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Nudging Nephrologists in Cardiovascular Risk Assessment and Management in Glomerular Diseases Treated with
Jovan Sao Ang Sim1, Felicia Loo2, Lydia Lim2
1Nanyang Technological University, Singapore, Singapore.
Insights
An electronic medical record prompt improved blood sugar monitoring for older adults with glomerulonephritis on immunosuppressants. However, it did not significantly impact cholesterol level evaluations, highlighting a need for targeted interventions for lipid management.
Area of Science:
- Nephrology
- Cardiology
- Health Informatics
Background:
- Glomerulonephritis and its treatments increase cardiometabolic disease risk.
- Optimizing glycaemic and lipid control is crucial for mitigating cardiovascular risk in these patients.
- Older adults with glomerulonephritis on immunosuppressants require careful monitoring of metabolic parameters.
Purpose of the Study:
- To assess the effect of an electronic medical record (EMR)-based physician prompt on glycaemic and lipid management.
- To evaluate the impact of this intervention in older adults with glomerulonephritis receiving immunosuppressive therapy.
- To determine if physician prompts can improve cardiovascular risk factor control in this specific patient population.
Main Methods:
- A single-centre, pre-post implementation study design was employed.
- Adults aged 40 years and older with active glomerulonephritis treated with immunosuppressants were included.
- Data from 859 follow-up visits (474 pre-intervention, 385 post-intervention) were analyzed using mixed-effects logistic regression.
Main Results:
- Glycaemic evaluation increased significantly post-intervention (51.7% to 69.6%, OR=2.38).
- The intervention did not significantly alter the frequency of fasting lipid evaluations (43.7% pre vs. 42.9% post).
- Lupus nephritis, IgA nephropathy, and ANCA-associated vasculitis were the most common glomerulonephritis causes.
Conclusions:
- Physician prompts integrated into EMR systems can effectively enhance glycaemic evaluation in older adults with glomerulonephritis.
- The intervention showed no significant improvement in lipid evaluation, indicating a gap in managing lipid control.
- Targeted strategies are needed to improve both glycaemic and lipid management for comprehensive cardiovascular risk reduction in this population.
Introduction:
Glomerulonephritis and its treatment may be associated with cardiometabolic disease, so optimizing glycaemic and lipid control is important to mitigate cardiovascular risk. We aimed to evaluate the impact of an electronic medical record (EMR)-based physician prompt on glycaemic and lipid management among older adults with glomerulonephritis receiving immunosuppressive therapy.
Methods:
This was a single-centre implementation study with a pre-post-design. We included adults ≥40 years old with active glomerulonephritis treated with immunosuppressants who received the physician prompt between July 2022 and June 2024. Data at 6-monthly intervals were obtained from the EMR. We compared the prevalence of glycaemic and lipid evaluation during follow-up visits before and after the intervention using mixed-effects logistic regression models.
Results:
A total of 192 patients (median age 58 [interquartile range: 48, 69] years) with 859 visits were included: 474 visits prior to the intervention and 385 visits after its implementation. The most frequent causes of glomerulonephritis were lupus nephritis (26.9%), IgA nephropathy (20.4%), and ANCA-associated vasculitis (15.7%). Glycaemic evaluation was performed at 51.7% and 69.6% of follow-up visits before and after intervention, respectively. Glycaemic evaluation was significantly more likely at post- compared with pre-intervention visits (OR = 2.42 [95% CI: 1.73, 3.36]) after accounting for patients and physicians as random effects, and after adjusting for age, sex, kidney function, follow-up clinic type and duration, and RAS blocker and statin therapy: OR = 2.38 (95% CI: 1.69, 3.38). Fasting lipid was performed at 43.7% and 42.9% of follow-up visits before and after intervention, respectively, and was not different pre- and post-intervention.
Conclusion:
A physician-directed nudge significantly increased glycaemic evaluation but not lipid evaluation in older patients with glomerulonephritis treated with immunosuppressants.
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