Ryan Haumschild, PharmD, MS, MBA: We’ve talked a lot about the different treatments that are available. We’ve talked about the benefits of multidisciplinary care and filling in those transitions, but we still know there [are] unmet needs, there [are] costs associated with these treatments and even barriers that decrease the ability to enhance that collaboration, and even from the patient. If you think about social determinants of health, you think about transportation vulnerability, how does that patient make it in all the time to keep up those additional appointments? Those are all key considerations, and hopefully we can delve into a little bit of those in this discussion. Dr Nicholas, I know you deal with a large patient population and [are] really an expert when it comes to CKD [chronic kidney disease] and a lot of the patients within your registry and within your practice. What are some of the unmet needs that remain in the treatment and management of patients with CKD?

Susanne B. Nicholas, MD, MPH, PhD: Well, there are several unmet needs that…need to be addressed.… We’ve touched on some of these already in terms of early diagnosis…being educated and aware of the guidelines that are already published, being aware of the medications that out there. But I think you mentioned some things that aren’t routinely accessed or required information when a patient comes to see their provider: social determinants of health. It’s only recently, even at my institution, that we’re now beginning to focus on social determinants of health and trying to get that information from the patient into the electronic health record. But we’ve known for many years of the impact of these social determinants of health on patients in terms, for example, of not being able to travel to the physician or not being able to have the income to support their medication regimen.... We’re only now beginning to understand the impact of this. What we really need to do is promote this even more, not only from the provider level, but also from the patient perspective, because patients aren’t aware of the impact of offering that information to the provider and the impact that it can have down the road. The education and awareness begin with the provider as well as with the patient—in terms of the importance of social determinants of health. Can the patient afford their medication? Does the patient have access to the [correct] types of foods? For example, in a patient who has chronic kidney disease, we really promote plant-based protein instead of [animal-based protein] diets. These are important things that only now we’re [beginning] to understand. That’s a huge unmet need and it’s a huge care gap that I think that still need to be filled.

Ryan Haumschild, PharmD, MS, MBA: Yeah, I appreciate that callout, especially when we think about CKD patients, right? We’ve got to think about the diversity of the patient base. We’ve got to think about the socioeconomic background, the financial toxicity, because there [are] barriers in how we communicate with each other, but there [are] barriers with the patient in [adhering] to medication and making sure they clearly understand their goals of therapy. I really appreciate you touching on that. You know, as we transition to barriers that are with the patient but maybe with the provider, I think about screening. Something that’s been very common is, why aren’t we screening more? This isn’t new information. Dr Anderson, when you think about the challenges that providers face in screening patients during early stages, what are some strategies that we can do to overcome it…and if anything, what can payers do as well to help overcome some of these obstacles, maybe by covering a certain test or creating awareness among the providers within their network? What are some of your ideas?

John E. Anderson, MD: I think [if you are] part of a large hospital system or a payer-based system, any time you provide incentives, reminders, education across the population to the primary care community, you will hopefully see improved screening. We talk about barriers to screening. There’s not a lot, at least in the primary care community. Let’s think about this. How many things am I in charge of? When was your last colon cancer screening? When was your last mammogram? When was your last [prostate-specific antigen screening], if it’s appropriate? They’re not the barriers there. When we talk about screening for chronic kidney disease and type 2 diabetes, I have to think about, when was your last dilated retinal exam? Have I checked a lipid profile this year? Have I checked an eGFR? Have I ordered a uACR [urine albumin-creatinine ratio screening]? They’re all covered. They’re all available. There’s really no barrier there. There are barriers sometimes with therapies that we have discussed that we need to talk about. [Dr Cohen] made a great point about looking at the economics. You know, what is the economics for a decrease of 30% for hospitalization, for heart failure? I think we can do the math there.… But from a primary care perspective, it’s more about education. It’s more about developing a system to do the right things than it is about barriers. There are very little barriers that I experience in doing proper screening for patients of any kind of disease state.

Ryan Haumschild, PharmD, MS, MBA:You know, I’m wondering too, we have busy primary care providers, and if we’re part of a practice or a network, how do we leverage order set so that some of these labs are pulled through so that that can be done for 1 click and then that information can be pulled forward? How do we start to leverage that technology in the EMR [electronic medical record], identifying patients maybe that have lower labs and comorbidities and flagging those for intervention to have discussions? I think those are great ideas because our providers are busy. There’s a lot of documentation and a lot of times the more we can leverage the EMR and bring that data forward, that is going to be a true benefit.

John E. Anderson, MD: I think any EMR reminder that pops up and says this person is 4 months overdue for a mammogram, this person is 10 years post colon cancer screening. If we have social determinants that keep a patient from being able to get a colonoscopy, we have other ways of screening now. Figure out what works for that individual patient. But I think we’re almost all electronic medical records now. There should be embedded within each system standards of ordering and standards of care that pop up, because we all get busy. If you don’t see that patient for another year, you may have missed a window of opportunity for a year. So, yes, I think those are important.

Jennifer B. Green, MD: Might I add something there? I would like to mention that at my institution we’ve just built an order set that essentially pulls in everything that the person with diabetes is overdue for. It will automatically look to see whether or not they’ve had a uACR test within the past year, to see if they’ve seen an eye doctor. If they haven’t, then the provider can click on this. It’s 1 click, and all of those things can be ordered, but I think it actually should be taken a step further because I don’t see why we have to wait for someone to remember to do that. I think it should just happen.… I haven’t seen that yet in any health systems. But why not?

Ryan Haumschild, PharmD, MS, MBA:It’s a very true statement and I appreciate that. I think that’s really where we’re headed. I think even as we’re watching these pharmacy leaders, as we’re developing order sets and bringing these through the digital platforms, how do we make sure we make these easier on our providers and then other individuals [who] can follow through and work as a care team?…

Susanne B. Nicholas, MD, MPH, PhD: I see that no-click with just making the diagnosis of chronic kidney disease. You look into the electronic health record system and some of these databases, and patients have CKD based on their eGFR, but they do not have a diagnosis code. We don’t need to click for that. No, it should just be there.

John E. Anderson, MD: That would be great if you could auto-populate anyone with an eGFR that meets the criteria and the provider doesn’t have to go in and enter CKD stage 3a and just boom, it populates in the problem list.

Jennifer B. Green, MD: Yes, it’s a laboratory diagnosis.

Transcript is AI-generated and edited for clarity and readability.