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Tesfaye W, Krass I, Sud K, Johnson DW, Van C, Versace VL, McMorrow R, Fethney J, Mullan J, Tran A, Robson B, Vagholkar S, Kairaitis L, Gisev N, Fathima M, Tong V, Coric N, Castelino RL. Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol. BMJ Open 2023; 13:e079110. [PMID: 38128937 DOI: 10.1136/bmjopen-2023-079110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims to evaluate the impact of a community pharmacy-led intervention combining CKD screening and medication review on CKD detection and quality use of medicines (QUM) for patients with CKD. We hypothesise that the proposed intervention will enhance detection of newly diagnosed CKD cases and reduce potentially inappropriate medications use by people at risk of or living with CKD. METHODS AND ANALYSIS This study is a multicentre, pragmatic, two-level cluster randomised controlled trial which will be conducted across different regions in Australia. Clusters of community pharmacies from geographical groups of co-located postcodes will be randomised. The project will be conducted in 122 community pharmacies distributed across metropolitan and rural areas. The trial consists of two arms: (1) Control Group: a risk assessment using the QKidney CKD risk assessment tool, and (2) Intervention Group: a risk assessment using the QKidney CKD plus Point-of-Care Testing for kidney function markers (serum creatinine and estimated glomerular filtration rate), followed by a QUM service. The primary outcomes of the study are the proportion of patients newly diagnosed with CKD at the end of the study period (12 months); and rates of changes in the number of medications considered problematic in kidney disease (number of medications prescribed at inappropriate doses based on kidney function and/or number of nephrotoxic medications) over the same period. Secondary outcomes include proportion of people on potentially inappropriate medications, types of recommendations provided by the pharmacist (and acceptance rate by general practitioners), proportion of people who were screened, referred, and took up the referral to visit their general practitioners, and economic and other patient-centred outcomes. ETHICS AND DISSEMINATION The trial protocol has been approved by the Human Research Ethics Committee at the University of Sydney (2022/044) and the findings of the study will be presented at scientific conferences and published in peer-reviewed journal(s). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12622000329763).
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Affiliation(s)
- Wubshet Tesfaye
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Ines Krass
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, New South Wales, Australia
- The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - David W Johnson
- Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Connie Van
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Rita McMorrow
- Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Judith Fethney
- School of Nursing, The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, Sydney, New South Wales, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, Sydney, New South Wales, Australia
- Western Sydney University School of Medicine, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Mariam Fathima
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Vivien Tong
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
| | - Natali Coric
- Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ronald L Castelino
- The University of Sydney School of Pharmacy, Sydney, New South Wales, Australia
- Pharmacy Department, Blacktown Hospital, Sydney, New South Wales, Australia
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Gheewala PA, Peterson GM, Zaidi STR, Jose MD, Castelino RL. Australian Community Pharmacists' Experience of Implementing a Chronic Kidney Disease Risk Assessment Service. Prev Chronic Dis 2018; 15:E81. [PMID: 29908050 PMCID: PMC6016429 DOI: 10.5888/pcd15.170485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Community pharmacists are well positioned to deliver chronic kidney disease (CKD) screening services. However, little is known about the challenges faced by pharmacists during service implementation. This study aimed to explore community pharmacists’ experiences and perceived barriers of implementing a CKD risk assessment service. Methods Data collection was performed by using semistructured, open-ended interview questions. Pharmacists who had implemented a CKD screening service in Tasmania, Australia, were eligible to participate. A purposeful sampling strategy was used to select pharmacists, with variation in demographics and pharmacy location. A conventional content analysis approach was used to conduct the qualitative study. Transcripts were thematically analyzed by using the NVivo 11 software program. Initially, a list of free nodes was generated and data were coded exhaustively into relevant nodes. These nodes were then regrouped to form highly conceptualized themes. Results Five broad themes emerged from the analysis: contextual fit within community pharmacy; perceived scope of pharmacy practice; customer perception toward disease prevention; CKD – an underestimated disease; and remuneration for a beneficial service. Pharmacists found the CKD service efficient, user-friendly, and of substantial benefit to their customers. However, several pharmacists observed that their customers lacked interest in disease prevention, and had limited understanding of CKD. More importantly, pharmacists perceived the scope of pharmacy practice to depend substantially on interprofessional collaboration between pharmacists and general practitioners, and customer acknowledgment of pharmacists’ role in disease prevention. Conclusion Community pharmacists perceived the CKD service to be worth incorporating into pharmacy practice. To increase uptake, future CKD services should aim to improve customer awareness about CKD before providing risk assessment. Further research investigating strategies to enhance general practitioner involvement in pharmacist-initiated disease prevention services is also needed.
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Affiliation(s)
- Pankti A Gheewala
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Private Bag 26, Hobart 7001, Australia.
| | - Gregory M Peterson
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Syed Tabish R Zaidi
- Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Matthew D Jose
- School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
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