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

BMC Family Practice

Research Article

Jeremy van Vlymen¹  Olga Dmitrieva¹  Tom Chan¹  Simon de Lusignan¹  Charles Tomson²  Ramez Golmohamad³  Mohammad A Tahir⁴  Hugh Gallagher⁵  Nicola Thomas⁶  Kevin Harris⁷ 

[1] Department of Health Care Management and Policy, University of Surrey, GU2 7XH, Guildford, Surrey, UK;Department of Renal Medicine, Southmead Hospital, BS10 5NB, Bristol, UK;Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, SW17 0RE, Cranmer Terrace, London, UK;Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, SW17 0RE, Cranmer Terrace, London, UK;Department of Health Care Management and Policy, University of Surrey, GU2 7XH, Guildford, Surrey, UK;Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, SW17 0RE, Cranmer Terrace, London, UK;SW Thames Renal & Transplantation Unit, St Helier Hospital, Wrythe Lane Carshalton, SM5 1AA UK, Surrey, UK;School of Community and Health Sciences, City University London, 20 Bartholomew Close, EC1A 7QN, London, UK;University Hospitals of Leicester NHS Trust, John Walls Renal Unit, Leicester General Hospital, LE5 4PW, Leicester, UK, UK;

关键词: Renal Insufficiency;    Chronic;    Primary Care;    Blood pressure;    Family Practice;    Quality of Healthcare;    Proteinuria;    Medical Records systems;    computerised;    Reimbursement;    incentives;   

DOI  :  10.1186/1471-2296-12-83

 received in 2010-12-11, accepted in 2011-08-05,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Tahir et al; licensee BioMed Central Ltd. 2011