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Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients
Author(s) -
Taber David J.,
Gebregziabher Mulugeta,
Posadas Aurora,
Schaffner Caitlin,
Egede Leonard E.,
Baliga Prabhakar K.
Publication year - 2018
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1024
Subject(s) - medicine , diabetes mellitus , blood pressure , kidney disease , renal function , pharmacist , risk factor , pharmacy , endocrinology , family medicine
Background Health disparities in African‐American (AA) kidney transplant recipients compared with non‐AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. Objective To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. Methods Prospective, pharmacist‐led, technology‐aided, 6‐month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one‐year posttransplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent‐to‐treat analyses, with differences assessed between AA and non‐AA recipients. Results The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs end of study 68%, P = 0.054) and hemoglobin A1c (HgbA1c) <7% (baseline 33% vs end of study 47%, P = 0.061). African‐Americans demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, P = 0.026), which was not evident in non‐AAs (−0.13 mmHg per month, P = 0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, P = 0.003), which was similar within AAs (−0.11% per month, P = 0.004) and non‐AAs (−0.14% per month, P = 0.029). There were no changes in low‐density lipoproteins, triglycerides, or high‐density lipoproteins over the course of the study. Medication errors were significantly reduced and self‐reported medication adherence significantly improved over the course of the study. Conclusion These results demonstrate the potential efficacy of a pharmacist‐led, technology‐aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients ( ClinicalTrials.gov NCT02763943).