A pharmacist based intervention to improve the care of patients with CKD

A pragmatic, randomized, controlled trial

Danielle Cooney, Helen Moon, Yang Liu, Richard Tyler Miller, Adam Perzynski, Brook Watts, Paul E. Drawz

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease (CKD). Multidisciplinary efforts may improve care for patients with chronic disease. Pharmacist based interventions have effectively improved management of hypertension. We performed a pragmatic, randomized, controlled trial to evaluate the effect of a pharmacist based quality improvement program on 1) outcomes for patients with CKD and 2) adherence to CKD guidelines in the primary care setting. Methods: Patients with moderate to severe CKD receiving primary care services at one of thirteen community-based Veterans Affairs outpatient clinics were randomized to a multifactorial intervention that included a phone-based pharmacist intervention, pharmacist-physician collaboration, patient education, and a CKD registry (n = 1070) or usual care (n = 1129). The primary process outcome was measurement of parathyroid hormone (PTH) during the one year study period. The primary clinical outcome was blood pressure (BP) control in subjects with poorly controlled hypertension at baseline. Results: Among those with poorly controlled baseline BP, there was no difference in the last recorded BP or the percent at goal BP during the study period (42.0% vs. 41.2% in the control arm). Subjects in the intervention arm were more likely to have a PTH measured during the study period (46.9% vs. 16.1% in the control arm, P <0.001) and were on more classes of antihypertensive medications at the end of the study (P = 0.02). Conclusions: A one-time pharmacist based intervention proved feasible in patients with CKD. While the intervention did not improve BP control, it did improve guideline adherence and increased the number of antihypertensive medications prescribed to subjects with poorly controlled BP. These findings can inform the design of quality improvement programs and future studies which are needed to improve care of patients with CKD. Trial registration: ClinicalTrials.gov: NCT01290614.

Original languageEnglish (US)
Article number56
JournalBMC Nephrology
Volume16
Issue number1
DOIs
StatePublished - Dec 1 2015

Fingerprint

Chronic Renal Insufficiency
Pharmacists
Patient Care
Randomized Controlled Trials
Blood Pressure
Primary Health Care
Quality Improvement
Parathyroid Hormone
Antihypertensive Agents
Guidelines
Hypertension
Guideline Adherence
Veterans
Patient Education
Ambulatory Care Facilities
Registries
Chronic Disease
Physicians

Keywords

  • Care management
  • Chronic disease
  • Hypertension
  • Medical informatics
  • Randomized trials

ASJC Scopus subject areas

  • Nephrology

Cite this

A pharmacist based intervention to improve the care of patients with CKD : A pragmatic, randomized, controlled trial. / Cooney, Danielle; Moon, Helen; Liu, Yang; Miller, Richard Tyler; Perzynski, Adam; Watts, Brook; Drawz, Paul E.

In: BMC Nephrology, Vol. 16, No. 1, 56, 01.12.2015.

Research output: Contribution to journalArticle

Cooney, Danielle ; Moon, Helen ; Liu, Yang ; Miller, Richard Tyler ; Perzynski, Adam ; Watts, Brook ; Drawz, Paul E. / A pharmacist based intervention to improve the care of patients with CKD : A pragmatic, randomized, controlled trial. In: BMC Nephrology. 2015 ; Vol. 16, No. 1.
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abstract = "Background: Primary care providers do not routinely follow guidelines for the care of patients with chronic kidney disease (CKD). Multidisciplinary efforts may improve care for patients with chronic disease. Pharmacist based interventions have effectively improved management of hypertension. We performed a pragmatic, randomized, controlled trial to evaluate the effect of a pharmacist based quality improvement program on 1) outcomes for patients with CKD and 2) adherence to CKD guidelines in the primary care setting. Methods: Patients with moderate to severe CKD receiving primary care services at one of thirteen community-based Veterans Affairs outpatient clinics were randomized to a multifactorial intervention that included a phone-based pharmacist intervention, pharmacist-physician collaboration, patient education, and a CKD registry (n = 1070) or usual care (n = 1129). The primary process outcome was measurement of parathyroid hormone (PTH) during the one year study period. The primary clinical outcome was blood pressure (BP) control in subjects with poorly controlled hypertension at baseline. Results: Among those with poorly controlled baseline BP, there was no difference in the last recorded BP or the percent at goal BP during the study period (42.0{\%} vs. 41.2{\%} in the control arm). Subjects in the intervention arm were more likely to have a PTH measured during the study period (46.9{\%} vs. 16.1{\%} in the control arm, P <0.001) and were on more classes of antihypertensive medications at the end of the study (P = 0.02). Conclusions: A one-time pharmacist based intervention proved feasible in patients with CKD. While the intervention did not improve BP control, it did improve guideline adherence and increased the number of antihypertensive medications prescribed to subjects with poorly controlled BP. These findings can inform the design of quality improvement programs and future studies which are needed to improve care of patients with CKD. Trial registration: ClinicalTrials.gov: NCT01290614.",
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