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




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BMC Family Practice

, 12:83

Knowledge, attitudes, behaviors, education, and communication

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.

KeywordsRenal Insufficiency Chronic Primary Care Blood pressure Family Practice Quality of Healthcare Proteinuria Medical Records systems computerised Reimbursement incentives Electronic supplementary materialThe online version of this article doi:10.1186-1471-2296-12-83 contains supplementary material, which is available to authorized users.

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Autor: Mohammad A Tahir - Olga Dmitrieva - Simon de Lusignan - Jeremy van Vlymen - Tom Chan - Ramez Golmohamad - Kevin Harris - C

Fuente: https://link.springer.com/







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