title: A pharmacist based intervention to improve the care of patients with CKD: a pragmatic, randomized, controlled trial.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01290614.
authors.affiliation: Louis Stokes Cleveland VAMC, Cleveland, OH, USA. Danielle.Cooney@va.gov.
authors.forename: Danielle
authors.initials: D
authors.lastname: Cooney
authors.affiliation: Louis Stokes Cleveland VAMC, Cleveland, OH, USA. helen.moon@va.gov.
authors.forename: Helen
authors.initials: H
authors.lastname: Moon
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. yxl268@case.edu.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: UT Southwestern, Dallas, TX, USA. tyler.miller@utsouthwestern.edu.
authors.forename: Richard Tyler
authors.initials: RT
authors.lastname: Miller
authors.affiliation: Case Western Reserve University, Cleveland, OH, USA. Adam.Perzynski@case.edu.|MetroHealth Medical Center, Cleveland, OH, USA. Adam.Perzynski@case.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Perzynski
authors.affiliation: Louis Stokes Cleveland VAMC, Cleveland, OH, USA. brook.watts@va.gov.|Case Western Reserve University, Cleveland, OH, USA. brook.watts@va.gov.
authors.forename: Brook
authors.initials: B
authors.lastname: Watts
authors.affiliation: Division of Renal Diseases & Hypertension, University of Minnesota, 717 Delaware Street SE, Office 353E, Minneapolis, MN, 55414, USA. draw0003@umn.edu.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D064792:Pragmatic Clinical Trials as Topic; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
chemical_list: D000959:Antihypertensive Agents