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Primary Care Providers’ Acceptance of Pharmacists’ Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease

Abstract

Background

Patients with diabetic kidney disease (DKD) often struggle with blood pressure control. In team-based models of care, pharmacists and primary care providers (PCPs) play important roles in supporting patients’ blood pressure management.

Objective

To describe whether PCPs’ acceptance of pharmacists’ recommendations impacts systolic blood pressure (SBP) at 36 months.

Design

An observational analysis of a subset of participants randomized to the intervention arm of the Simultaneous risk factor control using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study.

Participants

STOP-DKD participants for whom (1) the pharmacist made at least one recommendation to the PCP; (2) there were available data regarding the PCP’s corresponding action; and (3) there were SBP measurements at baseline and 36 months.

Intervention

Participants received monthly telephone calls with a pharmacist addressing health behaviors and medication management. Pharmacists made medication-related recommendations to PCPs.

Main Measures

We fit an unadjusted generalized linear mixed model to assess the association between the number of pharmacists’ recommendations for DKD and blood pressure management and PCPs’ acceptance of such recommendations. We used a linear regression model to evaluate the association between PCP acceptance and SBP at 36 months, adjusted for baseline SBP.

Key Results

Pharmacists made 176 treatment recommendations (among 59 participants), of which 107 (61%) were accepted by PCPs. SBP significantly declined by an average of 10.5 mmHg (p < 0.01) among 47 of 59 participants who had valid measurements at baseline and 36 months. There was a significant association between the number of pharmacist recommendations and the odds of PCP acceptance (OR 1.19; 95%CI 1.00, 1.42; p < 0.05), but no association between the number of accepted recommendations and SBP.

Conclusions

Pharmacists provided actionable medication-related recommendations. We identified a significant decline in SBP at 36 months, but this reduction was not associated with recommendation acceptance.

Trial Registration

NCT01829256

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Figure 1

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Author information

Correspondence to Hayden B. Bosworth PhD.

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Conflict of Interest

Dr. Zullig reports research grant support from the PhRMA Foundation, Proteus Digital Health and Sanofi, as well as consulting from Novartis. Dr. Davenport, Dr. Diamantidis, Dr. Moaddeb, Ms. Jazowski, Ms. Patel, and Ms. Oakes report no conflicts of interest. Dr. Bosworth reports research grants from Sanofi, PhRMA Foundation, Proteus Digital Health, Otsuka, Novo Nordisk, Improved Patient Outcomes, as well as consulting from Novartis, Otsuka, Abbott, and Sanofi.

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Zullig, L.L., Jazowski, S.A., Davenport, C.A. et al. Primary Care Providers’ Acceptance of Pharmacists’ Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease. J GEN INTERN MED 35, 63–69 (2020) doi:10.1007/s11606-019-05403-x

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KEY WORDS

  • diabetic kidney disease
  • blood pressure control
  • team-based primary care
  • medication management