Gaps, Barriers, and Facilitators to Implementing Comprehensive Medication Management in Cardiovascular-Kidney-Metabolic Care: A Qualitative Study.
Publication Title
J Am Coll Clin Pharm
Document Type
Article
Publication Date
7-1-2026
Keywords
Humans; Cardiovascular Diseases; Medication Therapy Management; Pharmacists; Qualitative Research; United States; Renal Insufficiency, Chronic; Patient Care Team; cardiologists; endocrinologist; interprofessional relations; medication therapy management; nephrologists; pharmacists; primary care health.; washington; spokane; pmrc
Abstract
BACKGROUND: Obesity, diabetes, and cardiovascular disease often co-exist in people with chronic kidney disease, placing them at high risk for adverse health outcomes. Availability of highly effective medications that span cardiovascular-kidney-metabolic (CKM) conditions, but limited uptake in real world settings, calls for a new transformative practice paradigm. We sought to identify key gaps, barriers, and facilitators to implementing a standardized CKM-focused comprehensive medication management (CMM) intervention, including needs/solutions among various care team members involved in CKM care in diverse health systems across the United States.
METHODS: This was a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) deployed in five health care systems across the United States. Clinical pharmacists, pharmacist administrators, primary care and specialty (nephrology, cardiology, endocrinology) physicians, and advanced practice professionals were interviewed using open-ended questions that were informed by results from three mainly quantitative online surveys.
RESULTS: A total of 26 interviews were conducted with 42 participants. Practitioners and administrators reported many similar challenges to successfully implement CMM for people with CKM including lack of standardized CMM practice and workflow across the health system, electronic medical record integrated tools to identify and track patients with CKM, automatic pharmacist referrals, broad clinical practice agreements, and holistic CKM performance metrics, as well as pharmacist time constraints and limited reimbursement. Participants also highlighted CMM-CKM practice facilitators including recognition across most health care professionals that CKM should be a system priority, requiring strong supportive professional relationships among physician and/or administrator champions, and tools, knowledge, and resources that could be shared with others.
CONCLUSION: Successful implementation of a transformative, holistic CMM-CKM interprofessional team-practice will require a tailored implementation strategy for each health system including consolidated tools such as a CMM-CKM Change Package, integrated with coaching, field experts, and peer-to-peer learning.
Area of Special Interest
Kidney & Diabetes
Area of Special Interest
Cardiovascular (Heart)
Area of Special Interest
Digestive Health
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Endocrinology
Specialty/Research Institute
Primary Care
DOI
10.1002/jac5.70253
