Pharmacist‐led, technology‐assisted study to improve medication safety, cardiovascular risk factor control, and racial disparities in kidney transplant recipients

Abstract

Introduction: Health disparities in African-American (AA) kidney transplant recipients compared with non-AA recipients are well established. Cardiovascular disease (CVD) risk control is a significant mediator of this disparity. Objective: To assess the efficacy of improved medication safety, CVD risk control, and racial disparities in kidney transplant recipients. Methods: Prospective, pharmacist-led, technology-aided, 6-month interventional clinical trial. A total of 60 kidney recipients with diabetes and hypertension were enrolled. Patients had to be at least one-year post transplant with stable graft function. Primary outcome measured included hypertension, diabetes, and lipid control using intent-to-treat analyses, with differences assessed between AA and non-AA recipients. Results: The participants mean age was 59 years, with 42% being female and 68% being AA. Overall, patients demonstrated improvements in blood pressure <140/90 mmHg (baseline 50% vs. end of study 68%, p=0.054) and hemoglobin A1c <7% (baseline 33% vs. end of study 47%, p=0.061). AAs demonstrated a significant reduction from baseline in systolic blood pressure (−0.86 mmHg per month, p=0.026), which was not evident in non-AAs (−0.13 mmHg per month, p=0.865). Mean HgbA1c decreased from baseline in the overall group (−0.12% per month, p=0.003), which was similar within AAs (−0.11% per month, p=0.004) and non-AAs (−0.14% per month, p=0.029). There were no changes in low-density lipoproteins, triglycerides, or high-density lipoproteins over the course of the study. Medication errors were significantly reduced and self-reported medication adherence significantly improved over the course of the study. Conclusion: These results demonstrate the potential efficacy of a pharmacist-led, technology-aided, educational intervention in improving medication safety, diabetes, and hypertension and reducing racial disparities in AA kidney transplant recipients. (ClinicalTrials.gov NCT02763943)

Transplant clinical pharmacy services improve cardiovascular risk factor management and control in Veteran organ transplant recipients

“…14 As previous literature has shown, implementing transplant clinical pharmacy services helps in a variety of ways, including those in reducing CVD risk factors by optimizing medication use and monitoring. As supported in the Tsuyuki and Taber studies, 12,13 the current study also saw a decrease in values of A1c and LDL, with a significant increase in monitoring. As improvements were seen in A1c and LDL measures, the RHJ VAMC data had robust primary care pharmacist-led clinics, which could have impeded the impact of seeing significance because some starting points for variables were already improved from the national average.…”

“…12 In another study conducted by Taber and colleagues, after a 6-month intervention period using technology-driven, pharmacist-led interventions, there were decreases seen in both BP and A1c measures (P = .054, P = .061, respectively), thus demonstrating the importance of having transplant clinical pharmacy services available. 13 Lastly, this viewpoint is furthered by a systematic review by Altowaijra and colleagues which reports that having clinical pharmacy services are associated with improvements in clinical outcomes for patients as compared with usual care not involving pharmacist-led interventions. 14 This study also concluded that by having an impact on improving CVD risk factor control, quality of life and health care costs likewise followed.…”

“…Clinical pharmacists provide an important role in optimizing the management and control of CVD in high-risk patients. [12][13][14] They can assist with ensuring CVD medications with compelling indications are prescribed, coordinate care with other providers, work with patients to minimize nonadherence, manage adverse drug events and preemptively identify drug interactions. [12][13][14] Clinical pharmacists have demonstrated improved process measures and outcomes in the management of CVD risk factor control within the general population, but there is paucity in the studies assessing this in organ transplant recipients.…”

“…[12][13][14] They can assist with ensuring CVD medications with compelling indications are prescribed, coordinate care with other providers, work with patients to minimize nonadherence, manage adverse drug events and preemptively identify drug interactions. [12][13][14] Clinical pharmacists have demonstrated improved process measures and outcomes in the management of CVD risk factor control within the general population, but there is paucity in the studies assessing this in organ transplant recipients. 12 Thus the objective of this study was to assess the impact of transplant clinical pharmacy services on CVD risk factor control and prescribing of medications with compelling indications for CVD prevention in Veteran postorgan transplant recipients.…”

Racial Differences in Medication Utilization for Secondary Prevention of Cardiovascular Disease in Kidney Transplant Recipients: A Post Hoc Analysis of the FAVORIT Trial Cohort

“…Understanding where there are racial differences in J o u r n a l P r e -p r o o f 15 CVD care delivery (i.e., primary prevention, secondary prevention, use of diagnostic testing) and the mechanisms underlying disparate care delivery is key to developing targeted interventions to mitigate these disparities. 32 Other limitations include a small number of participants included in our final analyses and that the majority of patients (60% in both models) had a diagnosis of CVD and were on statin or aspirin at the time of enrollment, though we accounted for this uncertainty by using interval censoring. Also, lack of granular information on transplant center specific practices, side effects of aspirin and statin, and potential indications, or contraindications for their use for secondary CVD prevention poses the risk for residual confounding and limits interpretation of the results.…”