Determining best practices to delivering comprehensive medication management in practices with patients with chronic kidney disease: A qualitative study

Introduction: New payment models have intensified the importance of providing comprehensive medication management (CMM) to patients with chronic kidney disease. While some practices have pharmacists integrated into their kidney care teams, increasing the presence of pharmacists providing CMM will be key to practices achieving kidney-related care outcomes and taking advantage of emergent value-based payment models. To support future practices, the objective of this study was to understand what an ideal practice providing CMM to patients with kidney disease would look like from the perspective of those already in practice. Methods: Qualitative semi-structured interviews were carried out with 11 pharmacists practicing in diverse settings where kidney care was provided. Transcripts were coded deductively using a CMM practice management framework to determine the state of current practice, limitations, and components of an ideal practice. Results: Some components of an ideal CMM practice that were coded include alternative methods of CMM billing and revenue capture, incorporating methods for identifying CMM patients beyond a referral-based system, and having collaborative practice agreements in place. Barriers cited by those currently in practice include not always having support staff available for CMM, and a lack of processes in place to consistently and frequently measure CMM outcomes. Conclusion: While this study outlined several of the components that would contribute to an ideal practice providing CMM to patients with kidney disease, it also revealed that many existing CMM practices face practice management barriers or limitations. Given the rising importance of providing CMM to patients with kidney disease, a number of implementation supports are now under development. Utilization of these supports will be key to expanding and optimizing CMM services thereby meeting the public health need of improving kidney health and reducing health care costs.