Subject(s)
Delivery of Health Care/organization & administration , Kidney Failure, Chronic/therapy , Quality of Health Care/economics , Renal Dialysis/economics , Renal Dialysis/standards , Clinical Decision-Making , Cost Control , Humans , Interdisciplinary Communication , Medicaid , Medicare , Patient Navigation , Quality Indicators, Health Care , United StatesABSTRACT
End stage renal disease (ESRD) patients require a large number of medications and are known to have high rates of nonadherence. It is estimated that >50% of ESRD patients do not take their phosphate binders as prescribed. The renal pharmacy FreseniusRx provides coordinated ESRD medication delivery and adherence support for enrolled patients. We investigated whether coordinated pharmacy care of mineral and bone disorder (MBD) therapies is associated with improvements in laboratory. outcomes. We used data from hemodialysis patients treated at Fresenius Medical Care North America (FMCNA) clinics from February 2014 to January 2015. We included patients who were residing in a state with >100 patients in the FMCNA network, not in a nursing home, and prescribed a phosphate binder and/or calcimimetic. We found 15,287 pharmacy patients who met the study criteria. Concurrent control patients not in the pharmacy were matched to pharmacy patients on a monthly basis that was based off the first date of receipt of therapy from FreseniusRx using 1:1 nearest neighbor matching on the logit of the propensity score for an array of clinical and non-clinical parameters. Logistic regression was used to measure the association between pharmacy care and patients achieving their laboratory goals for phosphorus (PO4) and intact parathyroid hormone (iPTH), and combined goals for total calcium (Ca), PO4, and iPTH. We analyzed data from 30,574 patients (15,287 pharmacy and control). In unadjusted and adjusted analyses, we consistently observed that pharmacy patients were more likely to achieve their MBD laboratory goals as compared to controls. In an adjusted analysis, we found pharmacy patients were more likely to achieve their MBD laboratory targets at 3, 6, 9, and 12 months for PO4 (11.1%, 10.5%, 11.8% and 12.7% respectively), iPTH (8.9%, 17.5%, 23.4% and 27.9% respectively) and combined goals for Ca, PO4, and. iPTH (12.1%, 13.4%, 16.7% and 21.2% respectivelv) versus controls (n<0.01 for all comparisons). These findings indicate that coordinated pharmaceutical care may be associated with improvements in patients achieving their MBD laboratory goals.
Subject(s)
Medication Adherence , Patient Education as Topic/methods , Practice Guidelines as Topic , Renal Dialysis/standards , Renal Insufficiency, Chronic/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United StatesABSTRACT
As we approach the end of the first decade of the 21st century, we are witnessing the confluence of a number of factors that, taken together, have the opportunity to fulfill the promise of health information technology. CMS is bringing substantial financial pressure to bear through ARRA, PQRI, and the e-prescribing initiatives. The OIG safe harbor and the Stark exception for EHR donations facilitate the provision of additional incentives to many nephrologists. Technological advances related to speed, interoperability, and mobile platforms are converging to allow EHRs to offer the right information at the right time to support the nephrologist's delivery of the best care possible to an increasingly complex patient population. In this dynamic environment, nephrologists must move both quickly and cautiously as they select, implement and adopt an electronic health record.
