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Physician assistants in the Phoenix Veterans Administration Health Care System (PVAHCS) undertook a process improvement project addressing the need for over-the-counter (OTC) medication counseling for diabetic patients. Within the framework of the Kidneys-in-a-Box (KIB) program, published by the National Academy of Nephrology PAs, participants examined current practices for the six modifiable factors outlined in the National Kidney Disease Education Program (NKDEP) of the National Institutes of Health (NIH). Chart review by PVAHCS found a significant lack in OTC medication education, with less than 10% of reviewed patients having been counseled on medications that may affect kidney function. OTC medication counseling and distribution of a brochure developed for the project were implemented over a three-month time frame in the daily practices of the participating PAs and the PVAHCS Nephrology Clinic. Post project chart review of 110 patient records found a statistically significant increase in patient education (50.9%). While the change in PA behavior is significant, the goal of the project moving forward is to show impact on incidence of acute kidney injury (AKI) in the diabetic veteran population.

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.