Barnes Kelli D, Tayal Neeraj H, Lehman Amy M, Beatty Stuart J
Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, Ohio.
Pharmacotherapy. 2014 Dec;34(12):1330-5. doi: 10.1002/phar.1508. Epub 2014 Oct 25.
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.
This intervention was completed at a National Committee for Quality Assurance tier 3 PCMH associated with a major, academic health system.
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.
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.
这项人群管理干预措施的目的是识别患有3期、4期或5期慢性肾脏病（CKD）的患者，并在以患者为中心的医疗之家（PCMH）改善护理。干预措施的目标是：（i）增加CKD的识别率；（ii）增加CKD患者中阿司匹林和血管紧张素转换酶抑制剂（ACE-Is）或血管紧张素II受体阻滞剂（ARBs）的使用；（iii）确保根据肾功能为CKD患者开具的所有药物剂量适当。
这项干预措施在与一个大型学术医疗系统相关的美国国家质量保证委员会3级PCMH中完成。
使用电子病历生成了一份估计肾小球滤过率<60 mL/（min·1.73 m²）的328名患者名单；146名患者接受了干预。
由一名药剂师对电子病历进行审查，以根据估计肾小球滤过率确认3期、4期或5期CKD，确保开具了ACE-Is/ARBs和阿司匹林，并确保根据肾脏剂量调整建议所有药物剂量适当。针对改善CKD患者的用药和安全性提出了建议。干预前，73%的患者开具了ACE-I/ARB，72%的患者开具了阿司匹林。干预后，这些药物的使用分别增加到了77%和82%的患者。针对138种药物（每位患者0.95种药物）根据Cockcroft-Gault计算的肌酐清除率提出了调整药物剂量的药剂师建议；90条（65.2%）建议被患者的医生接受。
这些结果证明了在PCMH中由药剂师推动的肾脏药物剂量干预措施对CKD患者用药和安全性的影响。
