Nephrology practice and research network opinion paper: Pharmacists' perspectives on the Advancing American Kidney Health initiative

Abstract

Patients with chronic kidney disease (CKD) are at high risk for clinically significant medication therapy problems (MTPs) due primarily to the complex pharmacotherapy prescribed by numerous providers, and the significant changes in pharmacokinetic and pharmacodynamic properties of many medications due to their kidney disease. While MTPs are well recognized, pharmacists are not routinely involved in the health care teams that provide care for patients with CKD. The Advancing American Kidney Health initiative was announced in July 2019 and is poised to shift models of care in nephrology toward value‐based payment. This represents an opportunity for pharmacists to integrate into teams to improve quality of care and outcomes for patients with CKD. Pharmacists should engage in medication reconciliation, transitions of care, and medication‐focused kidney disease education programs within a comprehensive medication management (CMM) framework to optimize pharmacotherapy outcomes. To implement these services, pharmacists need to utilize certified pharmacy technicians, telehealth, interprofessional skills, and other tools in innovative ways. Current models of successful practice from Canada can serve as a template for United States‐based nephrology pharmacy practice. In this opinion paper, we characterize the current state of nephrology practice and identify significant opportunities for advancement. We propose metrics to evaluate pharmacy services and a framework for key stakeholder engagement which will be critical to advance the profession of pharmacy within nephrology. The Advancing American Kidney Health initiative offers a distinct opportunity to demonstrate the value of CMM provided by pharmacists in the nephrology arena to optimize patient care.

Pharmacist's role in reducing medication‐related racial disparities in African American patients with chronic kidney disease

“…Resources for pharmacists to provide equitable care to all of their patients will be provided by AKHOMM. 59,60…”

“…The Advancing Kidney Health through Optimal Medication Management (AKHOMM) was formed to train pharmacists and help practices incorporate a pharmacist on the care team to ensure that every person with kidney disease receives optimal medication management. Resources for pharmacists to provide equitable care to all of their patients will be provided by AKHOMM 59,60 …”

Education Standards for Pharmacists Providing Comprehensive Medication Management in Outpatient Nephrology Settings

“…In 2020, a group of nephrology pharmacists convened to discuss potential roles of pharmacists in the new practice models and published an opinion paper on this topic. 22 From this activity, the AKHOMM initiative was developed with the vision that every person with kidney disease receives optimal medication management through team-based care including a pharmacist to ensure medications are safe, effective, and convenient for them to use. 23 AKHOMM is positioned to help nephrology practices, health systems, and wrap-around kidney care companies implement CMM within their practices by incorporating pharmacists into their care teams to help achieve the quadruple aim of health care; that is, reducing costs of care, improving population health, enhancing the patient experience, and improving provider satisfaction.…”

The Impact of Medication Cost on Dialysis Patients

“…The use of medication reconciliation and management services to identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care consistently and systematically. 6 Beginning in 2022, CMS will require dialysis facilities to report on a new Quality Incentive Program measure with respect to medication reconciliation. This measure will describe the percentage of patient-months in a dialysis facility for which a medication reconciliation was performed and documented by an eligible professional.…”