Transitional care medication intervention to optimize outcomes in patients with CKD

Purpose: To pilot test the effectiveness of a medication information transfer intervention to improve clinically relevant outcomes in patients with chronic kidney disease (CKD). The aims of the study are to evaluate the impact of the intervention in patients with CKD on: 1. acute care utilization following hospital discharge; and 2. management of CKD risk factors and complications. Rationale/Background/Conceptual Basis: Transitional care interventions reduce hospital readmissions and slow the progression of declining health in hospitalized patients. Patients with CKD generally have multiple co-morbidities; treatment often includes the use of many medications. Patients with CKD have one of the highest rates of hospital readmission, and thus are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The Chronic Care Model provides the conceptual basis for the ongoing study with the focus on improving patients’ abilities to be informed and activated so they can engage in productive interactions with their health care professionals. Methods:A single-blind randomized clinical trial with IRB-approved protocol is being implemented. Hospitalized patients >21 years old (n=120) who have a diagnosis of CKD stage 3-5 (not including those treated by dialysis or kidney transplant) are being recruited. All participants receive a clinic evaluation at baseline, 30 and 90 days following hospital discharge. Participants randomized to the intervention receive a home visit from a pharmacist within one week of hospital discharge. The medication information transfer intervention delivered by the pharmacist is guided by the 5As Self-Management Model. Statistical analyses will include a mixed model approach utilizing generalized estimating equations for longitudinal multiple-variable analysis with a priori significance set at 0.05 for all analyses. Results:Preliminary findings from this ongoing clinical trial will be presented. Implications: Study findings will have implications for improving knowledge about strategies to overcome delivery system design and medication self-management barriers. Enhancing patients’ and providers’ abilities for meticulous medication management is critical to improving outcomes for patients with CKD, including reducing acute care use and overall healthcare costs. This research is funded by the National Institute for Diabetes, Digestive and Kidney Diseases: R34DK09014016-01.