Effect of Pharmaceutical Care on Adherence, Drug-Related Problems, Cost of Illness, and Quality of Life in Hemodialysis Outpatients

Background: Complex treatment regimens in hemodialysis patients often lead to drug-related problems (DRPs), non-adherence, diminished quality of life, and a high medical cost burden. This presents an opportunity to implement pharmaceutical care to optimize patients' therapeutic outcomes. Objective: This study aimed to analyze medication adherence, drug-related problems (DRPs), cost of illness (COI), and quality of life in hemodialysis patients following a pharmacist-led pharmaceutical care intervention. Methods: A single-group, quasi-experimental study with a pre-test and post-test design was conducted using total sampling from March to June 2026 at Meuraxa Regional General Hospital, Banda Aceh. The pharmaceutical care intervention included medication reconciliation, pharmacotherapy review,individual counseling using the "teach-back" method, and medication monitoring. Adherence was assessed using the Medication Adherence Report Scale-5 (MARS-5) questionnaire; DRPs were evaluated using the Pharmaceutical Care Network Europe (PCNE) classification (version 9.1); COI was analyzed to determine the magnitude and composition of direct medical costs; and quality of life was measured using the WHOQOL-BREF questionnaire. Data were analyzed using non-parametric tests, specifically the Wilcoxon signed-rank test and the Friedman test (for COI). Results: Patient adherence significantly increased by 67.6% (p<0.001), and the incidence of DRPs decreased from 63 to 32 occurrences (p=0.022). Patients' quality of life improved by 54.2% (p<0.001). The difference in costs between the pre-test and post-test was not statistically significant after Bonferroni correction (p=0.045), although the cost per dialysis visit decreased by 5.8%. Conclusion: Pharmaceutical care can improve medication adherence, reduce the incidence of DRPs, and enhance the quality of life of hemodialysis patients. Controlled studies are required to establish causality and economic benefits.