Developing a pharmacy-led integrated primary care model for chronic kidney disease prevention in community pharmacy settings under Thailand’s Universal Health Coverage System: an action research

Chronic kidney disease (CKD) represents a growing public health challenge, particularly in low- and middle-income countries, where delayed diagnosis and limited access to early screening contribute to disease progression and increased healthcare burden. Community pharmacies, as accessible primary care points, offer significant potential for early detection and prevention of CKD. To develop, implement, and evaluate a pharmacy-led model for screening, prevention, and delay of CKD progression among high-risk populations in community pharmacy settings under the Universal Health Coverage system in Thailand. This study used an action research design to develop and refine a pharmacist-led CKD care model for community pharmacy settings. Each cycle comprised planning, action, observation, and reflection. Cycle 1 focused on contextual assessment, stakeholder engagement, and initial model development. Cycle 2 involved pilot implementation and qualitative evaluation to identify barriers, facilitators, and required modifications. Cycle 3 incorporated these findings to refine and finalize the care model, followed by implementation in 17 community pharmacies across four provinces. The refined model was implemented among 1,000 adults at high risk of CKD, with assessments at baseline, 3 months, and 6 months. Qualitative data were analyzed thematically, and predefined participant-level outcomes included CKD-related knowledge, lifestyle modification, self-management, kidney function, and medication-related problems. Across the three cycles, iterative qualitative findings informed progressive refinement of the service workflow, data-collection tools, digital support, and referral processes. The final model comprised CKD risk screening, pharmacist-led risk communication and self-management support, medication therapy management, referral and care coordination, and digitally supported longitudinal follow-up. Among 1,000 high-risk participants, the proportion with 205 participants, a positive Microalbuminuria Rapid Test (MRT) result decreased from 20.5% at baseline to 10.7% at 3 months and 4.1% at 6 months. Among participants with a positive baseline MRT result, mean estimated glomerular filtration rate increased from 72.42 to 79.17 mL/min/1.73 m² at 6 months (mean change, 6.75; 95% CI, 5.67–7.83; p < 0.001). Mean CKD-related knowledge, lifestyle modification, and self-management scores also increased during follow-up. The three-cycle action research process resulted in a refined pharmacist-led CKD care model suitable for subsequent evaluation of its effectiveness under routine primary care conditions. The action research process supported the development and contextual refinement of a pharmacy-led integrated primary care model for CKD prevention in community pharmacy settings under Thailand’s Universal Health Coverage system. The study generated preliminary evidence regarding implementation feasibility and participant-level outcomes under the study conditions. Because the study used a single-arm pre–post design without a concurrent control group, the findings do not establish causal effectiveness, long-term sustainability, or scalability. Further controlled and longer-term implementation studies are needed to evaluate the model before broader scale-up.