Medication safety in patients with hepatic impairment: a survey of community pharmacists' knowledge level and their practice in caring for these patients

AIMS: To study community pharmacists' level of knowledge on medication safety in patients with hepatic impairment and their practice in caring for these patients.

METHODS: Pharmacists from Dutch community pharmacies (n=1545) were invited to participate in an online survey. The survey consisted of 27 questions covering two main topics: knowledge and current practice. The level of knowledge was measured by a six-item knowledge test. Multiple linear regression was used to identify predictors of correctly answered responses.

RESULTS: In total, 338 pharmacists (22%) completed the questionnaire. The mean knowledge score was 2.8 (SD 1.6). Only 30.3% of respondents were able to appropriately advise on use of analgesics in severe cirrhosis. Postgraduate education on hepatic impairment, knowledge of recently developed practical guidance, and fewer years of practice were associated with a higher level of knowledge. In total, 70.4% indicated to evaluate medication safety in a patient with hepatic impairment at least once weekly. In the past 6 months, 83.3% of respondents consulted a prescriber about a patient with hepatic impairment. Frequently encountered barriers in practice were insufficient knowledge on the topic and a lack of essential patient information (i.e. diagnosis and severity of the impairment).

CONCLUSION: Community pharmacists regularly evaluate the safety of medication in patients with hepatic impairment, yet their level of knowledge was insufficient and additional education is needed. Pharmacists experienced several difficulties in providing pharmaceutical care. If these issues are resolved, pharmacists can play a more active role in ensuring medication safety in their patients with hepatic impairment.