Abstract
Background and Rationale: Chronic Kidney Disease (CKD) is a significant public health issue
in Thailand, with an increasing trend that negatively impacts patients’ quality of life and
imposes a heavy financial burden on the Universal Health Coverage (UHC) system. Early-stage
prevention and delay of kidney deterioration are essential, particularly at the primary care
level. However, the current healthcare system faces limitations in workforce, budget, and
access to care in managing CKD patients in Thailand.
Objective: To develop an integrated primary care service model by involving community
pharmacists under the UHC system to prevent and delay CKD progression in high-risk
populations in Thailand.
Methods: This mixed-method research employed both action research and a quasi-experimental study. The study population included 1,000 participants at high risk of CKD who
were customers of community pharmacies under the UHC system in Health Region 7 (Roi Et,
Khon Kaen, Maha Sarakham, and Kalasin). Data collection took place from November 2024 to
May 2 0 2 5 . The intervention model integrated community pharmacists’ roles in CKD
prevention, utilizing Microalbuminuria Rapid Test (MRT) for urine protein screening. Individuals
with positive MRT results underwent estimated glomerular filtration rate (eGFR) testing. Those
with eGFR < 60 ml/min/1.73 m² were referred to hospital nephrology clinics. Individuals with
negative MRT or eGFR ≥ 60 ml/min/1.73 m² received lifestyle modification counseling from
pharmacists, followed by remote pharmaceutical care and repeat MRT testing at 3 months.
Results: The majority of participants were female (72.0%), with a mean age of 61 years (S.D.
= 8.5). The average body mass index (BMI) was 24.7 kg/m² (S.D. = 4.0), with 73.0% classified as
overweight. Most volunteers had controlled blood pressure levels (83.0%) and an average
estimated glomerular filtration rate (eGFR) of 75.1 ml/min/1.73 m² (S.D. = 4.4). Major risk factors
for chronic kidney disease (CKD) included age over 60 years (38.0%), hypertension (24.0%), and
diabetes (23.0%). Among the participants, a total of 36.0% of participants had no underlying
diseases, followed by those with diabetes (23.0%) and hypertension (22.0%). Regarding
comorbidities, 37.0% had no more than one comorbid condition, and 35.0% had no
comorbidities. Screening for high-risk individuals for CKD was conducted among 1,000
participants. Proteinuria was detected in 205 individuals (20.5%), while 795 individuals (79.5%)
showed no signs of protein leakage. All individuals were provided with lifestyle modification
advice to delay kidney function decline and were scheduled for follow-up testing using the
Microalbuminuria Rapid Test (MRT) at the 3rd month. Among the 205 participants who initially
had urine protein levels ≥20 micrograms per deciliter, eGFR testing revealed that 155
individuals (75.6%) had eGFR values greater than 60 ml/min/1.73 m², while 50 individuals
(24.4%) had eGFR values below 60 ml/min/1.73 m². In the second round of testing, 107
individuals were found to have persistent proteinuria ≥20 micrograms per deciliter. Among
them, 83 participants (77.6%) had eGFR values greater than 60 ml/min/1.73 m², and 24
participants (22.4%) had eGFR values below 60 ml/min/1.73 m². A total of 74 individuals were
referred for further treatment, of which 24 (32.4%) were diagnosed with CKD and received care
in hospital settings. Notably, after a 3-month intervention involving pharmacist-led behavioral
modification counseling to slow CKD progression, the number of participants with proteinuria
decreased from 205 to 107 (a reduction of 47.8%). The intervention, which included CKD
education, promotion of healthy lifestyle changes, and self-management strategies,
significantly improved kidney function as evidenced by statistically significant improvements
in eGFR (p < 0.001). Overall, participants reported a high level of satisfaction with the program,
with a mean satisfaction score of 4.93 (S.D. = 0.30).
Conclusion and Discussion: The development of a primary care system integrating
community pharmacists for CKD screening, counseling, follow-up, and referral is feasible and
produces positive clinical and behavioral outcomes. Expanding the role of community
pharmacists in CKD prevention significantly reduced proteinuria and improved eGFR (p<0.001).
This model should be supported by national policies, budget allocation, and pharmacist
capacity building to ensure sustainable scale-up nationwide.
Policy Recommendations and Applications: Policy recommendations synthesized from
feedback from 10 participating pharmacies and the Pharmacy Council include: promoting
community pharmacies as proactive health service units for CKD screening and prevention
under the UHC; developing adaptable community-level screening and follow-up models with
multidisciplinary collaboration; ensuring community engagement; supporting health
information systems for monitoring outcomes; and proposing a comprehensive pharmacist-based CKD prevention model to the National Health Security Office (NHSO).
