title: Pharmacist-driven renal medication dosing intervention in a primary care patient-centered medical home.
abstract: OBJECTIVE
  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 (ARBs) in patients with CKD, and (iii) ensure that all medications prescribed to patients with CKD were dosed appropriately based on renal function.
  
  
  METHODS
  This intervention was completed at a National Committee for Quality Assurance tier 3 PCMH associated with a major, academic health system.
  
  
  METHODS
  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.
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, Ohio.
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Barnes
authors.forename: Neeraj H
authors.initials: NH
authors.lastname: Tayal
authors.forename: Amy M
authors.initials: AM
authors.lastname: Lehman
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Beatty
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010595:Pharmacists / Q000592:standards*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011320:Primary Health Care; D014481:United States
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: chronic kidney disease; electronic medical record; patient-centered medical home; pharmacist; population management; primary care