Chronic kidney disease Urological and Genital Diseases Other disorders of kidney and ureter, not elsewhere classified
Conditions
Interventions
The three interventions are:
1. Usual practice: a minimum of contacts will be made of these practices other than for data collection (n = 35 practices)
2. Distribution of clinical practice guidelines
Sponsors
St George's University of London (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: The primary research participants are general practitioners involved in the study who will receive the various quality improvement interventions listed below. The interventions will be implemented at the practice (cluster) rather than the individual level. The study subjects (who may be regarded as secondary participants) will be all individuals with chronic kidney disease within the study practices. Inclusion criteria: 1. Practices who provide written consent to participate 2. Locality specialist who will support the participation of the practice and the implementation of standard guidelines across the participating practices (appropriate to the arm of the study they are involved in) 3. Primary Care Trust (PCT) commissioners' engagement with the project and willingness to consider learning from its findings 4. Practice has had the same computer system for the last five years and has no plans to change it, or will allow access to check data quality 5. Practice has electronic laboratory links for the last three years
Exclusion criteria
Exclusion criteria: 1. Practices in whom the computing system has changed over the last five years 2. Practices lacking an appropriate computer system from which data can be extracted 3. Practices in which referral data (from primary care to secondary care) is not available
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The reduction of systolic blood pressure in hypertensive people with stage 3 to 5 chronic kidney disease according to the agreed target. The measure of primary and secondary outcome measures will take place at t = 0 (baseline), t = 1 year and t = 2 years. | — |
Secondary
| Measure | Time frame |
|---|---|
| Clinical and laboratory markers: 1. Recording and management of key co-morbidities: 1.1. Diabetes and its complications 1.2. Ischaemic heart disease 1.3. Heart failure 1.4. Obstruction/lower urinary tract symptoms 2. Recording and management of other cardiovascular risk factors: 2.1. Smoking status 2.2. Lipid management 2.3. Proteinuria 2.4. Anaemia 2.5. Glycated haemoglobin and microalbuminuria in people with diabetes mellitus 3. Serial measures of serum creatinine concentration and estimated glomerular filtration rate (GFR) 4. Avoiding harm. We wish to collect data to monitor whether blood pressure reduction is associated with an increased number of falls particularly in older people. Most people with CKD are elderly and at potential risk of falls. Notwithstanding the results of recent systematic reviews which failed to show an association between falls and anti-hypertensive medication, this possibility remains a genuine concern to some practitioners, and one that we propose to examine. A falls dataset will be devised and integrated into the renal dataset. We will investigate the relationship with use of angiotensin converting enzymes (ACE) inhibitors and angiotensin II receptor blockers and systolic blood pressure below 120 in CKD. 5. Practitioner confidence to be measured at t = 0, t = 1 year, and at end of project 6. Medicines management: 6.1. Use of drugs/therapy which affect renal function (for example non-steroidal anti-inflammatory drugs) 6.2. Use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers to control hypertension 6.3. Recording of medicines possession ratio based on days prescribed therapy as an index of concordance with anti-hypertensive therapy The measure of primary and secondary outcome measures will take place at t = 0 (baseline), t = 1 year and t = 2 years. | — |
Countries
United Kingdom
Outcome results
None listed