{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:59:49Z","timestamp":1787338789209,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100013607","name":"American College of Clinical Pharmacy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013607","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Am Coll Clin Pharm"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Obesity, diabetes, and cardiovascular disease often co\u2010exist in people with chronic kidney disease, placing them at high risk for adverse health outcomes. Availability of highly effective medications that span cardiovascular\u2010kidney\u2010metabolic (CKM) conditions, but limited uptake in real world settings, calls for a new transformative practice paradigm. We sought to identify key gaps, barriers, and facilitators to implementing a standardized CKM\u2010focused comprehensive medication management (CMM) intervention, including needs\/solutions among various care team members involved in CKM care in diverse health systems across the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) deployed in five health care systems across the United States. Clinical pharmacists, pharmacist administrators, primary care and specialty (nephrology, cardiology, endocrinology) physicians, and advanced practice professionals were interviewed using open\u2010ended questions that were informed by results from three mainly quantitative online surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 26 interviews were conducted with 42 participants. Practitioners and administrators reported many similar challenges to successfully implement CMM for people with CKM including lack of standardized CMM practice and workflow across the health system, electronic medical record integrated tools to identify and track patients with CKM, automatic pharmacist referrals, broad clinical practice agreements, and holistic CKM performance metrics, as well as pharmacist time constraints and limited reimbursement. Participants also highlighted CMM\u2010CKM practice facilitators including recognition across most health care professionals that CKM should be a system priority, requiring strong supportive professional relationships among physician and\/or administrator champions, and tools, knowledge, and resources that could be shared with others.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Successful implementation of a transformative, holistic CMM\u2010CKM interprofessional team\u2010practice will require a tailored implementation strategy for each health system including consolidated tools such as a CMM\u2010CKM Change Package, integrated with coaching, field experts, and peer\u2010to\u2010peer learning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jac5.70253","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T10:10:17Z","timestamp":1782727817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Gaps, Barriers, and Facilitators to Implementing Comprehensive Medication Management in Cardiovascular\u2010Kidney\u2010Metabolic Care: A Qualitative Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4305-6167","authenticated-orcid":false,"given":"Omolayo","family":"Umaru","sequence":"first","affiliation":[{"name":"College of Pharmacy, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5096-1991","authenticated-orcid":false,"given":"Deborah L.","family":"Pestka","sequence":"additional","affiliation":[{"name":"Center for Learning Health System Sciences, Medical School, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9219-3566","authenticated-orcid":false,"given":"Lindsay A.","family":"Sorge","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9247-5064","authenticated-orcid":false,"given":"Chi\u2010Han","family":"Cheng","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Dryden","sequence":"additional","affiliation":[{"name":"College of Pharmacy and Pharmaceutical Sciences, Washington State University  Spokane Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5024-7891","authenticated-orcid":false,"given":"Janani","family":"Rangaswami","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2235-0103","authenticated-orcid":false,"given":"Katherine R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Inland Northwest Health  Spokane Washington USA"},{"name":"Nephrology Division and Kidney Research Institute, University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5026-2363","authenticated-orcid":false,"given":"Amanda","family":"Brummel","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Minnesota  Minneapolis Minnesota USA"},{"name":"Fairview Pharmacy Services, MHealth Fairview  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4734-7402","authenticated-orcid":false,"given":"Joshua J.","family":"Neumiller","sequence":"additional","affiliation":[{"name":"College of Pharmacy and Pharmaceutical Sciences, Washington State University  Spokane Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2201-3019","authenticated-orcid":false,"given":"Wendy L. St.","family":"Peter","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Chronic Kidney Disease in the United States 2023 \u201cCenters for Disease Control and Prevention \u201d2026 https:\/\/www.cdc.gov\/kidney\u2010disease\/php\/data\u2010research\/index.html."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001184"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.120.007264"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2022.100564"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1653"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.3796"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1496"},{"key":"e_1_2_11_9_1","unstructured":"CMM Implementation System: Assess your Foundations \u201cOptimizing Medications for Better Health \u201d2026 https:\/\/www.optimizingmeds.org\/."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.12.008"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2020.01.001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxab271"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300\u2010023\u201001416\u20102"},{"key":"e_1_2_11_14_1","volume-title":"Medication Therapy Management Interventions in Outpatient Settings","author":"Viswanathan M.","year":"2014"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.7326\/m15\u20103058"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1700"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012\u2010022\u201001245\u20100"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177705148"},{"key":"e_1_2_11_19_1","unstructured":"\u201c@rev Investigative Intelligence Platform \u201d(2026) https:\/\/www.rev.com\/."},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732320921835"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxac104"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.1927"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/jac5.70198"},{"key":"e_1_2_11_24_1","unstructured":"\u201cAdvancing Kidney Health Through Optimal Medication Management \u201d2026 www.kidneymedicationmanagement.org\/."},{"key":"e_1_2_11_25_1","unstructured":"American Heart Association \u201cCardiovascular\u2010Kidney\u2010Metabolic Health Implementation Guide \u201d2026 https:\/\/www.heart.org\/en\/professional\/cardiovascular\u2010kidney\u2010metabolic\u2010health\/implementation."}],"container-title":["JACCP:  JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jac5.70253","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jac5.70253","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jac5.70253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:18:39Z","timestamp":1783502319000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/jac5.70253"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/jac5.70253"],"URL":"https:\/\/doi.org\/10.1002\/jac5.70253","archive":["Portico"],"relation":{},"ISSN":["2574-9870","2574-9870"],"issn-type":[{"value":"2574-9870","type":"print"},{"value":"2574-9870","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"assertion":[{"value":"2026-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70253"}}