Final Thoughts on IRC Management

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Thank you all for this rich and informative discussion. Before concluding, I would like to hear the final thoughts of each of you. Let’s start with Dr. Feldman. Leave us some parting thoughts for our viewers based on this discussion.

Jeffrey Feldman, MD: I want to emphasize that we must be more preventive in the treatment of the disease before it becomes chronic and progressive, in reference to diabetes and CKD [chronic kidney disease]. We haven’t talked about how there are now studies available, especially SGLT2 studies, and Dr. Agarwal said some studies are going to be done with MRAs. [mineralocorticoid receptor antagonists]that CKD with or without diabetes can be treated, and [you can] slow progress. When you slow progress, you have less [poor] cardiovascular outcomes, including heart failure, which is #1, and patients feel better. Quality of life studies are on the horizon. SGLT2 inhibitors all have [good] quality of life. People are better. When people get better, they are happier and can enjoy life, even if they have chronic kidney disease.

I’ll end with something I heard on the radio one day on my way home that made me smile. As the Beatles said, “Here comes the sun”. I will end on this. New medicines, new implementation, use of social determinants of health, and use of a team approach with the patient at the center will improve patient outcomes. I thank you all.

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Thank you for this positive outlook. I’m also excited about the future treatment landscape. Dr Agarwal, I am curious to hear your final thoughts for our viewers.

Rajiv Agarwal, MD, MS: I’m going to make a point that’s probably important to any listening doctor. It has to do with the social story we take. When we ask our medical students to take a social history, you hear about smoking, drugs, or alcohol, and that’s where it stops. We need to do much better. Whenever I do patient rounds or see outpatients, I am truly honored to see how important social factors play a role in patient genesis, progression, and acute illness. If we don’t treat them, we just put a bandage on.

The social determinants of health have naturally become an important topic. It has become an important area of ​​interest, including at Humana. Paul Sapia highlighted the initiatives, and I applaud them. But at the level of individual physicians, we need to do better. You need to know how your patients live, where they live and if they have any activities going on. Do they have a pet? Do they walk him? Or do they just watch TV? I have visited patients’ homes, and a simple 5 minute drive will tell me exactly how and why the patient got there, because I know what they do and where they live. We need to explore this much more when we see our patients on a day-to-day basis rather than relying on textbooks. That’s all.

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Excellent thoughts. Thanks. Dr. Pitt, what final thoughts do you have for us?

Bertram Pitt, MD: I’ve been around for a while, and over my lifetime there have been dramatic changes in the way we treat heart failure and kidney disease. We now have tools that allow us to move on to prevention and even to stop the progression and development of the disease. But I’m also excited about the future. There are clues that we can make a big difference.

During the discussion, Dr. Feldman alluded to inflammation and autoimmunity. There are new modalities that we can [use to] start attacking that, which has not been attacked. There are many things for the future. But above all, we now have tools that we must learn to use. There may be things coming in the future—I think there are—but if we don’t use the tools we have now, we’ve missed a tremendous opportunity. We have very powerful tools, with the SGLT2 [inhibitors] and now non-steroidal ARMs, such as finerenone.

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: [We have] great new therapies. How can we ensure that we use them and that patients have access to them? I’m going to ask our esteemed managed care colleague, Paul, to give our final thought from our panel.

Paul Sapia, MHA: We’ve all talked about the social determinants of health and understood the postcode issues and the community issues that exist. Dr Agarwal talked about going into the house and being able to see [their living situation]. Is there food at home? Is it clean? Does the air conditioning work? These are all important things. As we look at our clinician partners and our other types of provider partners who go into the home to help people get things like food and nutrition, how do we bring a lens into the patient’s home to understand?

The other aspect I talked about earlier is caregivers and family support. [In addition] For the member to change behavior, family members and caregivers need to support that behavior change. It is important to explain why we have to do this, why it is important, how to do it and give them the tools to be able to do it. If we look at prevention, we have the data and the analytics, and we understand what’s going on with the community, so we could focus a lot of those efforts on the specific communities that have a high incidence of diabetes, heart disease and obesity, and start changing what’s happening in those postcodes and areas. Thanks a lot. I enjoy being part of the panel.

Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Thank you all, once again. And thank you to our audience of viewers. We hope you found this AJMC® Peer exchange be useful and informative.

Transcript edited for clarity.

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