Pharmacist-led structured care for patients with diabetic nephropathy

Intensive multifactorial intervention reduces end points in patients with diabetic nephropathy. Traditional clinics struggle to provide the intensity of care required to meet targets for this growing patient group. We designed a pharmacist-led, protocol driven clinic to offer stepwise intensive treatment to patients with diabetic nephropathy picked up at the traditional secondary care clinic. One hundred and sixteen individuals received more than one review. The clinic achieved significant improvements in blood pressure (BP): systolic 151±19 mmHg vs.133±15 mmHg (p<0.001), diastolic 80±10 mmHg vs. 68±10 mmHg (p<0.001) and total cholesterol 4.56 mmol/L±1.05 mmol/L vs. 4.03±1.07 mmol/L (p<0.001). Albumin:creatinine ratio also improved 27±44 vs. 20±31 (p=0.02). Structured intervention within a pharmacist-led clinic has led to a rapid and significant reduction in BP and cholesterol in microalbuminuric patients. This format of care can form the basis of patient focused, target driven, care.