RESEARCH ARTICLE Outcomes of pharmacist-provided medication review in collaborative care for adult Singaporeans receiving hemodialysis Bih Yee Chia 1 • McVin Hua Heng Cheen 1,2 • Xin Yi Gwee 1 • Melissa Mee Yin Chow 1 • Giat Yeng Khee 1 • Wan Chee Ong 1 • Hui Lin Choong 3 • Paik Shia Lim 1 Received: 24 February 2017 / Accepted: 11 August 2017 Ó Springer International Publishing AG 2017 Abstract Background Patients receiving hemodialysis are predisposed to drug related problems (DRPs). While col- laborative care (CC) models with pharmacist involvement can reduce DRP occurrence, few have examined its impact on clinical and economic outcomes. Objective To deter- mine whether a CC model with pharmacist-provided medication review can reduce unplanned admissions and healthcare utilization in patients receiving hemodialysis, compared to usual care (UC). Setting Outpatient nephrol- ogy clinic of a tertiary hospital in Singapore. Method In this retrospective observational study, patients who were taking more than 10 medications or had prior unplanned admissions were included. Patients were identified as being managed under CC (n = 134) if they received compre- hensive pharmacist-provided review, or under the UC (n = 190) if they did not. Those perceived to be at greater risk were given priority for receiving CC. All outcomes analyses were adjusted for covariates. Main outcome measure The primary outcome was incidence of unplanned admissions within 6 months post index visit. Secondary outcomes included length of stay (LOS), mortality and healthcare utilization cost. Results CC reduced unplanned admissions by 27% (IRR 0.73, 95% CI 0.54–0.99, p = 0.047) and shortened mean LOS by 1.3 days [6.7 (2.6) vs. 8.0 (3.2), p \ 0.001] compared to UC. There were no significant differences in mortality (p = 0.189) or mean healthcare utilization cost (p = 0.165) between groups. Pharmacists identified 515 DRPs with 429 (83.3%) resolved after review. Conclusion The CC model with pharmacist-provided medication review reduced unplanned admissions and LOS in patients receiving hemodialysis. Further studies are warranted to confirm reductions in mortality and healthcare utilization. Keywords Collaborative care Á Cost analysis Á Hemodialysis Á Hospital admissions Á Medication review Á Pharmacist Á Singapore Impacts on practice • Drug related problems, in particular medication non- adherence, are highly prevalent among hemodialysis patients. Pharmacists can potentially address these issues and improve dialysis outcomes. • Integrating pharmacist-provided medication review into a collaborative care model in the care of patients receiving hemodialysis can reduce unplanned hospital admissions and length of stay. Introduction Patients receiving hemodialysis often have to manage multiple comorbidities including anemia, mineral bone disease, cardiovascular diseases, hypertension and hyper- lipidemia. Consequently, they are subjected to polyphar- macy and frequent medication changes [1, 2]. This combination of factors places them at high risk of drug- & Paik Shia Lim lim.paik.shia@sgh.com.sg 1 Department of Pharmacy, Singapore General Hospital, Singapore, Singapore 2 Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore 3 Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore 123 Int J Clin Pharm DOI 10.1007/s11096-017-0528-1