Pharmacist-led community pharmacy model flags early kidney risk in Thailand

Community pharmacies in Thailand have been used as the setting for a new pharmacist-led model of care that aims to catch chronic kidney disease early, before it progresses to stages that strain patients and health systems alike. The model, developed through a structured action research process and published in BMC Primary Care, was implemented across 17 community pharmacies in four provinces and tested among 1,000 adults at high risk of kidney disease under the country’s Universal Health Coverage system.

Chronic kidney disease is a growing public health challenge, particularly in low- and middle-income countries, where delayed diagnosis and limited access to early screening allow the disease to advance silently. Because community pharmacies are among the most accessible points of primary care, the researchers saw them as a practical venue for early detection and prevention rather than relying solely on hospitals and clinics.

The study used an action research design, in which the care model was developed and refined over three iterative cycles, each comprising planning, action, observation and reflection. The first cycle focused on assessing the local context, engaging stakeholders and building an initial model. The second cycle piloted the service and gathered qualitative evaluations to identify barriers, facilitators and needed modifications. The third cycle incorporated those findings to refine and finalize the model before its wider implementation.

Across the three cycles, the qualitative findings progressively shaped the service workflow, the data-collection tools, digital support systems and referral processes. The final model brought together several components: CKD risk screening, pharmacist-led risk communication and self-management support, medication therapy management, referral and care coordination, and digitally supported longitudinal follow-up.

The refined model was then implemented among 1,000 adults identified as being at high risk of chronic kidney disease, with assessments at baseline, three months and six months. Predefined participant-level outcomes included CKD-related knowledge, lifestyle modification, self-management, kidney function and medication-related problems.

The screening results showed a marked shift over the six-month follow-up. The proportion of participants with a positive Microalbuminuria Rapid Test result fell from 20.5 percent at baseline to 10.7 percent at three months and 4.1 percent at six months. Among participants who had a positive baseline test, mean estimated glomerular filtration rate rose from 72.42 to 79.17 mL/min/1.73 m² at six months, a mean change of 6.75 (95 percent CI, 5.67 to 7.83; p < 0.001).

Alongside these physiological measures, mean scores for CKD-related knowledge, lifestyle modification and self-management all increased during follow-up, suggesting that the pharmacists’ risk communication and self-management support components were reaching participants as intended.

The authors are careful about what these numbers do and do not show. The study used a single-arm pre–post design without a concurrent control group, which means the findings do not establish causal effectiveness, long-term sustainability or scalability. The action research process is instead presented as having generated preliminary evidence on implementation feasibility and participant-level outcomes under the study conditions, and as having produced a refined model suitable for subsequent evaluation of its effectiveness under routine primary care conditions.

That caution matters for interpretation. Without a control group, changes in microalbuminuria test results and kidney function could reflect the intervention, natural variation, regression to the mean among people selected for elevated risk, or other factors operating during the follow-up period. The study team itself states that further controlled and longer-term implementation studies are needed before any broader scale-up of the model.

Even so, the work offers a concrete template for how community pharmacies might be integrated into chronic disease prevention under a universal health coverage framework. The three-cycle process yielded a defined package of services, screening, risk communication, medication review, referral coordination and digital follow-up, that was refined in response to real-world barriers and facilitators rather than imposed from the top down. Whether that package can deliver durable kidney health benefits at scale will depend on the controlled studies the researchers say must come next.

Subject of Research: Development of a pharmacist-led community pharmacy model for chronic kidney disease screening and prevention in Thailand

Article Title: Developing a pharmacy-led integrated primary care model for chronic kidney disease prevention in community pharmacy settings under Thailand’s Universal Health Coverage System: an action research

Article References: Panngern, W., Anutrakulchai, S., & Lertsinudom, S. (2026). Developing a pharmacy-led integrated primary care model for chronic kidney disease prevention in community pharmacy settings under Thailand’s Universal Health Coverage System: an action research. BMC Primary Care. https://doi.org/10.1186/s12875-026-03606-w

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03606-w

Keywords: chronic kidney disease, community pharmacy, pharmacist-led care, primary care, Thailand, Universal Health Coverage, action research, screening, microalbuminuria, glomerular filtration rate, self-management, implementation science