New models of chronic kidney disease care including pharmacists: improving medication reconciliation and medication management.
OBJECTIVE
Patients with chronic kidney disease (CKD) are complex, have many medication-related problems (MRPs) and high rates of medication nonadherence, and are less adherent to some medications than patients with higher levels of kidney function. Nonadherence in CKD patients increases the odds of uncontrolled hypertension, which can increase the risk of CKD progression. This review discusses reasons for gaps in medication-related care for CKD patients, pharmacy services to reduce these gaps and successful models that incorporate pharmacist care.


RESULTS
Pharmacists are currently being trained to deliver patient-centred care, including identification and management of MRPs and helping patients overcome barriers to improve medication adherence. A growing body of evidence indicates that pharmacist services for CKD patients, including medication reconciliation and medication therapy management, positively affect clinical and cost outcomes, including lower rates of decline in glomerular filtration rates, reduced mortality and fewer hospitalizations and hospital days, but more robust research is needed. Team-based models including pharmacists exist today and are being studied in a wide range of innovative care and reimbursement models.


CONCLUSIONS
Opportunities are growing to include pharmacists as integral members of CKD and dialysis healthcare teams to reduce MRPs, increase medication adherence and improve patient outcomes.
aChronic Disease Research Group, Minneapolis Medical Research Foundation bCollege of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA cManitoba Renal Program dWinnipeg Regional Health Authority Pharmacy Program, Winnipeg, Manitoba, Canada eDepartment of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Wendy L
WL
St Peter
Lori D
LD
Wazny
Uptal D
UD
Patel
D006801:Humans; D055118:Medication Adherence; D059065:Medication Reconciliation; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*