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Management of chronic kidney disease in an academic primary care clinic
Ajay Israni1, Cynthia Korzelius, Raymond Townsend
1Renal-Electrolyte, Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, Pa, USA. aisrani@cceb.med.upenn.edu
Insights
Primary care management of chronic kidney disease (CKD) shows room for improvement in blood pressure control and medication use. This study highlights opportunities to enhance CKD patient care in outpatient settings.
Area of Science:
- Nephrology
- Primary Care Medicine
- Healthcare Management
Background:
- An estimated 3 million individuals in the U.S. have chronic kidney disease (CKD).
- Effective management of CKD patients within primary care settings remains understudied.
- Outpatient primary care is a critical touchpoint for managing chronic conditions like CKD.
Purpose of the Study:
- To assess the current state of primary care management for chronic kidney disease (CKD).
- To identify specific areas for improvement in CKD care within an academic primary care setting.
- To establish a baseline for evaluating future interventions in CKD management.
Main Methods:
- A retrospective chart review was conducted at a single academic hospital primary care site.
- Patient records from October 1997 to March 1999 were analyzed for individuals with confirmed elevated serum creatinine (SCr).
- Predefined indicators of CKD management, based on literature and guidelines, were assessed.
Main Results:
- Suboptimal management was observed in blood pressure control, use of ACE inhibitors/ARBs, proteinuria assessment, and renal referrals.
- Hemoglobin A1c measurement for diabetic CKD patients was a positive finding.
- CKD care quality was consistent across diabetic/non-diabetic patients and varied CKD severity levels.
Conclusions:
- Chronic kidney disease (CKD) care is measurable in outpatient academic primary care clinics.
- Specific opportunities for enhancing CKD management were identified.
- This study provides a foundation for quality improvement initiatives in primary care nephrology.
Background:
Three million people in the United States are estimated to have chronic kidney disease (CKD). Management of these CKD patients in the outpatient primary care clinic setting has not been well studied.
Hypothesis:
Primary care management of CKD can be assessed and opportunities for improvement can be identified.
Methods:
Management of CKD based on available published literature and guidelines was assessed in a single primary care site of an academic hospital with 23,000 annual visits and 8,300 patients. Charts of patients seen between October 1, 1997 and March 25, 1999 with an elevated SCr > or = 1.7 mg/dl on two separate measurements at least 6 months apart were reviewed for predefined indicators of CKD management.
Results:
Assessment identified several aspects of CKD management to be suboptimal: control of blood pressure, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, assessment of proteinuria, and renal consultation. Better management was found with respect to hemoglobin A1c measurement for diabetic patients. In general, CKD care was similar for diabetic and non-diabetic patients. CKD management was also similar regardless of level of creatinine clearance (> or = 50 vs. 50-30 vs. < or = 30 ml/min).
Conclusion:
CKD care can be measured in an outpatient academic primary care clinic and opportunities to improve were identified.
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