Abstract
Background: Reducing medication-related problems and improving medication adherence in hemodialysis patients may improve clinical outcomes. In 2005, a large US dialysis organization created an integrated pharmacy program for its patients. We aimed to compare the outcomes of hemodialysis patients enrolled in this program and matched control patients. Study Design: Quality improvement report. Setting & Participants: Hemodialysis patients with concurrent Medicare and Medicaid eligibility who chose to receive program services and propensity score-matched controls; the propensity score was an estimated function of demographic characteristics, comorbid conditions, medication exposure, serum concentrations, and vascular access method. Quality Improvement Plan: Program services included medication delivery, refill management, medication list reviews, telephonic medication therapy management, and prior authorization assistance. Outcomes: Relative rates of death and hospitalization. Measurements: Survival estimates calculated with the Kaplan-Meier method; mortality hazards compared with Cox regression; hospitalization rates compared with Poisson regression. Results: In outcome models, there were 8,864 patients receiving integrated pharmacy services and 43,013 matched controls. In intention-to-treat and as-treated analyses, mortality HRs for patients receiving integrated pharmacy services versus matched controls were 0.92 (95% CI, 0.86-0.97) and 0.79 (95% CI, 0.74-0.84), respectively. Corresponding relative rates of hospital admissions were 0.98 (95% CI, 0.95-1.01) and 0.93 (95% CI, 0.90-0.96), respectively, and of hospital days, 0.94 (95% CI, 0.90-0.98) and 0.86 (95% CI, 0.82-0.90), respectively. Cumulative incidences of disenrollment from the pharmacy program were 23.4% at 12 months and 37.0% at 24 months. Limitations: Patients were not randomly assigned to receive integrated pharmacy services; as-treated analyses may be biased because of informative censoring by disenrollment from the pharmacy program; data regarding use of integrated pharmacy services were lacking. Conclusions: Receipt of integrated pharmacy services was associated with lower rates of death and hospitalization in hemodialysis patients with concurrent Medicare and Medicaid eligibility. Studies are needed to measure pharmacy program use and assess detailed clinical and economic outcomes.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 557-567 |
| Number of pages | 11 |
| Journal | American Journal of Kidney Diseases |
| Volume | 62 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 2013 |
Bibliographical note
Funding Information:Support: This work was supported by funding from DaVita Clinical Research, Minneapolis, MN. The interpretation and reporting of these data are the responsibility of the authors, who retain final authority over manuscript content. The conclusions and opinions expressed are those of the authors and do not represent those of the USRDS or the National Institutes of Health.
Funding Information:
Financial Disclosure: The authors are employed by or associated with the Chronic Disease Research Group, which receives research funding from DaVita Inc. The authors declare that they have no other relevant financial interests.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
Keywords
- Hemodialysis
- hospitalization
- integrated pharmacy
- medication therapy management
- mortality
