synthesize and present the available evidence on the structures, processes and related outcomes of clinical pharmacy practice in the care of patients with CKD. While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists' involvement in the multidisciplinary team providing care to patients with CKD, more high-quality research is warranted. A sequential explanatory design underpinned by the Consolidated Framework of Implementation Research (CFIR) was employed in Stage 2 of this doctoral research. It was executed in two phases of data generation. The findings from the first phase informed the subsequent phase. In Phase 1, an online theoretically based cross-sectional survey was conducted on the behaviours and experiences of clinical pharmacists caring for patients with CKD. Seventy-one respondents completed the survey with a response rate of 50%. The majority of respondents provided general pharmaceutical care to dialysis and transplant patients, were confident in their abilities and tried new ways of working including independent prescribing. There was high level of agreement among the respondents in relation to CFIR items for clinical practice. Most respondents strongly agreed / agreed with CFIR items for prescribing practice, yet 39.6% disagreed that they had sufficient cover for their prescribing duties when they are away. Many expressed that lack of resources was the main barrier to providing more advanced care. Further work is needed to explore these matters in more depth. Phase 2 of Stage 2 involved a semi-structured qualitative interview with clinical pharmacist prescribers' members of the UK Renal Pharmacy Group involved in the care of patients with CKD. Data saturation was confirmed after completing and analysing 14 interviews. The key findings of the interviews demonstrated positive views of prescribing practice for patients with CKD among the pharmacists. Underpinning the research with CFIR helped identify the key facilitators and barriers to the implementation of prescribing practice and facilitated identifying key areas for further developing the service. Overall, this doctoral research produced original contribution to knowledge in the area of clinical pharmacy services in the care for patients with CKD in the UK and with emphasis of prescribing practice. The rigorous and robust findings from Stage 2 of the research can help further develop pharmacy practice and prescribing practice in the care for patients with CKD. More research is needed to explore the potential to implement such practices in a wider context