Effect of a Population Health Management Intervention on Medication Therapy Problems in People With Chronic Kidney Disease: Post Hoc Analysis of the K-CHAMP Cluster-Randomized Trial

Abstract

Rationale & Objective

Medication therapy problems (MTPs) are therapeutic issues related to medications that may cause undesirable events. People with chronic kidney disease (CKD) are at high risk of experiencing MTPs owing to comorbid conditions and medication burden. This study characterizes MTPs in individuals enrolled in the Kidney Coordinated Health Management Partnership trial and evaluates the intervention’s effect on MTPs.

Study Design

Post hoc analysis of a pragmatic, cluster-randomized trial.

Setting & Participants

Individuals aged 18-85 years with an estimated glomerular filtration rate of <60 mL/min/1.73 m², moderate to high risk of CKD progression, and not seeing a nephrologist enrolled from 101 primary care practices (May 2019 to November 2021).

Intervention(s)

Electronic health record-based multidisciplinary care including nephrology e-consult, pharmacist medication review, and patient education at baseline and every 6 months.

Outcomes

MTP type and frequency of occurrence were characterized along with associated medication classes. Descriptive statistics of MTPs were conducted, and cumulative probabilities of resolution over time were estimated using the discrete-time survival method.

Results

Baseline medication reviews were completed by telephone (52%) or chart review (48%) in 730 out of 754 (97%) intervention-arm participants (mean age, 74 ± 9 years and estimated glomerular filtration rate, 37 ± 8 mL/min/1.73 m²). Polypharmacy was evident in 63% of participants. At baseline, 78% had MTPs and 79% had medication discrepancies. The most common MTP was indication without drug therapy, associated with sodium-glucose cotransporter-2 (SGLT-2) inhibitors. The average number of MTPs per participant decreased from 2.01 at baseline to 1.28 at 6 months (36% reduction), and 1.15 at 12 months (43% reduction). Based on the discrete-time survival model, an estimated 92% of MTPs were resolved by 12 months.

Limitations

Medication management was not completed for control-arm participants. No standardized tool was used to assess medication adherence. We relied on electronic health record chart review to identify MTPs in participants who could not be reached by telephone.

Conclusions

MTPs and medication discrepancies are highly prevalent in nondialysis-dependent CKD. Medication management through multidisciplinary team care can optimize medication therapy in CKD.

Plain-Language Summary

People with chronic kidney disease (CKD) are at risk of experiencing medication therapy problems (MTPs), which are issues related to medications that may cause undesirable events. In this study, we characterized the types of MTPs experienced by people with CKD in the primary care setting and evaluated the effect of a multidisciplinary intervention on MTPs. At baseline, 78% of participants had MTPs. The most common problem was not being prescribed a medication for a diagnosed condition. The average number of MTPs per participant decreased by 43% at 12 months. This study helped us to understand MTP characteristics in people with CKD and shows that multidisciplinary team care can optimize medications.