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Electronic records suggest suboptimal management of chronic kidney disease in general practice
Louis S J Pilotto1, Partick A Ball, Jane M Smithard
1Murrumbidgee Medicare Local Limited, Wagga Wagga, New South Wales, Australia. louis.pilotto@mmll.org.au
Insights
General practitioners
Area of Science:
- Nephrology and General Practice
- Pharmacotherapy and Chronic Disease Management
Background:
- Chronic kidney disease (CKD) management in primary care requires careful monitoring of kidney function and appropriate medication.
- Angiotensin-converting enzyme inhibitors (ACE/ARBs) are crucial for managing hypertension and diabetic nephropathy, key components of CKD.
Purpose of the Study:
- To evaluate the electronic health record data concerning the management of chronic kidney disease (CKD) by general practitioners (GPs).
- To assess the recording of estimated glomerular filtration rate (eGFR) and the prescription rates of ACE/ARBs in patients with CKD.
- To identify potential gaps in CKD care and prescribing patterns within general practice.
Main Methods:
- A cross-sectional study analyzing electronic records from thirteen general practices.
- Inclusion of 15,415 active patients aged 50 years and above.
- Examination of recorded eGFR, diabetes status, and the prescription of ACE/ARBs.
Main Results:
- 17% of patients had an eGFR < 60 mL/min/1.73 m², with 22% lacking recorded eGFR.
- Prescribing of ACE/ARBs was related to hypertension, diabetes, and low eGFR, yet 31% of diabetics and 23% of those with low eGFR were not on these therapies.
- Significant variations in ACE/ARB prescribing rates (up to 23%) were observed between practices for patients with diabetes and low eGFR.
Conclusions:
- The recording of eGFR and the prescription of ACE/ARBs in patients with CKD, particularly diabetics, appear suboptimal in general practice.
- Observed variations in prescribing practices warrant further investigation to improve CKD management.
- There is a need to enhance data recording and adherence to treatment guidelines for better patient outcomes in CKD.
Objective:
To examine electronic records of GP management of chronic kidney disease.
Design:
Cross-sectional study.
Setting:
Thirteen general practices.
Participants:
Fifteen thousand four hundred and fiftteen active patients aged 50 years and over.
Main Outcome Measure:
Recorded estimated glomerular filtration rate (eGFR) and diabetes, and rate of prescribing of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE/ARBs).
Results:
Six thousand and fifty-nine (39%) patients had hypertension and 1859 (12%), diabetes. Two thousand six hundred and eighty-nine (17%) patients were recorded with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) , while 3344 (22%) did not have an eGFR result recorded. Hypertension, diabetes and eGFR <60 mL min(-1) (1.73 m(2) )(-1 ) were shown to be significantly related to prescribing of ACE/ARBs; however, 31% of known diabetics and 23% of diabetics with an eGFR < 60 mL min(-1) (1.73 m(2) )(-1 ) are not recorded as receiving ACE or ARB therapy. Forty-two per cent of patients with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) , are also not recorded as receiving ACE or ARB therapy. There was a 23% variation in the rates of prescribing of ACE/ARBs by practice for patients with diabetes and eGFR < 60 mL min(-1) (1.73 m(2) )(-1) .
Conclusion:
The overall recording of eGFR and the recorded prescribing of ACE or ARB therapy in known diabetics and patients with eGFR < 60 mL min(-1) (1.73 m(2) )(-1) appear suboptimal. Also, the variations in prescribing between practices require further investigation.
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