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Partnering with a Renal Pharmacy

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PHARMACY MEDICATION THERAPY MANAGEMENT SERVICESa DEFINITION CLINICAL APPLICATIONS
Comprehensive medication review10 

A systematic process collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver, and/or prescriber. Performed by pharmacist.

May be focused on high-risk groups:

  • Post hospital discharge
  • Transition to dialysis
  • Post-acute kidney injury

Interventions may include:

  • Patient/prescriber consultation/intervention

Collaborative practice agreement11

Legal document that creates formal relationships between pharmacists and physicians or other providers. Collaborative practice agreements define certain patient care functions that a pharmacist can autonomously provide under specified situations and conditions.

May include:
  • Selecting, initiating, administering, monitoring, modifying, or discontinuing medication therapy
  • Patient assessment
  • Lab interpretation
  • Disease screening

Medication reconciliation

The process of creating the most accurate list possible of all medications a patient is taking—including drug name, dosage, frequency, and route. May be conducted by a pharmacist or pharmacy technician.

Performed at each care transition or at a recurring interval.

Targeted medication review

Medication-specific review or consultation based on claims or electronic health record.

Often based on high-risk or contraindicated medication(s).

May include:

  • Patient/prescriber consultation/intervention
  • Adherence calls or monitoring program

aDefinitions of medication therapy management or medication management services may vary based on determinations made by the Centers for Medicare & Medicaid Services, payors, professional pharmacy organizations, and others. 

References

  1. St. Peter WL. Management of Polypharmacy in Dialysis Patients. Semin Dial 2015;28:427-432.
  2. Manley HJ, Cannella CA, Bailie GR, St. Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis 2005;46:669-680.
  3. Helper CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-543.
  4. Salgado TM, Moles R, Benrimoj SI, Fernandez-Llimos F. Pharmacists' interventions in the management of patients with chronic kidney disease: a systematic review. Nephrol Dial Transplant 2012;27:276-292.
  5. Lalonde L, Normandeau M, Lamarre D, et al. Evaluation of a training and communication-network nephrology program for community pharmacists. Pharm World Sci 2008;30(6):924-33.
  6. Quintana-Bárcena P, Lord A, Lizotte A, Berbiche D, Lalonde L. Prevalence and management of drug-related problems in chronic kidney disease patients by severity level: a subanalysis of a cluster randomized controlled trial in community pharmacies. J Manag Care Spec Pharm 2018;24(2):173-181.
  7. Jang SM, Cerulli J, Grabe DW, et al. NSAID-avoidance education in community pharmacies for patients at high risk for acute kidney injury, upstate New York, 2011. Prev Chronic Dis 2014;11:E220.
  8. Pai AB. Keeping kidneys safe: the pharmacist's role in NSAID avoidance in high-risk patients. J Am Pharm Assoc 2015;55:e15-23.
  9. Burnier M, Pruijm M, Wuerzner G, et al. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant 2015;30(1):39-44.
  10. Centers for Medicare & Medicaid services. CY 2019 Medication Therapy Management Program Guidance and Submission Instructions. 2018. Accessed June 7, 2019: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Memo-Contract-Year-2019-Medication-Therapy-Management-MTM-Program-Submission-v-040618.pdf
  11. APhA Foundation. Collaborative Practice Agreements (CPA) and Pharmacists’ Patient Care Services. Accessed June 7, 2019: https://www.aphafoundation.org/collaborative-practice-agreements.