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Conference Abstracts

Virtual Pharmacy: An Integrated Collaborative Redesign Targeting Medication Outcomes in Chronic Kidney Diseases

Authors:

Stephanie W Ong ,

University Health Network, CA
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Abhijat Kitchlu1,

University Health Network, CA
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David Cherney,

University Health Network, CA
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Heather Reich,

University Health Network, CA
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Arenn Jauhal,

University Health Network, CA
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Emily Huang,

McKesson Canada, CA
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Eric Georgieff,

McKesson Canada, CA
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Adnan Bodalbhai,

McKesson Canada, CA
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Karen Chuk,

McKesson Canada, CA
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Christopher T Chan

University Health Network, CA
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Abstract

Background: Collaborative management of kidney disease relies on coordinated and effective partnerships between multiple providers, including primary care physicians (PCPs), specialists, and community pharmacists. Siloed traditional health systems limit access and collaboration between key clinicians, resulting in delays in diagnosis, access to treatment, and inefficient monitoring. These lead to poor medication adherence, adverse drug events, and ultimately, disempowered providers and patients.  To date, only a handful of clinical teams have embraced a comprehensive, integrated care model to redesign a coordinated and collaborative team-based approach centred on the patient.  Community pharmacists, for example, are not well integrated into the patient’s circle of care and often face communication barriers with physicians and patients to relay medication-related issues.  With medication-related problems being one of the leading causes of death in patients with complex chronic diseases, it is an opportune time to harness the integrated delivery model to address these gaps in care.

Objective: To assess the feasibility and impact of using an integrated and collaborative model between nephrologists and community pharmacists targeting medication outcomes in patients with kidney disease.  

Methods: University Health Network’s Division of Nephrology partnered with community pharmacists with McKesson Canada (Toronto, Canada) in patients at high risk of adverse drug events (co-existing kidney, cardiovascular and oncological diseases).  We conducted an eight-month two-part observational, mixed-methods study.  The first part consisted of iterative semi-structured interviews with patients or caregivers and clinicians (nephrologists and pharmacists) to provide feedback and assess their experience with the model of care.  The second part involved a retrospective review of referrals with respect to types of referrals and outcomes measured using the Quadruple Aim Framework, particularly:

1.Patient and Caregiver experience

2.Provider experience – physicians and pharmacists

3.Clinical outcomes specific to medication-related outcomes: (medication adherence, adverse drug events)

4.Value and efficiency: Access (time to treatment, medication reimbursement resolved)

Results: In our eight-month observational study (February 1, 2021, to October 31, 2021), five nephrology clinics participated in this model of care. 54 patient referrals submitted during that period involved patients across the five clinics (72% male; Median age 60 [27,85]; Median medications 8 [4,13]).  Compared to traditional models, access to treatment improved by 43% through resolved medication reimbursement issues with a turnaround time of 2 days, which otherwise would have denied drug treatment and access. 25% of patients who experienced an adverse drug event were intervened on to prevent any further potential or severe harm (e.g., uncontrolled blood pressure, prevention of acute kidney injury).  Nephrologists revealed high satisfaction, citing efficiency, timely response, and collaboration with pharmacists as key facilitators. Ninety-eight percent of patients and caregivers were extremely satisfied with the service, demonstrating an improved patient experience.

Conclusion:  A collaborative and integrated model was feasible for providing access to nephrology care from the perspective of clinicians and patients. More importantly, efficiencies in care delivery addressing medication-related care gaps, patient experience, and healthcare outcomes improved in patients with complex diseases at high risk of adverse drug events.  

 

How to Cite: Ong SW, Kitchlu1 A, Cherney D, Reich H, Jauhal A, Huang E, et al.. Virtual Pharmacy: An Integrated Collaborative Redesign Targeting Medication Outcomes in Chronic Kidney Diseases. International Journal of Integrated Care. 2022;22(S3):198. DOI: http://doi.org/10.5334/ijic.ICIC22096
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Published on 04 Nov 2022.

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