By Savannah Roberts, Pharm.D.
Health care’s shift to accountable care means the integration of pharmacists into the health care team is becoming even more essential to improving patient outcomes.
The benefits of this integration may be most evident in end stage renal disease patients. The average patient on dialysis requires 10 to 12 medications to manage a variety of diseases1, and medication adherence issues contribute to approximately one-half of hospitalizations for dialysis patients2.
According to the United States renal data systems, approximately 70 percent of dialysis patients are enrolled in Medicare Part D plans. Because of the complexity of their disease and their medication burden, most of these patients qualify for Medicare-sponsored medication therapy management (MTM) services. These services enable pharmacists to contact patients directly to ensure they are following their medication regimen and discuss any questions they have – supporting medication adherence and improved outcomes.
In a recent study by our partners at Albany College of Pharmacy and Health Sciences (ACPHS), dialysis staff reported a widespread need for access to MTM services for their patients. They identified pharmacists as the ideal provider of these services, particularly to deliver medication reconciliation and patient education.
It is rewarding to be part of a coordinated care team. At FreseniusRx, we partner with Fresenius Kidney Care clinics to keep patients out of the hospital, manage comorbidities and improve outcomes to reduce the cost of care. As renal specialists, we are uniquely positioned to provide our patients with personalized outreach and support on the medication review process to help them and their physicians understand how various medications could impact kidneys and overall health.
We began an MTM pilot with a group of our dialysis patients more than a year ago. Each of the patients opted in to receive medication reconciliation calls from a pharmacist, who spent dedicated time reviewing all of their prescriptions and over-the-counter medications to help ensure medication adherence and patient compliance. Our pharmacists are certified through an exclusive nephrology pharmacotherapy curriculum from the National Kidney Foundation and ACPHS, so we also can review medications patients take for other conditions to ensure that they do not have an adverse effect on their kidneys.
Through this MTM pilot, FreseniusRx reviewed medications for more than 150 patients and provided more than 300 recommendations back to prescribing physicians. These recommendations helped physicians adjust their drug recommendations and dosages to avoid negative impacts to their patients’ health. Because our pharmacists are well-equipped with various interviewing techniques to find root-causes of non-adherence, we also were able to identify common barriers, such as financial limitations, that impacted each patient’s medication adherence.
Our experience shows that MTM services, especially when offered by renal pharmacists, can make a real impact in supporting patients with this complex disease. We hope to grow this program so we can provide even greater support to physicians and clinic staff as part of the overall patient care team.
1 Cardone KE, Bacchus S, Assimon MM, et al. Medication-related problems in CKD. Adv Chronic Kidney Dis. 2010;17(5):404-412.
2 United States renal data systems, USRDS 2013 annual data report; atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, MD, 2013.