The renal-geriatrics clinic is based on an interprofessional, collaborative approach to care for Veterans at the Jamaica Plain campus of the VA Boston Healthcare System. Patients with kidney disease are typically older, medically complex, and carry a high burden of comorbidities and medications. Understanding that these patients often require a higher level of care, the clinic incorporated providers with different backgrounds to provide holistic, patient-centered care. Our team includes a nephrologist, geriatrician, social worker, pharmacist, and trainees of various levels and backgrounds. Each provider brings their specialized insight to the team “huddle” to formulate one, comprehensive treatment plan.
Training in the “Geri-Renal” clinic is a unique opportunity to learn from different members of the team. As a trainee, you are able to work with learners at different levels, with different specialties. As a pharmacy trainee, I have worked with nephrology fellows, geriatric fellows, neuropsychiatry residents, and other pharmacy trainees and students. This clinic embodies the layered learning model as all recommendations are discussed with the renal attending, before ultimately discussing with the patient. Not only does the renal clinic offer robust clinical training but also offers the opportunity to participate in various, interprofessional quality improvement projects. Traditionally, different trainees have come together with our geriatric-oriented attending nephrologist, Dr. Julie Paik, to create and implement innovative treatment models for our patients. Most recently, this training includes a project joining pharmacists and nephrologists to initiate and manage medications for diabetes in patients with kidney disease, namely the SGLT-2 inhibitors and GLP-1 agonists. These medications have shown renal and cardiovascular benefit in patients with chronic kidney disease and/or heart failure. The team works together to determine which patients may benefit from these medications, initiate them appropriately, and follow-up to ensure adherence and safety. Working in the renal-geriatrics clinic is a wonderful learning experience for a VA trainee, regardless of their background.