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Randomized Controlled Trial
. 2011 Aug 5:12:83.
doi: 10.1186/1471-2296-12-83.

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

Mohammad A Tahir  1 , Olga Dmitrieva, Simon de Lusignan, Jeremy van Vlymen, Tom Chan, Ramez Golmohamad, Kevin Harris, Charles Tomson, Nicola Thomas, Hugh Gallagher
Affiliations
Randomized Controlled Trial

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

Mohammad A Tahir et al. BMC Fam Pract. .

Abstract

Background: Much 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.

Method: We 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.

Results: 87% (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.

Conclusions: Practitioners are less likely to achieve management targets where their confidence is low.

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Figures

Figure 1
Figure 1
Age-sex profile of non-questionnaire practices (left) with questionnaire practices (right).
Figure 2
Figure 2
The scheme of distribution and collection of questionnaires.
Figure 3
Figure 3
Confidence in managing hypertension.
Figure 4
Figure 4
Confidence in using antihypertensive drugs.
Figure 5
Figure 5
Salaried GP, GP Partner and Practice Nurse scores across practice list size.
See this image and copyright information in PMC

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