Evaluating a pharmacist-led cardio-renal-metabolic service to reduce healthcare inequities in a socioeconomically deprived population: a prospective intervention study.

Abstract

Background: Chronic kidney disease (CKD) is a leading cause of premature mortality, often coexisting with cardiovascular disease and diabetes mellitus; disproportionately affecting socioeconomically deprived groups. CKD is projected to increase due to ageing, obesity and diabetes. General practice clinical pharmacists (GPCPs) have been shown to be effective in challenging chronic disease prescribing. GPCP services for CKD remains underexplored.

Aim: This study aimed to scope the potential of a GPCP-led intervention to optimise cardio-renal and metabolic risk factors in CKD stages 3-4.

Method: Adults with CKD stages 3-4 from two urban, socioeconomically deprived general practices in NHS Greater Glasgow and Clyde in UK, were identified via practice records and GP referrals. Eligible patients were invited to attend a GPCP-led clinic (Nov 2021-Jan 2024), that included CKD monitoring (primary measure), patient education, life-style advice and medicines optimisation. Anonymised pre- and post-intervention data were analysed.

Results: In total, 253 participants (median age 77, range 26-99) met inclusion criteria; 62% lived in the most deprived areas of Scotland; 62% were female. Of the 163 (64%) attending. eGFR increased by a mean of 2.9 (95% CI 1.41-4.40, P < 0.001) ml/min/1.73 m² over 12 months, with improvements in CKD staging, blood pressures, lipid profiles, and HbA1c. Medicines optimisation included lipid lowering (62%), antihypertensives (47%), sodium-glucose co-transporter-2 inhibitors (42%), adverse drug effect management (16%), including nephrotoxic cessation.

Conclusion: An integrated pharmacist-led, general practice-based cardio-renal and metabolic clinic, improved key CKD-related outcomes in deprived population. Further studies are needed to confirm long-term impact.