Systematic Reviews/Meta-Analysis
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Background: Cardiovascular-Kidney-Metabolic (CKM) conditions are associated with increased risk of morbidity and mortality, thus there is a need for improved treatment delivery. This systematic review assessed coordinated care programs for CKMs, including program types, components, and outcomes.
Methods: We searched Embase and Medline for studies on coordinated-care programs from Jan 2015–Mar 2023, and congress abstracts from Jan 2021–Mar 2023. Studies were included if patients had =2 CKMs and all 3 CKM were addressed through treatment, monitoring, or risk reduction. Two reviewers extracted and assessed for data accuracy. Randomized controlled trials (RCTs) were assessed for potential bias in the design, conduct, and reporting of clinical trials risk of bias (RoB) using the Cochrane RoB tool, version 2. Observational studies were assessed using the Newcastle-Ottawa Scale.
Results: Twenty-two interventions met our inclusion criteria. The sample size of RCTs and observational studies ranged from 25–1598 and 14–9601, respectively. Interventions included patient visits to multidisciplinary team (MDT) care clinics (n=9), pharmacist integration (n=5), patient engagement and education (n=6), or MDT/multispecialty team meetings (n=2). Of the 12 interventions that specified a program lead, 45% were led by a pharmacist or nurse. Benefits of pharmacist- or nurse-delivered interventions included lower costs and empowering patients to manage their conditions, therefore improving clinical outcomes. Pharmacist-physician collaboration present an opportunity to optimize care for patients; through regular medication reviews, pharmacists identified unsuitable therapies, treatment-related adverse events, and adherence issues
Discussion:
Coordinated care is effective in improving clinical outcomes and reducing healthcare costs. Integrating pharmacists into the care team has proven effective in identifying medication adverse events and optimizing medication management. Limitations included heterogeneity in the interventions’ design, delivery, CKM population, and outcomes assessed.
Other: This study was funded by Boehringer Ingelheim Pharmaceuticals Inc. and Lilly USA LLC. The protocol was prospectively registered with PROSPERO (CRD42023409731).
Presenting Author
Joshua Neumiller PharmDWashington State University
Authors
Radica Alicic MD, FHM, FACP
Providence Medical Research Center
O Kenrik Duru MD, MS
David Geffen School of Medicine
Patrick Gee PhD
P. Gee Consulting, LLC
Roy O. Mathew MD
Loma Linda VA Health Care System
Susanne B. Nicholas MD, MPH, PhD
David Geffen School of Medicine,
Janani Rangaswami MD, FACP, FCRS, FAHA
George Washington University
Glenda V. Roberts B.S.
Kidney Research Institute
Wendy St. Peter Pharm.D.
University of Minnesota College of Pharmacy
Katherine Tuttle MD, FASN, FACP, FNKF
Providence Medical Research Center
Muthiah Vaduganathan MD, MPH
Brigham and Women's Hospital