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Exploration of chronic kidney disease screening, diagnosis and management in Australian general practice using
Daniel Petzke1, Christine Mary Hallinan1, Judy Trevena1,2
1Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Insights
Australian primary care data reveals low rates of chronic kidney disease (CKD) documentation and monitoring, highlighting opportunities for quality improvement. Applying Canadian CKD quality indicators showed significant gaps in diagnosis and management, impacting patient care.
Area of Science:
- Primary care research
- Nephrology
- Health services research
Background:
- Chronic kidney disease (CKD) is a global health burden, often under-recognized in primary care.
- Quality indicators developed in Canada were adapted to assess CKD care in Australia.
- Electronic medical record (EMR) data from Australian general practices were utilized.
Purpose of the Study:
- To evaluate the feasibility of applying Canadian CKD quality indicators to Australian primary care EMR data.
- To assess the current state of CKD detection and management practices in Australian general practices.
Main Methods:
- Utilized de-identified EMR data from the Patron repository covering 78 Australian general practices.
- Applied 16 validated Canadian CKD quality indicators to assess diagnosis, monitoring, and treatment.
- Indicators covered clinical/pathological tests, medication prescribing (antihypertensives, statins), and influenza immunisation rates.
Main Results:
- Of 362,078 patients, only 28.1% with CKD-consistent pathology had a recorded CKD diagnosis.
- Among patients with eGFR < 60 ml/min/1.73m², only 54.2% had repeat eGFR and 28.8% had ACR tests.
- Screening rates for at-risk patients showed 76.1% eGFR and 34.2% ACR tests within 18 months.
- Monitoring rates were slightly higher; 71.1% had recorded blood pressure, and 45% met blood pressure targets.
Conclusions:
- Canadian CKD quality indicators are applicable to Australian primary care EMR data, yielding comparable insights.
- Low rates of CKD documentation and pathology monitoring indicate significant potential for quality improvement.
- Initiatives targeting improved CKD diagnosis and management are needed to reduce disease burden.
Background:
CKD is a common but under-recognised condition that places significant burden on the individual and the health system globally. Our study applied a set of primary care quality indicators originally developed and validated using Canadian primary care data for screening, diagnosis and monitoring of CKD. These indicators were then applied to a large primary care dataset to assess CKD detection and management practices in Australia.
Methods:
We used de-identified data from the Patron repository, which contains data extracted from electronic medical records (EMRs) in Australian general practices. The 16 CKD indicators developed using Canadian EMR data were applied to this dataset. These indicators measured and reported on the use of clinical and pathological tests to diagnose and monitor CKD, the prescribing of antihypertensive and statin medications, and on rates of influenza immunisation.
Results:
Among the 362,078 unique patients identified across 78 general practices, 24,348 had a diagnosis or pathology consistent with CKD, of whom only 28.1% (6,841) had a diagnosis of CKD recorded. Of the 26,307 patients who initially presented with an eGFR below 60 ml/min/1.73m2, 54.2% (14,254) underwent a repeat eGFR within six months and 28.8% (7,586) completed an ACR test. Of the patients recommended for screening based on the presence of risk factors, 76.1% had an eGFR performed within the last 18 months, whilst 34.2% had an ACR performed in the same period. Rates of monitoring of patients with CKD were slightly higher. A blood pressure had been recorded within the last 9 months in 71.1% of patients with CKD, and in 75.6% of the subset of patients with both diabetes and albuminuria. Around 45% of all patients with CKD were meeting their blood pressure targets at their last recording.
Conclusions:
The results of this study demonstrate that it is feasible to derive meaningful and informative indicators of CKD diagnosis and management from primary care EMR data in Australia, which are comparable with international data. The low rates of CKD documentation and pathology monitoring provide opportunities for quality improvement initiatives to reduce disease burden.
Clinical Trial Number:
Not applicable.
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