BACKGROUND AND AIMS
Chronic kidney disease (CKD) affects 10% of the global population.1,2 Medication dosing errors in people with impaired kidney function are common and can lead to serious harm. Community pharmacy-based interventions may help improve medication safety in this population.3,4 An electronic drug-dosing and decision-support kidney (eDoseCKD) intervention integrated 30 validated algorithms into a digital health platform to support dosing.5 This study aimed to implement and evaluate the effectiveness and safety of the eDoseCKD intervention in primary care pharmacies over a 6-month period.
MATERIALS AND METHODS
Using a mixed-methods design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, the intervention was evaluated across 12 urban and rural pharmacies. Adults (≥18 years) with kidney disease were eligible if prescribed an intervention medication requiring kidney-based dose adjustment; participants received educational materials on medication safety. Reach was assessed via the at-risk kidney population and participation rates. Effectiveness was measured by the number of medication changes, unexpected adverse events, and patient and pharmacist satisfaction assessed using a 5-point Likert survey. Adoption was measured by site and pharmacist participation, implementation fidelity by consistency of intervention use, and maintenance at 3 months post-dose change and tool use at 6 months.
RESULTS
Eighteen pharmacists from six urban and six rural pharmacy sites participated. All were female (mean±SD age: 41±11 years), and over half had greater than 15 years of experience. Eighty-six of 91 participants at-risk of kidney disease (57% female; mean±SD age: 78±7.5 years; mean±SD eGFR: 32±10.7 mL/min) consented and were enrolled, yielding a 94.5% participation rate. Ninety-three medication adjustments were made, most commonly metformin, sitagliptin, gabapentinoids, rivaroxaban, apixaban, rosuvastatin, and famotidine. Dose reductions worsened symptoms in two patients with gabapentin. Overall mean±SD patient and pharmacist participant satisfaction was 4.66±0.58 and 4.83±0.3, respectively. Adoption was high, with only two sites and three pharmacists declining. The intervention was implemented as intended in all but four people. All but one adjustment persisted at 3 months, with all pharmacists using the tool at 6 months.
CONCLUSION
The eDoseCKD intervention demonstrated high reach, adoption, acceptability, implementation fidelity, and short-term maintenance across urban and rural pharmacies. The intervention was effective in identifying and implementing kidney-based medication dose adjustments, with minimal adverse effects, supporting eDoseCKD as a safe, feasible, and scalable tool for community pharmacy practice.
