Mark Gasparini, MD

Urology, KP South San Francisco


“This program would have been difficult to develop anywhere but in a medical group like TPMG, where physicians embrace preventative care and practice evidence-based medicine in an intensely collaborative, patient-centered environment.”

Heed the advice from someone who’s been there—passing a kidney stone is not for the faint of heart. American author Edward Abbey once said, “One must be reasonable in one’s demands on life. For myself, all that I ask is: (1) accurate information; (2) coherent knowledge; (3) deep understanding; (4) infinite loving wisdom; and (5) no more kidney stones, please.”

Kidney stone disease is not uncommon: 1 in 10 people will have a kidney stone at some point in their lives. Of those, approximately 60% require an emergency department visit, and 20% need surgery. And while not having to suffer through another one might seem like a reasonable demand, recurrence rates are unfortunately high—approximately half of patients will have another painful stone episode, and many will suffer multiple recurrences.

Fortunately, kidney stones are preventable. With proper evaluation and preventive care, risk can be reduced by 50% to 300%. This fact is not lost on Dr. Gasparini, a TPMG urologist who, along with his colleagues, spearheaded a kidney stone prevention program that has dramatically improved kidney stone prevention throughout KP Northern California.

Dr. Gasparini set out to build a pharmacist-managed program that would rely on evidence-based protocols administered via telemedicine to efficiently improve preventive care. Working with local leadership and multiple specialty groups, he implemented a pilot program at KP South San Francisco and Oakland.

The results demonstrated dramatic improvements—dietary education that had been occurring about half the time increased to 100%, and complete metabolic evaluations increased from 16% to 80%. After honing the protocols locally with physicians and pharmacists, the Northern California Kidney Stone Prevention program was expanded regionwide in 2019.

“This program is a beautiful example of TPMG’s ability to perform delivery science—taking the knowledge that everyone in medicine knows we should do and leveraging our integration to actually do it,” says John Skerry, MD, physician-in-chief at KP South San Francisco.

Today the Northern California Kidney Stone Prevention program is managed by just two pharmacists and a pharmacy technician. It’s estimated the program will eliminate 1,000 kidney stone episodes, 700 urology consults, and 200 surgical procedures per year