Community Pharmacist-Led Medication Management for Diabetic Kidney Disease in Adults with Type 2 Diabetes Without a Primary Care Provider

What this Trial Is About

Type 2 diabetes is a leading cause of chronic kidney disease, which can lead to serious health problems like kidney failure and heart disease. Despite effective medications existing to slow kidney damage, they are often underused, especially among people without a regular family doctor. To improve care for these individuals, 46 community pharmacy-led primary care clinics were set up in Nova Scotia in 2023. Pharmacists at these clinics can prescribe for chronic conditions but currently not for diabetic kidney disease. This research evaluates whether pharmacist-led prescribing algorithms can improve the use of kidney-protective medications in people with diabetic kidney disease who lack regular primary care. The study compares two groups of adults with type 2 diabetes and diabetic kidney disease who do not have a primary care provider. One group receives pharmacist-led care using validated prescribing algorithms integrated into a digital health app, supporting medication management for diabetic kidney disease. The other group receives usual care through walk-in, mobile, or virtual clinics. Participants are randomly assigned to one of these groups and followed for 12 months. Pharmacists will also complete surveys to identify what helps or hinders using these algorithms in real-world practice. Participants will be recruited from a diabetes registry and screened at pharmacy clinics to confirm diabetic kidney disease. They will have lab tests and follow-up visits as part of the study. Researchers will monitor how many start and continue recommended kidney-protective medications, any medication side effects, hospitalizations, and barriers to implementation. The main outcome is improved use of guideline-directed medical therapy over 12 months. The study aims to expand access to effective treatments for diabetic kidney disease and improve long-term health outcomes in underserved populations.

Improving Kidney Care in Type 2 Diabetes: A Study of Pharmacist Prescribing Versus Usual Care