Implementation of an Electronic Drug-Dosing Decision Support Kidney Tool for Pharmacists
Katie Halliday, Emma Phelan, Natalie Ratajczak, Karthik Tennankore, Marisa Battistella, Steven Soroka, Penelope Poyah, Keigan More, Cynthia Kendell, Jaclyn Tran, Maneka Sheffield, Heather Naylor, Natalie Kennie-Kaulbach, Daniel Rainkie, Andrea Bishop, Lisa Woodill, Rowan Sarty, Daniel Rasic, Jo-Anne S. WilsonBackground:
People with CKD experience polypharmacy, highlighting the need for appropriate dosing as kidney function declines. Community pharmacists are well positioned to mitigate inappropriate prescribing. We implemented and evaluated an electronic drug-dosing decision support kidney (eDoseCKD) tool in community pharmacies.
Methods:
Using a mixed-methods design guided by the RE-AIM framework, eDoseCKD was evaluated in 12 pharmacies during a 6-month intervention with 3-month follow-up. Adults with an eGFR<60 ml/min prescribed medications requiring kidney-based dose adjustment were eligible. Reach was measured by the at-risk CKD population and participation rates. Effectiveness was measured by medication changes, unexpected adverse events, and patient and pharmacist satisfaction. Adoption was examined through site and pharmacist participation; implementation fidelity through consistency of tool use and pharmacist interviews guided by the Theoretical Domains Framework to explore implementation barriers and facilitators. Maintenance was measured by sustained dose changes at 3 months and tool use at 6 months.
Results:
86% of pharmacists (18/21) and pharmacies (12/14), and 92% at-risk CKD patients (84/91) participated. Patients had a mean age of 78±8 years and eGFR 33±14 mL/min/1.73 m 2 . Using eDoseCKD, 93 medications were adjusted, most commonly famotidine, metformin, gabapentinoids, and anticoagulants. Two mild symptom-worsening events occurred. Mean patient and pharmacist satisfaction (5-point scale) was 4.6±0.6 and 4.9±0.3. Adoption was high, with 2 sites and 3 pharmacists declining. Most adjustments (91%) aligned with tool recommendations. Five themes identified barriers and facilitators to implementation, primarily related to environmental context and resources, beliefs about consequences, decision processes, and professional role. Nearly all dose adjustments persisted at 3 months, and all pharmacists continued using the tool at 6 months.
Conclusions:
eDoseCKD demonstrated good reach, effectiveness, adoption, implementation fidelity, and short-term maintenance across pharmacies. It enabled identification of kidney-based medication deprescribing opportunities with minimal adverse effects and highlighted barriers and facilitators, supporting feasibility and scalability.