Advancing the pilot: Reviewing and growing our renal ambulatory care service.

Abstract

Background: In 2021, a multidisciplinary nephrology ambulatory care clinic was established to provide review and consultative care to patients with early chronic kidney disease. Pharmacist EFT (0.1) was appointed to conduct medication reviews via telehealth prior to nephrologist clinic, for 4-5 patients per week.

Objectives: Understand the impact of a renal pharmacist telehealth service on nephrologist clinic attendance and clinician experience, and assess characteristics of referred patients across two years of clinic operations.

Method: A multifaceted quality improvement assessment of the pharmacist clinic was undertaken. Clinic referral and appointment statistics were analysed to understand coverage and did-not-attend rates. Semi-structured interviews with nephrologists were conducted to understand their perceptions of the service. Auditing of pharmacist clinic letters was conducted to understand patient characteristics and burden of kidney disease.

Results: From 2021 to 2023 the renal pharmacist clinic saw 64%(198/311) of patients attending the nephrologist clinic. Did-not-attend rates for the pharmacist clinic were 9%, with patients having lower did-not-attend rates if they attended the pharmacist clinic (14% vs 22%). Nephrologists reported their experience was enhanced when patients were consulted by the pharmacist prior, and recommended introducing follow up services and expanded pharmacist coverage. The audit demonstrated an increased complexity of referred patients over time, with a higher proportion of patients having more advanced renal disease (CKD G3b 47% versus 38%), more regular medications (10 versus 7) and more advanced age (68 versus 61 years) at referral in the second year of clinic operation.

Discussion: With nephrologist clinic growth, improved nephrologist experience with the addition of the renal pharmacist clinic, and increasing complexity of patients, there is strong evidence to support renal pharmacist clinic service expansion. The renal pharmacist clinic will move beyond pilot stage, increasing funding to expand coverage of clinic and expanding the clinical role of pharmacists in ambulatory patient care.