Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data

Abstract

BackgroundMuch of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD.Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes.MethodWe validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate.Results87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM).85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%.Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD.84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD.ConclusionsPractitioners are less likely to achieve management targets where their confidence is low.

Informatics as Tool for Quality Improvement: Rapid Implementation of Guidance for the Management of Chronic Kidney Disease in England as an Exemplar

“…People in primary care were sceptical about CKD [36], lacked confidence, were inconsistent in their testing of kidney function [37], and the lack of confidence was associated with lower levels of achievement [38]. An educational intervention improved quality, again this improvement was measured using routine data [39].…”

Correlation of Lower Concentrations of Hydrogen Sulfide with Atherosclerosis in Chronic Hemodialysis Patients with Diabetic Nephropathy

“…To our knowledge, cardiovascular diseases remain the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially with diabetes mellitus [13,14]. The prevalence of cardiovascular death in CKD patients, especially in those on dialysis therapy, is 10-20 times greater than the age-, gender-, and race-matched general population [15,16].…”

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

“…26 Underlying factors are that the GP's confidence in treating CKD is lower than in treating diabetes and hypertension, and that blood pressure targets in CKD are often regarded with scepticism. 27,28 A discussion is ongoing with regard to optimal blood pressure targets. 29 Systolic blood pressure of <120 mmHg is associated with stroke and diastolic blood pressure of <60 mmHg is associated with increased mortality in older people who are frail.…”