Closing the Gap


A NEW APPROACH TO CHRONIC KIDNEY DISEASE CARE


Prescribing general practice pharmacist Tania Ramos is passionate about addressing avoidable health inequalities. She believes where someone lives should not affect the care they receive.


Her practice in the Townhead area of Glasgow serves an area of high socioeconomic deprivation which directly and indirectly creates inequalities in health and social care. Tania has risen to the challenge of redressing these avoidable inequities that others may have avoided addressing.


Tania leads a pharmacist-led multidisciplinary chronic kidney disease (CKD) review clinic that identifies and proactively reaches out to review patients with CKD, polypharmacy and multimorbidity. Chronic kidney disease is a leading cause of premature mortality and it often co-exists alongside cardiovascular disease and diabetes. It is more likely to affect socioeconomically deprived groups.


Her work in this area is aimed at addressing avoidable progression to end stage kidney disease and the need for dialysis, which can be personally and financially costly for both patients and society. The outcome has been improvements in patients’ CKD status (blood pressure/lipid files) and a reduction in the number of kidney damaging medications. Some patients have benefitted from earlier onward referral too.


A Multidisciplinary Approach


To ensure appropriate clinical governance, Tania planned a general practice multidisciplinary team approach where she led the intervention as part of the practice team, drawing on the expertise of patient’s GPs and specialists where appropriate. This involved case based discussion and reviews, especially where the patients were more complex and required onward referral to specialist services.


In addition to this work, Tania also leads multimorbidity and polypharmacy outreach medication reviews for housebound patients who are routinely excluded from general practice based long-term condition management.


“I work in practices serving some of the most socioeconomically deprived communities in Scotland, where I repeatedly saw patients falling through gaps in existing care pathways,” explained Tania.


“Although the cardiovascular-renal and metabolic (CVRM) and care-at-home pharmacotherapy service (CAHPS) projects focused on different patient groups, they share the same underlying principle: identifying people who are “missing” from routine care and ensuring they receive timely, evidence-based interventions..


“The CVRM service addressed a gap in chronic kidney disease management, an area not routinely embedded within structured QOF-like chronic disease recall in Scotland. The CAHPS service addressed a different form of missingness by proactively reaching frail housebound patients who had become disconnected from routine reviews because they could no longer attend appointments independently.


“In both cases, the aim was to bridge gaps in care, optimise treatment, improve patients’ understanding of their conditions and reduce preventable complications. For patients with chronic kidney disease, that means slowing disease progression, reducing cardiovascular risk, and delaying or preventing dialysis, which has a profound impact on patients, families and the NHS. More broadly, I wanted to demonstrate how pharmacists in primary care can contribute to prevention, anticipatory care and long-term condition management by developing and evaluating services that improve patient outcomes and reduce health inequalities.”


Tania has mentored colleagues to deliver similar initiatives and developing others has included educational programs, supervised learning events and undergraduate experiential learners. She is also in the process of working with specialist renal teams in Glasgow and Leicester and at the Scottish Government to further develop and expand the CKD work with the aim of embedding it in routine general practice pharmacy team work to reduce avoidable medication-related harms, slow CKD progression and overcome avoidable barriers to care.


Chronic kidney disease is a leading cause of premature mortality and it often co-exists alongside cardiovascular disease and diabetes...


Balancing Demands


Tania has had to balance the demands of her CKD and polypharmacy outreach schemes with her other routine service demands such as prescribing cost saving initiatives, routine acute prescription management/processing and supporting and developing the wider North East Glasgow Health and Social Care Partnership (HSCP) pharmacy colleagues.


While the general practices were supportive and engaged with Tania’s CKD work, in order to create and protect time Tania applied for a small grant to fund half a day per week, with the support of her manager. The grant success and managerial support helped to increase the profile of her CKD service development and formalise it as HSCP Pharmacy Services work.


Although it was a small amount of time it enabled Tania to protect that time for delivery and evaluation of the CKD clinics.


Tania has published the findings of her work and has shared it with colleagues locally within NHSGGC. She has also presented at conferences locally and nationally and proactively contacted the Scottish Government’s prevent Cardiovascular Disease team.


Tania is keen to continue to develop, test and expand the CKD and other pharmacy-led initiatives. In order to do this she has recently secured an NHS Research Scotland Career Researcher Fellowship 2026-29, that will fund one day a week to continue to develop and formally test her pharmacist-led CKD intervention. This has involved engaging academics, policy makers, clinicians and people with lived experience as a collaborative team to help future work in addressing current CKD healthcare gaps and avoidable inequalities.


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