Impact of CAMP in an Ambulatory Renal Clinic
Impact of CAMP in an Ambulatory Renal Clinic
The purpose of this study is to see if a pharmacist can help patients understand how he/she
 should be taking their medications. The study is also being done to see if meeting with the
 pharmacist can help patients better control chronic kidney disease and the medical problems
 that can occur.
Chronic kidney disease (CKD) is a serious condition associated with premature mortality,
 decrease quality of life, and increase health-care costs. An estimated 19 million Americans
 (1 in 9 US adults) have non-dialysis dependent CKD (Stages 1-4).1 The health care
 expenditures for caring for patients with CKD are substantial. According to Centers for
 Medicare and Medicaid Services (CMS), the estimated annual health cost per patient for
 managing patients with CKD is markedly higher ($28,000) compared to the costs for caring for
 diabetic patients ($10,000 per patient) and heart failure patients ($5000 per patient). 2
 According to the National Kidney Foundation, as renal function declines, the number of renal
 complications, notably high blood pressure, anemia, malnutrition, and mineral and bone
 disorders, increases along with the severity. A large proportion of patients with CKD also
 develop multiple co-morbidities, particularly hypertension, diabetes, and hyperlipidemia.
 Fortunately, accumulating evidence indicates that treatment of earlier stages of chronic
 kidney disease can prevent the development of kidney failure (Stage 5)3. In addition, early
 prevention of cardiovascular risk factors in patients with CKD may reduce cardiovascular
 events before and after the onset of kidney failure.3 Because many patients, particularly in
 the later stages of CKD, have multiple renal complications and chronic co-morbidities, these
 patients are potentially at high risk of medication non-adherence and non-persistence
 (defined as premature discontinuation of medication therapy). Studies have demonstrated that
 patients with chronic diseases typically take only 50% of prescribed doses of medication,
 leading to increased disease severity, clinic visits, and hospital admissions, resulting in
 substantial healthcare expenditures.4,5 In the United States alone, the cost of illness, due
 to non-adherence was estimated to be $170 billion per year.6 In addition, the associated
 total cost of treating the complications resulting from poor adherence in dialysis and
 transplant patients exceeds $950 million.7 Potential barriers to medication adherence for
 patients with chronic diseases include, but are not limited to, complex medication regimens,
 multiple drug doses, treatment of asymptomatic conditions, and cognitive factors. Although
 not well-studied in pre-dialysis patients, limited data suggests that important causes of
 medication non-adherence in chronic dialysis patients include inadequate prescription
 coverage or high medication costs, lack of transportation, and adverse effects. 8
Inclusion Criteria:

 Patients will be eligible for enrollment if they are > 18 year old men or women receiving
 care from the VAMCSF Renal Clinic with a documented diagnosis of CKD stage 2-5, and are
 receiving pharmacological treatment for one or more medical conditions of CKD, including
 hypertension, diabetes, CKD-mineral and bone disorders, and/or anemia of chronic disease.

 Exclusion Criteria:

 Patients will be excluded from the study if they obtain medications prescribed for the
 above medical conditions from a facility outside the VAMCSF, are enrolled in Medi-Set
 clinic, are kidney transplant patients, are diagnosed with CKD stage 1, require assistance
 in the administration of their medications (i.e. caregiver), lack adequate transportation
 to clinic, and/or lack telephone access.