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Pharmacist‐Driven Renal Medication Dosing Intervention in a Primary Care Patient‐Centered Medical Home
Author(s) -
Barnes Kelli D.,
Tayal Neeraj H.,
Lehman Amy M.,
Beatty Stuart J.
Publication year - 2014
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1508
Subject(s) - medicine , kidney disease , renal function , dosing , pharmacist , aspirin , medical home , pharmacy , medical record , intensive care medicine , emergency medicine , primary care , family medicine
Purpose The purposes of this population management intervention were to identify patients with stage 3, 4, or 5 chronic kidney disease ( CKD ) and to improve care in a patient‐centered medical home ( PCMH ). Objectives of the intervention were to (i) increase the identification of CKD , (ii) increase the use of aspirin and angiotensin‐converting enzyme inhibitors ( ACE ‐Is) or angiotensin II receptor blockers ( ARB s) in patients with CKD , and (iii) ensure that all medications prescribed to patients with CKD were dosed appropriately based on renal function. Setting This intervention was completed at a National Committee for Quality Assurance tier 3 PCMH associated with a major, academic health system. Patients A list of 328 patients with an estimated glomerular filtration rate of < 60 mL/min per 1.73 m 2 was generated using the electronic medical record; 146 patients underwent the intervention. Measurements and Observations A pharmacist review of the electronic medical record was completed to confirm stage 3, 4, or 5 CKD based on estimated glomerular filtration rate, to ensure that ACE ‐Is/ ARBs and aspirin were prescribed, and to ensure that all medications were dosed appropriately based on renal dosing adjustment recommendations. Recommendations were made to improve medication use and safety in patients with CKD . Before intervention, 73% of patients were prescribed an ACE ‐I/ ARB and 72% of patients were prescribed aspirin. After the intervention, use of these medications increased to 77% and 82% of patients, respectively. Pharmacist recommendations to adjust medication dosing based on Cockcroft‐Gault calculated creatinine clearance were made for 138 medications (0.95 medication per patient); 90 (65.2%) recommendations were accepted by the patients’ physicians. Conclusion These results demonstrate the impact of a pharmacist‐driven renal medication dosing intervention within a PCMH on medication use and safety for patients with CKD .