TY - JOUR
T1 - Adherence to chronic kidney disease guidelines in primary care patients is associated with comorbidity
AU - van Dipten, Carola
AU - Berkel, Saskia van
AU - van Gelder, Vincent A.
AU - Wetzels, Jack F.M.
AU - Akkermans, Reinier P.
AU - de Grauw, Wim J.C.
AU - Biermans, Marion C.J.
AU - Scherpbier-de Haan, Nynke D.
AU - Assendelft, Willem J.J.
N1 - Funding Information:
Funding: the Dutch kidney foundation funded the study. Ethical approval: ethical approval was not required according to the accredited Medical Research Ethics Committee Arnhem/Nijmegen (ABR NL16590.091.07). This study was performed according to the Code of Conduct for Health Research, which has been approved by the Data Protection Authorities for conformity with the applicable Dutch privacy legislation. Conflict of interest: none
Publisher Copyright:
© The Author 2017. Published by Oxford University Press. All rights reserved.
PY - 2017/8
Y1 - 2017/8
N2 - Background. GPs insufficiently follow guidelines regarding consultation and referral for chronic kidney disease (CKD). Objective. To identify patient characteristics and quality of care (QoC) in CKD patients with whom consultation and referral recommendations were not followed. Method. A 14 month prospective observational cohort study of primary care patients with CKD stage 3-5. 47 practices participated, serving 207 469 people. 2547 CKD patients fulfilled consultation criteria, 225 fulfilled referral criteria. We compared characteristics of patients managed by GPs with patients receiving nephrologist co-management. We assessed QoC as adherence to monitoring criteria, CKD recognition and achievement of blood pressure (BP) targets. Results. Patients treated in primary care despite a consultation recommendation (94%) had higher eGFR values (OR 1.07; 95% CI: 1.05-1.09), were less often monitored for renal function (OR 0.42; 95% CI: 0.24-0.74) and potassium (OR 0.56; 95% CI: 0.35-0.92) and CKD was less frequently recognised (OR 0.46; 95% CI: 0.31-0.68) than in patients with nephrologist co-management. Patients treated in primary care despite referral recommendation (70%) were older (OR 1.03; 95% CI:1.01-1.06) and had less cardiovascular disease (OR 0.37; 95% CI: 0.19-0.73). Overall, in patients solely managed by GPs, CKD recognition was 50%, monitoring disease progression in 36% and metabolic parameters in 3%, BP targets were achieved in 51%. Monitoring of renal function and BP was positively associated with diabetes (OR 3.10; 95% CI: 2.47-3.88 and OR 7.78; 95% CI: 3.21- 18.87) and hypertension (OR 3.19; 95% CI: 2.67-3.82 and OR 3.35; 95% CI: 1.45-7.77). Conclusion. Patients remaining in primary care despite nephrologists' co-management recommendations were inadequately monitored, and BP targets were insufficiently met. CKD patients without cardiovascular comorbidity or diabetes require extra attention to guarantee adequate monitoring of renal function and BP.
AB - Background. GPs insufficiently follow guidelines regarding consultation and referral for chronic kidney disease (CKD). Objective. To identify patient characteristics and quality of care (QoC) in CKD patients with whom consultation and referral recommendations were not followed. Method. A 14 month prospective observational cohort study of primary care patients with CKD stage 3-5. 47 practices participated, serving 207 469 people. 2547 CKD patients fulfilled consultation criteria, 225 fulfilled referral criteria. We compared characteristics of patients managed by GPs with patients receiving nephrologist co-management. We assessed QoC as adherence to monitoring criteria, CKD recognition and achievement of blood pressure (BP) targets. Results. Patients treated in primary care despite a consultation recommendation (94%) had higher eGFR values (OR 1.07; 95% CI: 1.05-1.09), were less often monitored for renal function (OR 0.42; 95% CI: 0.24-0.74) and potassium (OR 0.56; 95% CI: 0.35-0.92) and CKD was less frequently recognised (OR 0.46; 95% CI: 0.31-0.68) than in patients with nephrologist co-management. Patients treated in primary care despite referral recommendation (70%) were older (OR 1.03; 95% CI:1.01-1.06) and had less cardiovascular disease (OR 0.37; 95% CI: 0.19-0.73). Overall, in patients solely managed by GPs, CKD recognition was 50%, monitoring disease progression in 36% and metabolic parameters in 3%, BP targets were achieved in 51%. Monitoring of renal function and BP was positively associated with diabetes (OR 3.10; 95% CI: 2.47-3.88 and OR 7.78; 95% CI: 3.21- 18.87) and hypertension (OR 3.19; 95% CI: 2.67-3.82 and OR 3.35; 95% CI: 1.45-7.77). Conclusion. Patients remaining in primary care despite nephrologists' co-management recommendations were inadequately monitored, and BP targets were insufficiently met. CKD patients without cardiovascular comorbidity or diabetes require extra attention to guarantee adequate monitoring of renal function and BP.
KW - Chronic kidney disease
KW - Electronic medical records
KW - Nephrology
KW - Patient care management
KW - Primary health care
KW - Referral and consultation
UR - http://www.scopus.com/inward/record.url?scp=85028364471&partnerID=8YFLogxK
U2 - 10.1093/fampra/cmx002
DO - 10.1093/fampra/cmx002
M3 - Article
C2 - 28207923
AN - SCOPUS:85028364471
SN - 0263-2136
VL - 34
SP - 459
EP - 466
JO - Family practice
JF - Family practice
IS - 4
ER -