The use of pharmaceutical care to improve health-related quality of life in hemodialysis patients in Iran

Background Compared with the general population, hemodialysis patients suffer from worse health-related quality of life (HRQoL). Poor HRQoL results in the higher risk of hospitalization and mortality. Objective This study was designed to assess the impact of pharmaceutical care on HRQoL of hemodialysis patients. Setting This study was performed in a university hemodialysis center in Iran. Methods At the initiation of the study HRQoL of dialysis patients were assessed using SF-36 instrument and patients’ demographic and laboratory data were gathered. Hemodialysis patients were randomized to receive either only standard care of the ward consisted of brief medication review by nurses and monthly visits by nephrology fellow and attending physicians as the control group or receive clinical pharmacist-led pharmaceutical care in addition to the standard care of the ward as the case group. Finally patients’ HRQoL were assessed at the end of the month six of the study in both groups. Main Outcome Measure Quality of life as measured with the SF-36 was compared between case and control groups and within each group at the initiation and at the end of 6 months study. Results During this study, median (IQR) of HRQoL improved significantly from 56.9 (37.7–71.7) at the initiation of the study to 72.2 (55.3–83.7) at the end of the study in the case group (P = 0.001) especially in the role-emotional [from 66.6 (33.3–66.6) to 100.0 (100.0–100.0); P = 0.001], mental health [from 54.2 (40.8–73.5) to 68.3 (58.9–90.2); P = 0.007], social functioning [from 73.6 (37.5–100.0) to 93.4 (75.0–100.0); P = 0.01], and general health [from 45.0 (30.0–70.0) to 65.0 (48.8–75.0); P = 0.001] dimensions. Conversely, HRQoL did not change or decreased in the control group. This decrease was statistically significant in the general health domain [from 47.5 (33.8–56.3) to 40.0 (23.7–51.2); P = 0.04]. Conclusion Providing pharmaceutical care significantly improved HRQoL of hemodialysis patients especially in the role-emotional, mental health, social functioning, and general health dimensions.