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Almaqhawi A. Knowledge and Competence Regarding the Management of Chronic Kidney Disease among Family Medicine Professionals in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:880. [PMID: 39063457 PMCID: PMC11276965 DOI: 10.3390/ijerph21070880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
Diabetes is a significant risk factor for chronic kidney disease (CKD) and a primary cause of global morbidity and mortality, resulting in significant costs to healthcare systems. The management of diabetic CKD in the primary care setting remains an ongoing challenge despite the current best practices in the quality of care. This study evaluated family medicine physicians' knowledge and confidence regarding managing CKD in the Eastern Province of Saudi Arabia. A self-administered online questionnaire was distributed to physicians through various social media sites and email lists. The largest number of participants reported a full confidence in knowing kidney disease stages, blood pressure targets and the importance of urine albumin-creatinine ratio testing. Overall, 71.8% of physicians reported a high confidence level, followed by 23.9% reporting average and 4.2% reporting low confidence. Being younger and working at PHC were identified as significant predictors of increased confidence. Although most of the physicians reported a high confidence in managing CKD patients, the need for improvement was evident. Age and workplace institutions were the greater contributors to physicians' confidence. Continuous education among healthcare practitioners is crucial to updating knowledge and providing optimum quality of care among this group of patients.
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Affiliation(s)
- Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
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Al-Zaman N, Alem A, Alharbi OA, Ahmed Abdullah E, Azouni DW, Hammad RK, Alhejaily RM, Albadrani M. Physicians' Knowledge, Attitudes and Barriers Regarding Chronic Kidney Disease Diagnosis and Management in Saudi Arabia. Cureus 2023; 15:e50247. [PMID: 38196437 PMCID: PMC10774705 DOI: 10.7759/cureus.50247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is defined as abnormalities of kidney structure and/or function persisting for a minimum of three months. METHODS An online cross-sectional study was conducted in the Kingdom of Saudi Arabia (KSA) between June and August 2022 to assess the knowledge, attitudes, practices, and barriers among family, internal medicine, and general physicians related to CKD screening, diagnosis, and management. RESULTS A total of 427 physicians were included in the study. The majority exhibited a strong grasp of the accurate definition of CKD (83%) and recognized common risk factors, such as diabetes (99%), drugs (95%), and hypertension (98%). Two-thirds of physicians were aware of the five stages of CKD and identified estimated glomerular filtration rate (eGFR) and creatinine clearance as the most suitable markers for kidney function. Physicians also displayed knowledge of CKD-related complications. However, a noticeable gap between knowledge and practice was evident. Only one-third of participants reported screening their patients every year, primarily using serum creatinine (92.5%) and eGFR (97%) for diagnosis, while only 16% recognized that stage 4 CKD is the appropriate time to refer patients to nephrologists. In terms of barriers, the majority of physicians reported encountering low barriers to CKD management, but general practitioners working in primary healthcare centers experienced significantly higher levels of barriers. CONCLUSION Most participants in our study possess a good level of knowledge and positive attitudes towards CKD diagnosis and management. Nevertheless, a discrepancy between knowledge and practical application, particularly in terms of over-screening and early referral, highlights the need for educational efforts to improve physician practice in KSA. These findings underscore the importance of addressing this gap to promote effective CKD management.
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Affiliation(s)
- Naweed Al-Zaman
- Internal Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Alaa Alem
- Internal Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Ohood A Alharbi
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | | | - Duha W Azouni
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | - Raghad K Hammad
- Medicine, College of Medicine, Taibah University, Medina, SAU
| | | | - Muayad Albadrani
- Family and Community Medicine, College of Medicine, Taibah University, Medina, SAU
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Seidu S, Cos X, Topsever P. Self-rated knowledge and competence regarding the management of chronic kidney disease in primary care: A cross-sectional European survey of primary care professionals. Prim Care Diabetes 2023; 17:19-26. [PMID: 36513582 DOI: 10.1016/j.pcd.2022.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes is a major risk factor for chronic kidney disease (CKD), which is a leading cause of global morbidity and mortality and also associated with substantial costs to healthcare systems. Despite the current best practice standards of care, management of CKD in diabetes in the primary care setting remains an ongoing challenge. Using an online survey, we aimed to assess the self-rated knowledge and competence of primary care professionals involved in the management of CKD in diabetes in the European region. METHODS An online anonymous survey was developed by the Primary Care Diabetes Europe research group and administered to primary care professionals involved in managing CKD in diabetes from 23rd March 2022-9 th October 2022. Descriptive statistics were used to summarise questionnaire responses. Factors influencing ability to initiate treatment strategies were evaluated using logistic regression. RESULTS A total of 266 respondents (51.9% males) completed the questionnaire. Most respondents were GPs (82.7%) followed by nurses (9.4%). The age of respondents ranged from 25 to 72 years with a median of 51 years. About a third of respondents indicated that they were fully confident in the screening and diagnosis of CKD in diabetes. With regards to CKD presentation, staging and prognosis, 16.5-21.8% of respondents stated they were fully confident in this area; however, about 11% of respondents were not confident on how to predict CKD prognosis using established clinical guidelines. About a third of respondents stated they were confident without support regarding the complications of kidney disease in diabetes and it being a risk multiplier; just a quarter of respondents were fully confident. A third of respondents stated they were fully confident regarding appropriate management strategies for preventing or slowing down the progression of CKD and the initiation of newer agents. In multivariable analyses, confidence in the knowledge of the stages of kidney disease and criteria for the diagnosis of kidney disease were each associated with an increased odds in the confidence to select and initiate appropriate management strategies. CONCLUSIONS With regards to almost all aspects of management of CKD in diabetes, only up to a third of primary care professionals stated they are fully confident and are able to teach others; the majority are confident but would like to know more or require extra support. This may be a contributor to the challenges faced in providing optimal CKD care in people with diabetes in the primary care setting. Effective interventions that can promote the uptake of best practice clinical guidelines in primary care are urgently needed.
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Affiliation(s)
- Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
| | - Xavier Cos
- The Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Spain
| | - Pinar Topsever
- Acibadem Mehmet Ali Aydinlar University School of Medicine Department of Family Medicine, Kerem Aydinlar Campus, Kayisdagi Cad. No 32, 34752 Atasehir, Istanbul, Turkey
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Del Cura-González I, Ariza-Cardiel G, Polentinos-Castro E, López-Rodríguez JA, Sanz-Cuesta T, Barrio-Cortes J, Andreu-Ivorra B, Rodríguez-Barrientos R, Ávila-Tomas JF, Gallego-Ruiz-de-Elvira E, Lozano-Hernández C, Martín-Fernández J. Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster. BMC MEDICAL EDUCATION 2022; 22:893. [PMID: 36564769 PMCID: PMC9789537 DOI: 10.1186/s12909-022-03843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed. METHODS A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods. RESULTS Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15-0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5-55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02-1.21). CONCLUSIONS The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02210442 . Registered 6 August 2014.
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Affiliation(s)
- Isabel Del Cura-González
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain.
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain.
| | - Gloria Ariza-Cardiel
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain
| | - Elena Polentinos-Castro
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - Juan A López-Rodríguez
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- General Ricardos Health Center, Primary Care Assistance Management, Madrid Health Service, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - Jaime Barrio-Cortes
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
| | - Blanca Andreu-Ivorra
- Preventive Medicine Unit, Alcorcon Foundation University Hospital, Alcorcón, Madrid Health Service, Madrid, Spain
| | - Ricardo Rodríguez-Barrientos
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
| | - José F Ávila-Tomas
- Santa Isabel Health Center, Primary Care Assistance Management, Madrid Health Service Leganes, Madrid, Spain
| | - Elisa Gallego-Ruiz-de-Elvira
- Servicio de Medicina Preventiva, Hospital Infantil Universitario Niño Jesús, Madrid Health Service, Madrid, Spain
| | - Cristina Lozano-Hernández
- Research Unit, Primary Care Assistance Management, Madrid Health Service Madrid, C/ San Martín de Porres, 6 _ 5ª Planta, 28035, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Primary Health Care Research and Innovation Foundation. FIIBAP, Madrid, Spain
| | - Jesús Martín-Fernández
- Department of Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Research Network Health Services in Chronic Diseases (REDISSEC) & Research Network RICORS-RICAPP. ISCIII, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañon, IiSGM, Madrid, Spain
- Multiprofessional Family and Community Care Teaching Unit Madrid, Madrid, Spain
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Wang C, Wang Y. Trends in prevalence and treatment rate of anemia in the U.S. population: cross-sectional study using data from NHANES 2005-2018. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:881-888. [PMID: 35962563 DOI: 10.1080/16078454.2022.2109557] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the trends in anemia prevalence, treatment rates, and their associated demographic and socioeconomic status factors in the U.S. nationally representative population. METHODS We extracted data from individuals ≥20-year-old from the NHANES from 2005 to 2018. The trends of anemia prevalence and treatment were assessed by Cochran-Armitage test. The association between two dependent variables (anemia status and treatment) and demographic were examined by multiple logistic regression. RESULTS The general anemia prevalence has a significant increasing trend from 5.71% to 6.86% (P trend<.001) from 2005 to 2018, whereas the trend in general anemia treatment rate was not significant (p = .148). Logistic regression showed that age groups (OR: 2.15for 60 or older vs. 20-39 years old), sex (0.47 for male vs. female), race (0.22 for NHW vs. NHB), education (0.80for some college or AA degree vs. less than high school), PIR (0.60 for ≥3.5 vs.≤1.3), and birthplace (0.88 for U.S. vs. other) were significantly associated with anemia. The factors significantly associated with anemia treatment were age group (1.51 for 60 years and older vs. 20-39 years old), sex (0.53 male vs. female), birthplace (1.88 U.S. vs. other), and insurance (1.80 for Yes vs. No). CONCLUSION While there was no significant increase in anemia treatment between 2005 and 2018, the anemia prevalence increased significantly, particularly among individuals with lower income, less education, and born outside the U.S. Moreover, the high anemia prevalence among NHB compared to other races indicated that more resources are needed to reduce disparities.
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Affiliation(s)
- Chen Wang
- Division of Hematology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
| | - Yan Wang
- Department of Laboratory Medicine, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, People's Republic of China
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Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study. BJGP Open 2022; 6:BJGPO.2021.0155. [DOI: 10.3399/bjgpo.2021.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/08/2022] [Accepted: 03/08/2022] [Indexed: 10/31/2022] Open
Abstract
BackgroundChronic kidney disease (CKD) is common in the elderly population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists.AimWe aimed to compare the characteristics of elderly (≥ 65 years old) patients with stage 3B CKD and above in the referral and non-referral groups.Design and settingsA cross-sectional study in the primary care organisation National University Polyclinics (NUP), Singapore.MethodRetrospective data were extracted from the electronic health records of CKD patients (≥ 65 years old) with stage 3B CKD and above.ResultsFrom 1 January to 31 December 2018, a total of 1,536 patients aged 65 years or older were diagnosed with stage 3B CKD or above (non-referral group =1,179 vs. referral group =357). The mean patient age in the non-referral group (78.3 years) was older than that in the referral group (75.9 years) (P<0.001). Indian elderly patients were referred more compared to their Chinese counterparts (P=0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, and antiplatelet than the referral group (P<0.05), but only the difference in fibrates remained significant on subsequent multivariate analysis.ConclusionsThis study demonstrates that there is a considerable number of elderly CKD patients exclusively managed in the primary care setting (n = 1,179) and that referrals primarily depend on demographic factors, namely age and ethnicity, rather than medical determinants of CKD severity or case complexity.
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Ariza-Cardiel G, Del Cura-González II, Polentinos-Castro E, López-Rodríguez JA, Gil-Moreno JC, Martín-Fernández J. [Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain]. Aten Primaria 2021; 53:101941. [PMID: 33592535 PMCID: PMC7893431 DOI: 10.1016/j.aprim.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/07/2020] [Accepted: 08/08/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task. MATERIAL AND METHODS Design: Cross-sectional descriptive study with analytical approach. PARTICIPANTS Training Units in Spain (N=94). MAIN MEASUREMENTS Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG. RESULTS 45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units. CONCLUSIONS The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs.
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Affiliation(s)
- Gloria Ariza-Cardiel
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Móstoles, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - I Isabel Del Cura-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - Elena Polentinos-Castro
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Juan Antonio López-Rodríguez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Centro de Salud General Ricardos, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Juan Carlos Gil-Moreno
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Jesús Martín-Fernández
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Oeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Móstoles, Madrid, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Wolide AD, Kumela K, Kerga F, Debalke S, Seboka M, Edilu B, Gashe F, Bobassa EM. Knowledge, attitude, and practices toward chronic kidney disease among care providers in Jimma town:cross-sectional study. BMC Public Health 2020; 20:1079. [PMID: 32646400 PMCID: PMC7346627 DOI: 10.1186/s12889-020-09192-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common and growing health problem that requires adequate Knowledge by health care providers to reduce the progress of the disease. Thus, this study aimed to assess the care provider's Knowledge, attitude, and practices toward CKD. METHOD A cross-sectional study conducted among 326 care providers at Jimma University Specialized hospital and three medium to higher clinics found in Jimma Town. Collected data entered into Epi-Data version 3.1 and exported to SPSS version 21 for windows for data analysis. Descriptive statistics and generalized linear modal used to analyze the data. RESULT The mean age and service year of the participants were 29.68(±4.877) and 4.28(±4.561), respectively. The overall weighted Knowledge, attitude, and practice score of the study participant were 9.0971(8.77, 9.42), 2.53(2.4, 2.65), 10.14(9.94, 10.33) respectively. Over half of the care providers had the awareness to use eGFR to assess kidney function and patient referral to Nephrologists. Also, many care providers knew the five-stage of CKD and the risk factors of CKD, such as diabetes, long-term alcohol consumption, anemia, and cardiovascular disorders, respectively. Care providers had an understanding of late detection, and referral of CKD would increase kidney disease complications. Besides, 275(84.4%) of them are worried about treatment costs related to CKD. Over half of the care providers, 238(73.0%), believed that the Ethiopian ministry of health gave less attention to the problem. Furthermore, 234(71.8%) are interested in studying more on CKD management. Majority 256(78.5%), very likely or likely refer the patient to senior physician and Nephrologist. CONCLUSION Care providers showed enough Knowledge, a favorable attitude, and practice toward CKD.
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Affiliation(s)
- Amare Desalegn Wolide
- Department of Medical Physiology, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia.
| | - Kabaye Kumela
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Fantu Kerga
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Serkadis Debalke
- Department of Medical Microbiology, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Meskerem Seboka
- Department of Health Service Management, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Birtukan Edilu
- Department of Reproductive Health, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Fanta Gashe
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
| | - Eshetu Mulisa Bobassa
- Department of Pharmacy, Institute of Health Sciences, Jimma University, 378, Jimma, Ethiopia
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Li Y, Shi H, Wang WM, Peng A, Jiang GR, Zhang JY, Ni ZH, He LQ, Niu JY, Wang NS, Mei CL, Xu XD, Guo ZY, Yuan WJ, Yan HD, Deng YY, Yu C, Cen J, Zhang Y, Chen N. Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease: First multicenter, cross-sectional study. Medicine (Baltimore) 2016; 95:e3872. [PMID: 27310973 PMCID: PMC4998459 DOI: 10.1097/md.0000000000003872] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This was the first multicenter, cross-sectional survey to assess the prevalence of anemia, patient awareness, and treatment status in China. Data of patients with chronic kidney disease (CKD; age, 18-75 years; both out- and inpatients) from 25 hospitals in Shanghai, seeking medical treatment at the nephrology department, were collected between July 1, 2012 and August 31, 2012. The prevalence, awareness, and treatment of anemia in patients with nondialysis CKD (ND-CKD) were assessed. Anemia was defined as serum hemoglobin (Hb) levels ≤12 g/dL in women and ≤13 g/dL in men. A total of 2420 patients with ND-CKD were included. Anemia was established in 1246 (51.5%) patients: 639 (51.3%) men and 607 (48.7%) women. The prevalence of anemia increased with advancing CKD stage (χtrend = 675.14, P < 0.001). Anemia was more prevalent in patients with diabetic nephropathy (68.0%) than in patients with hypertensive renal damage (56.6%) or chronic glomerulonephritis (46.1%, both P < 0.001). Only 39.8% of the anemic patients received treatment with erythropoietin and 27.1% patients received iron products; furthermore, 22.7% of the patients started receiving treatment when their Hb level reached 7 g/dL. The target-achieving rate (Hb at 11-12 g/dL) was only 8.2%. Of the 1246 anemia patients, only 7.5% received more effective and recommended intravenous supplementation. Anemia is highly prevalent in patients with ND-CKD in China, with a low target-achieving rate and poor treatment patterns. The study highlights the need to improve multiple aspects of CKD management to delay the progression of renal failure.
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Affiliation(s)
- Ya Li
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Hao Shi
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Wei-Ming Wang
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Ai Peng
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University
| | - Geng-Ru Jiang
- Department of Nephrology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University
| | | | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Li-Qun He
- Department of Nephrology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
| | - Jian-Ying Niu
- Department of Nephrology, Shanghai Fifth People's Hospital, Fudan University
| | - Nian-Song Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Chang-Lin Mei
- Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University
| | - Xu-Dong Xu
- Department of Nephrology, Shanghai Minhang District Central Hospital
| | - Zhi-Yong Guo
- Department of Nephrology, Shanghai Changhai Hospital, Second Military Medical University
| | - Wei-Jie Yuan
- Department of Nephrology, Shanghai Jiao Tong University Affiliated First People's Hospital
| | - Hai-Dong Yan
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine
| | - Yue-Yi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Chen Yu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine
| | - Jun Cen
- Department of Nephrology, Shanghai Jiangong Hospital
| | - Yun Zhang
- Department of Nephrology, Shanghai Yangpu District Central Hospital, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University
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Sombolos K, Tsakiris D, Boletis J, Vlahakos D, Siamopoulos KC, Vargemezis V, Nikolaidis P, Iatrou C, Dafnis E, Xynos K, Argyropoulos C. Multicenter epidemiological study to assess the population of CKD patients in Greece: results from the PRESTAR study. PLoS One 2014; 9:e112767. [PMID: 25406080 PMCID: PMC4236082 DOI: 10.1371/journal.pone.0112767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 10/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a relatively common condition not only associated with increased morbidity and mortality but also fuelling End Stage Renal Disease (ESRD). Among developed nations, Greece has one of the highest ESRD incidence rates, yet there is limited understanding of the epidemiology of earlier stages of CKD. METHODS Cross-sectional survey of pre-dialysis CKD outpatients in nephrology clinics in the National Health Care system between October 2009 and October 2010. Demographics, cause of CKD, blood pressure, level of renal function, duration of CKD and nephrology care, and specialty of referral physician were collected and analyzed. Different methods for estimating renal function (Cockroft-Gault [CG], CKD-Epi and MDRD) and staging CKD were assessed for agreement. RESULTS A total of 1,501 patients in 9 centers were enrolled. Diabetic nephropathy was the most common nephrologist assigned cause of CKD (29.7%). In total, 36.5% of patients had self-referred to the nephrologist; patients with diabetes or serum creatinine above 220 µmol/l (eGFR<40 ml/min/1.73 m2) were more likely to have been referred by a physician. Agreement between MDRD and CKD-Epi, but not between CG, the other estimating equations, was excellent. There was substantial heterogeneity with respect to renal diagnoses, referral patterns and blood pressure among participating centers. CONCLUSIONS In this first epidemiologic assessment of CKD in Greece, we documented delayed referral and high rates of self-referral among patients with CKD. eGFR reporting, currently offered by a limited number of laboratories, may facilitate detection of CKD at an earlier, more treatable stage.
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Affiliation(s)
| | | | - John Boletis
- Nephrology Clinic, Laiko Hospital, Athens, Greece
| | | | | | | | | | - Christos Iatrou
- Center for Nephrology, G Papadakis, Nikea Hospital, Athens, Greece
| | - Eugene Dafnis
- Nephrology Clinic, PE.PA.G.N.I, Crete University Hospital, Iraklio, Greece
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11
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Micallef L, Rodgers P. eulerAPE: drawing area-proportional 3-Venn diagrams using ellipses. PLoS One 2014; 9:e101717. [PMID: 25032825 PMCID: PMC4102485 DOI: 10.1371/journal.pone.0101717] [Citation(s) in RCA: 342] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/10/2014] [Indexed: 12/22/2022] Open
Abstract
Venn diagrams with three curves are used extensively in various medical and scientific disciplines to visualize relationships between data sets and facilitate data analysis. The area of the regions formed by the overlapping curves is often directly proportional to the cardinality of the depicted set relation or any other related quantitative data. Drawing these diagrams manually is difficult and current automatic drawing methods do not always produce appropriate diagrams. Most methods depict the data sets as circles, as they perceptually pop out as complete distinct objects due to their smoothness and regularity. However, circles cannot draw accurate diagrams for most 3-set data and so the generated diagrams often have misleading region areas. Other methods use polygons to draw accurate diagrams. However, polygons are non-smooth and non-symmetric, so the curves are not easily distinguishable and the diagrams are difficult to comprehend. Ellipses are more flexible than circles and are similarly smooth, but none of the current automatic drawing methods use ellipses. We present eulerAPE as the first method and software that uses ellipses for automatically drawing accurate area-proportional Venn diagrams for 3-set data. We describe the drawing method adopted by eulerAPE and we discuss our evaluation of the effectiveness of eulerAPE and ellipses for drawing random 3-set data. We compare eulerAPE and various other methods that are currently available and we discuss differences between their generated diagrams in terms of accuracy and ease of understanding for real world data.
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Affiliation(s)
- Luana Micallef
- School of Computing, University of Kent, Canterbury, Kent, United Kingdom
- * E-mail:
| | - Peter Rodgers
- School of Computing, University of Kent, Canterbury, Kent, United Kingdom
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12
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Abdel-Kader K, Greer RC, Boulware LE, Unruh ML. Primary care physicians' familiarity, beliefs, and perceived barriers to practice guidelines in non-diabetic CKD: a survey study. BMC Nephrol 2014; 15:64. [PMID: 24755164 PMCID: PMC4021215 DOI: 10.1186/1471-2369-15-64] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/16/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Most non-dialysis dependent chronic kidney disease (CKD) patients are cared for by their primary care physicians (PCPs). Studies suggest many CKD patients receive suboptimal care. Recently, CKD clinical practice guidelines were updated with additional emphasis on albuminuria. METHODS We performed an internet-based, cross-sectional survey of active PCPs in the United States using the American Medical Association Physician Masterfile. We explored CKD guideline familiarity, self-reported practice behaviors, and attitudinal and external barriers to implementing guideline recommendations, including albuminuria testing. RESULTS Of 12,034 PCPs targeted, 848 opened a study email, 165 (19.5%) responded. Most respondents (88%) spent ≥50% of their time in clinical care. Respondents were generally in private practice (46%). Most PCPs (96%) felt that eGFR values were helpful. Approximately, 75% and 91% of PCPs reported testing for albuminuria in non-diabetic hypertensive patients with an eGFR > 60 ml/min/1.73 m2 and < 60 ml/min/1.73 m2, respectively. Barriers to albuminuria testing included a lack of effect on management, limited time, and the perceived absence of guidelines recommending testing. While PCPs expressed high levels of agreement with the definition of CKD, 30% were concerned with overdiagnosis in older adults with an eGFR in the CKD stage 3a range. Most PCPs felt that angiotensin converting enzyme inhibitor (ACEi)/ angiotensin II receptor blockers (ARBs) improved outcomes in CKD, though agreement was lower with severe vs. moderate albuminuria (78% vs. 85%, respectively, p = 0.03). Many PCPs (51%) reported being unfamiliar with CKD guidelines, but were receptive to systematic interventions to improve their CKD care. CONCLUSIONS PCPs generally agree with CKD clinical practice guidelines regarding CKD definition and albuminuria testing. However, future interventions are necessary to improve PCPs' familiarity with CKD guidelines, overcome barriers to albuminuria testing and, assist PCPs in targeting ACEi/ARBs to the patients most likely to benefit.
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Affiliation(s)
- Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Vanderbilt University, 1161 21st Ave, S,, MCN S-3223, Nashville, TN 37232, USA.
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Bannister E, Nakonezny P, Byerly M. Curricula for teaching clinical practice guidelines in US psychiatry residency and child and adolescent fellowship programs: a survey study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:198-204. [PMID: 24619912 DOI: 10.1007/s40596-014-0057-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 09/12/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the characteristics of curricula for teaching the content of clinical practice guidelines (CPGs) in psychiatric residency and child and adolescent fellowship programs as well as to determine if and how the learning of CPG content is applied in clinical care settings. METHODS We conducted a national online survey of directors of general psychiatry residency and child and adolescent fellowship programs in the USA. The survey questionnaire included 13 brief questions about the characteristics used to teach CPGs in the programs, as well as two demographic questions about each program and director. Descriptive statistics were reported for each questionnaire item by program classification (i.e., child and adolescent vs. general psychiatry). RESULTS The survey response rate was 49.8% (146 out of 293). Just 23% of programs reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect of CPGs was their content (72% of programs). Didactic sessions were the most frequently employed teaching strategy (79% of programs). Regarding the application of CPG learning in treatment care settings, just 16% of programs applied algorithms in care settings, and 15% performed evaluations to determine consistency between CPG recommendations and care delivery. Only 8% of programs utilized audit and feedback to residents about their adherence to CPGs. Faculty time constraints and insufficient interest were the leading barriers (39% and 33% of programs, respectively) to CPG teaching, although 38% reported no barriers. However, child and adolescent programs less commonly identified insufficient interest among faculty as a barrier to teaching CPGs compared to general programs (20% vs. 43%). Moreover, compared to general programs, child and adolescent fellowship programs taught more aspects of CPGs, used more educational activities to teach the content of specific CPGs, and used more methods to evaluate the teaching of CPGs. CONCLUSIONS Although the majority of programs provided some teaching of CPGs, the rigorousness of the teaching approaches was limited, especially attempts to evaluate the extent and effectiveness of their use in clinical care. Child and adolescent fellowship programs provided more extensive teaching and evaluation related to CPGs.
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Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One 2014; 9:e84943. [PMID: 24392162 PMCID: PMC3879360 DOI: 10.1371/journal.pone.0084943] [Citation(s) in RCA: 348] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/14/2013] [Indexed: 01/09/2023] Open
Abstract
Anemia is one of the many complications of chronic kidney disease (CKD). However, the current prevalence of anemia in CKD patients in the United States is not known. Data from the National Health and Nutrition Examination Survey (NHANES) in 2007-2008 and 2009-2010 were used to determine the prevalence of anemia in subjects with CKD. The analysis was limited to adults aged >18 who participated in both the interview and exam components of the survey. Three outcomes were assessed: the prevalence of CKD, the prevalence of anemia in subjects with CKD, and the self-reported treatment of anemia. CKD was classified into 5 stages based on the glomerular filtration rate and evidence of kidney damage, in accordance with the guidelines of the National Kidney Foundation. Anemia was defined as serum hemoglobin levels ≤12 g/dL in women and ≤13 g/dL in men. We found that an estimated 14.0% of the US adult population had CKD in 2007-2010. Anemia was twice as prevalent in people with CKD (15.4%) as in the general population (7.6%). The prevalence of anemia increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5. A total of 22.8% of CKD patients with anemia reported being treated for anemia within the previous 3 months-14.6% of patients at CKD stages 1-2 and 26.4% of patients at stages 3-4. These results update our knowledge of the prevalence and treatment of anemia in CKD in the United States.
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Affiliation(s)
| | - Tao Fan
- Merck & Co., Inc., Whitehouse Station, New Jersey, United States of America
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15
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Greer RC, Crews DC, Boulware LE. Challenges perceived by primary care providers to educating patients about chronic kidney disease. J Ren Care 2013; 38:174-81. [PMID: 23176576 DOI: 10.1111/j.1755-6686.2012.00323.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify primary care providers' (PCPs) perceived barriers to educating patients about chronic kidney disease (CKD) during routine clinical visits. METHODS We conducted three focus groups of eighteen PCPs in Baltimore, Maryland (MD), USA. Focus groups began with the presentation of a hypothetical case of a patient with CKD, followed by open-ended questions to assess providers' perceived barriers to delivering education about CKD. Groups were audiotaped, transcribed and coded independently by two investigators who identified major themes. RESULTS PCPs reported on several patient, provider and system level barriers contributing to poor education about CKD in primary care that were both common and unique to barriers previously reported in educating patients regarding other chronic diseases. CONCLUSIONS Interventions designed to address barriers to CKD education identified by PCPs could improve the delivery of education about CKD in primary care settings.
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Affiliation(s)
- Raquel C Greer
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Yaqub S, Kashif W, Raza MQ, Aaqil H, Shahab A, Chaudhary MA, Hussain SA. General practitioners' knowledge and approach to chronic kidney disease in Karachi, Pakistan. Indian J Nephrol 2013; 23:184-90. [PMID: 23814416 PMCID: PMC3692143 DOI: 10.4103/0971-4065.111842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Due to lack of adequate number of formally trained nephrologists, many patients with chronic kidney disease (CKD) are seen by general practitioners (GPs). This study was designed to assess the knowledge of the GPs regarding identification of CKD and its risk factors, and evaluation and management of risk factors as well as complications of CKD. We conducted a cross-sectional survey of 232 randomly selected GPs from Karachi during 2011. Data were collected on a structured questionnaire based on the kidney disease outcomes and quality initiative recommendations on screening, diagnosis, and management of CKD. A total of 235 GPs were approached, and 232 consented to participate. Mean age was 38.5 ± 11.26 years; 56.5% were men. Most of the GPs knew the traditional risk factors for CKD, i.e., diabetes (88.4%) and hypertension (80%), but were less aware of other risk factors. Only 38% GPs were aware of estimated glomerular filtration rate in evaluation of patients with CKD. Only 61.6% GPs recognized CKD as a risk factor for cardiovascular disease. About 40% and 29% GPs knew the correct goal systolic and diastolic blood pressure, respectively. In all, 41% GPs did not know when to refer the patient to a nephrologist. Our survey identified specific gaps in knowledge and approach of GPs regarding diagnosis and management of CKD. Educational efforts are needed to increase awareness of clinical practice guidelines and recommendations for patients with CKD among GPs, which may improve management and clinical outcomes of this population.
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Affiliation(s)
- S Yaqub
- Department of Medicine, Section of Nephrology, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
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Chen JB, Yang YH, Lee WC, Liou CW, Lin TK, Chung YH, Chuang LY, Yang CH, Chang HW. Sequence-based polymorphisms in the mitochondrial D-loop and potential SNP predictors for chronic dialysis. PLoS One 2012; 7:e41125. [PMID: 22815937 PMCID: PMC3399812 DOI: 10.1371/journal.pone.0041125] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/21/2012] [Indexed: 01/12/2023] Open
Abstract
Background The mitochondrial (mt) displacement loop (D-loop) is known to accumulate structural alterations and mutations. The aim of this study was to investigate the prevalence of single nucleotide polymorphisms (SNPs) within the D-loop among chronic dialysis patients and healthy controls. Methodology and Principal Findings We enrolled 193 chronic dialysis patients and 704 healthy controls. SNPs were identified by large scale D-loop sequencing and bioinformatic analysis. Chronic dialysis patients had lower body mass index, blood thiols, and cholesterol levels than controls. A total of 77 SNPs matched with the positions in reference of the Revised Cambridge Reference Sequence (CRS) were found in the study population. Chronic dialysis patients had a significantly higher incidence of 9 SNPs compared to controls. These include SNP5 (16108Y), SNP17 (16172Y), SNP21 (16223Y), SNP34 (16274R), SNP35 (16278Y), SNP55 (16463R), SNP56 (16519Y), SNP64 (185R), and SNP65 (189R) in D-loop of CRS. Among these SNPs with genotypes, SNP55-G, SNP56-C, and SNP64-A were 4.78, 1.47, and 5.15 times more frequent in dialysis patients compared to controls (P<0.05), respectively. When adjusting the covariates of demographics and comorbidities, SNP64-A was 5.13 times more frequent in dialysis patients compared to controls (P<0.01). Furthermore, SNP64-A was found to be 35.80, 3.48, 4.69, 5,55, and 4.67 times higher in female patients and in patients without diabetes, coronary artery disease, smoking, and hypertension in an independent significance manner (P<0.05), respectively. In patients older than 50 years or with hypertension, SNP34-A and SNP17-C were found to be 7.97 and 3.71 times more frequent (P<0.05) compared to patients younger than 50 years or those without hypertension, respectively. Conclusions and Significance The results of large-scale sequencing suggest that specific SNPs in the mtDNA D-loop are significantly associated with chronic dialysis. These SNPs can be considered as potential predictors for chronic dialysis.
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Affiliation(s)
- Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Mitochondrial Research Unit, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Mitochondrial Research Unit, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Wei Liou
- Department of Neurology and Mitochondrial Research Unit, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsu-Kung Lin
- Department of Neurology and Mitochondrial Research Unit, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Hua Chung
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Li-Yeh Chuang
- Department of Chemical Engineering & Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan
- * E-mail: (HWC); (CHY)
| | - Hsueh-Wei Chang
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Taiwan
- Center of Excellence for Environmental Medicine, Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (HWC); (CHY)
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Mula-Abed WAS, Al Rasadi K, Al-Riyami D. Estimated Glomerular Filtration Rate (eGFR): A Serum Creatinine-Based Test for the Detection of Chronic Kidney Disease and its Impact on Clinical Practice. Oman Med J 2012; 27:108-13. [PMID: 22496934 PMCID: PMC3321332 DOI: 10.5001/omj.2012.23] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/03/2012] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) is an important epidemic and public health problem that is associated with a significant risk for vascular disease and early cardiovascular mortality as well as progression of kidney disease. Currently it is classified into five stages based on the glomerular filtration rate (GFR) as recommended by many professional guidelines. Radiolabelled methods for measuring GFR are accurate but not practical and can be used only on a very limited scale while the traditional methods require timed urine collection with its drawback of inaccuracy, cumbersomeness and inconvenience for the patients. However, the development of formula- based calculation of estimated GFR (eGFR) has offered a very practical and easy approach for converting serum creatinine value into GFR result taking into consideration patient's age, sex, ethnicity and weight (depending on equation type). The commonly used equations include Cockraft and Gault (1976), Modification of Diet in Renal Disease (MDRD) (1999) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (2009). It is the implementation of these equations particularly the MDRD that has raised the medical awareness in the diagnosis and management of CKD and its adoption by many guidelines in North America and Europe. The impact and pitfalls of each of these equations in the screening, diagnosis and management of patients with CKD are presented and discussed in this review.
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Affiliation(s)
- Waad-Allah S. Mula-Abed
- Department of Chemical Pathology, Directorate of Laboratory Medicine and Pathology, Royal Hospital, Muscat, Sultanate of Oman
| | - Khalid Al Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Dawood Al-Riyami
- Department of Medicine, Nephrology Unit, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Identification and management of chronic kidney disease complications by internal medicine residents: a national survey. Am J Ther 2012; 18:e40-7. [PMID: 19918169 DOI: 10.1097/mjt.0b013e3181bbf6fc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many patients with chronic kidney disease (CKD) receive care from primary care physicians. Identification and management of CKD complications in primary care is suboptimal. It is not known if current residency curriculum adequately prepares a future internist in this aspect of CKD care. We performed an online questionnaire survey of internal medicine residents in the United States to determine knowledge of CKD complications and their management. Four hundred seventy-nine residents completed the survey with postgraduate year (PGY) distribution 166 PGY1, 187 PGY2, and 126 PGY3. Most of the residents correctly recognized anemia (91%) and bone disease (82%) as complications at estimated glomerular filtration rate less than 60 mL/min/1.73 m; however, only half of the residents identified coronary artery disease (54%) as a CKD complication. For a patient with estimated glomerular filtration rate less than 60 mL/min/1.73 m, two thirds of the residents would workup for anemia (62%), whereas half of them would check for mineral and bone disorder (56%). With regard to anemia of CKD, less than half of the residents knew the CKD goal hemoglobin level of 11 to 12 g/dL (44%); most would supplement iron stores (86%), whereas fewer would consider nephrology referral (28%). For mineral and bone disorders, many residents would recommend dietary phosphorus restriction (68%) and check 25-hydroxyvitamin D (62%); fewer residents would start 1,25-dihydroxyvitamin D (40%) or refer to the nephrologist (45%). Residents chose to discontinue angiotensin-converting enzyme inhibitor for medication-related complication of greater than 50% decline in estimated glomerular filtration rate (68%) and potassium greater than 5.5 mEq/L (93%). Mean performance score improved with increasing PGY (PGY1 59.4% ± 17.6%, PGY2 63.6% ± 15.6%, and PGY3 66.2% ± 16.5%; P = 0.002). Our study identified specific gaps in knowledge of CKD complications and management among internal medicine residents. Educational efforts such as instruction on use of CKD clinical practice guidelines may help raise awareness of CKD complications, benefits of early intervention, and improve CKD management.
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Thomas B. Improving blood pressure control among adults with CKD and diabetes: provider-focused quality improvement using electronic health records. Adv Chronic Kidney Dis 2011; 18:406-11. [PMID: 22098658 DOI: 10.1053/j.ackd.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 10/21/2011] [Accepted: 10/21/2011] [Indexed: 01/13/2023]
Abstract
Current evidence demonstrates poor provider knowledge and compliance to clinical practice guidelines (CPGs) for CKD screening, blood pressure (BP) goals specific to people with diabetes mellitus (DM) and CKD, and underutilization or incorrect drug selection for antihypertensive therapy. This 12-week provider-focused quality improvement project sought to (1) increase primary care provider (PCP) adherence to CPG in the treatment and control of BP among adults with CKD and DM by using electronic health records (EHRs) and patient-level feedback (scorecards); (2) increase PCP delivery of basic CKD patient education by using EHR-based decision support; and (3) assess whether electronic decision support and scorecards changed provider behavior. The project included 46 PCPs, physicians, and nurse practitioners, in a statewide federally qualified health center that operates 12 comprehensive primary care sites in Connecticut. There were 6781 DM visits, among 3137 unique, racially diverse patients. There was a statistically significant increase in CKD screening, diagnosis, and use of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker. There was a statistically, but not clinically, significant increase in CKD basic education and ancillary service provider use when the provider was aware of the diagnosis or used EHR enhancements. EHR decision support and real-time provider feedback are necessary but not sufficient to improve uptake of CPG and to change PCP behavior.
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Greer RC, Powe NR, Jaar BG, Troll MU, Boulware LE. Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions. BMC Nephrol 2011; 12:1. [PMID: 21235763 PMCID: PMC3033812 DOI: 10.1186/1471-2369-12-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/14/2011] [Indexed: 01/13/2023] Open
Abstract
Background Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD) may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR) rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. Methods We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine) on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR < 30 to ≥ 30 mL/min/1.73m2) of their recommended referrals based on their use of creatinine versus eGFR. Results Primary care physicians recommended subspecialty referrals later (CKD more advanced) when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m2, p < 0.001]. Forty percent of primary care physicians significantly improved the timing of their referrals when basing their recommendations on eGFR. Improved timing occurred more frequently among primary care physicians practicing in academic (versus non-academic) practices or presented with White (versus African American) hypothetical patients [adjusted percentage(95% CI): 70% (45-87) versus 37% (reference) and 57% (39-73) versus 25% (reference), respectively, both p ≤ 0.01). Conclusions Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine) to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.
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Affiliation(s)
- Raquel C Greer
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Becker BN. Filling the gap in CKD: The health care workforce and faculty development. Am J Kidney Dis 2010; 57:198-201. [PMID: 21087815 DOI: 10.1053/j.ajkd.2010.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 08/20/2010] [Indexed: 11/11/2022]
Abstract
Given limited resources, adding another chronic illness to the panoply of chronic disease care is problematic. Nevertheless, chronic kidney disease (CKD) is increasing in recognition and prevalence across the world, and a management strategy for this growing population is necessary. A diverse group of health care professionals interacts with patients with CKD and their family members, including nurses, nurse practitioners, dieticians, social workers, pharmacists, physicians, physical therapists, physician assistants, and public health workers. All these individuals have the opportunity to reinforce CKD management. This potentially would bring a broader health care workforce to bear on CKD, reducing the impact of the nephrology workforce shortage. To realize such a strategy, it is necessary to bolster CKD awareness and knowledge in the diverse health care workforce. A faculty development program that extends CKD awareness to existing health care workers also has the possibility of migrating into the learner curriculum in health professional schools. This approach would expand CKD education, creating a skilled diverse health care workforce.
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Plantinga LC, Tuot DS, Powe NR. Awareness of chronic kidney disease among patients and providers. Adv Chronic Kidney Dis 2010; 17:225-36. [PMID: 20439091 DOI: 10.1053/j.ackd.2010.03.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/04/2010] [Accepted: 03/07/2010] [Indexed: 11/11/2022]
Abstract
Earlier recognition of chronic kidney disease (CKD) could slow progression, prevent complications, and reduce cardiovascular-related outcomes. However, current estimates of CKD awareness indicate that both patient- and provider-level awareness remain unacceptably low. Many of the factors that are possibly associated with CKD awareness, which could help guide implementation of awareness efforts, have yet to be fully examined. Also, little is known regarding whether increased patient or provider awareness improves clinical outcomes, or whether there are possible negative consequences of awareness for CKD patients. Further research is necessary to continue to design and refine awareness campaigns aimed at both patients and providers, but there is an immediate need for dissemination of basic CKD information, given both the high prevalence of CKD and its risk factors and the low estimated awareness of CKD.
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Akl EA, Mustafa R, Wilson MC, Symons A, Moheet A, Rosenthal T, Guyatt GH, Schünemann HJ. Curricula for teaching the content of clinical practice guidelines to family medicine and internal medicine residents in the US: a survey study. Implement Sci 2009; 4:59. [PMID: 19772570 PMCID: PMC2753632 DOI: 10.1186/1748-5908-4-59] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 09/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Teaching the content of clinical practice guidelines (CPGs) is important to both clinical care and graduate medical education. The objective of this study was to determine the characteristics of curricula for teaching the content of CPGs in family medicine and internal medicine residency programs in the United States. METHODS We surveyed the directors of family medicine and internal medicine residency programs in the United States. The questionnaire included questions about the characteristics of the teaching of CPGs: goals and objectives, educational activities, evaluation, aspects of CPGs that the program teaches, the methods of making texts of CPGs available to residents, and the major barriers to teaching CPGs. RESULTS Of 434 programs responding (out of 839, 52%), 14% percent reported having written goals and objectives related to teaching CPGs. The most frequently taught aspect was the content of specific CPGs (76%). The top two educational strategies used were didactic sessions (76%) and journal clubs (64%). Auditing for adherence by residents was the primary evaluation strategy (44%), although 36% of program directors conducted no evaluation. Programs made texts of CPGs available to residents most commonly in the form of paper copies (54%) while the most important barrier was time constraints on faculty (56%). CONCLUSION Residency programs teach different aspects of CPGs to varying degrees, and the majority uses educational strategies not supported by research evidence.
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Affiliation(s)
- Elie A Akl
- Department of Medicine, State University of New York at Buffalo, NY, USA
- Department of Family Medicine, State University of New York at Buffalo, NY, USA
| | - Reem Mustafa
- Department of Medicine, State University of New York at Buffalo, NY, USA
| | - Mark C Wilson
- Department of Internal medicine, University of Iowa, IA, USA
| | - Andrew Symons
- Department of Family Medicine, State University of New York at Buffalo, NY, USA
| | - Amir Moheet
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
- Department of Medicine, University of Rochester, NY, USA
| | - Thomas Rosenthal
- Department of Family Medicine, State University of New York at Buffalo, NY, USA
| | - Gordon H Guyatt
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University, Hamilton, ON, Canada
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Gentile G, Postorino M, Mooring RD, De Angelis L, Manfreda VM, Ruffini F, Pioppo M, Quintaliani G. Estimated GFR reporting is not sufficient to allow detection of chronic kidney disease in an Italian regional hospital. BMC Nephrol 2009; 10:24. [PMID: 19723333 PMCID: PMC2749028 DOI: 10.1186/1471-2369-10-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 09/01/2009] [Indexed: 01/09/2023] Open
Abstract
Background Chronic kidney disease (CKD) is an emerging worldwide problem. The lack of attention paid to kidney disease is well known and has been described in previous publications. However, little is known about the magnitude of the problem in highly specialized hospitals where serum creatinine values are used to estimate GFR values. Methods We performed a cross-sectional evaluation of hospitalized adult patients who were admitted to the medical or surgical department of Santa Maria della Misericordia Hospital in 2007. Information regarding admissions was derived from a database. Our goal was to assess the prevalence of CKD (defined as an estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) and detection of CKD using diagnostic codes (Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]). To reduce the impact of acute renal failure on the study, the last eGFR obtained during hospitalization was the value used for analysis, and intensive care and nephrology unit admissions were excluded. We also excluded patients who had ICD-9-CM codes for renal replacement therapy, acute renal failure, and contrast administration listed as discharge diagnoses. Results Of the 18,412 patients included in the study, 4,748 (25.8%) had reduced eGFRs, falling into the category of Kidney Disease Outcomes Quality Initiative (KDOQI) stage 3 (or higher) CKD. However, the diagnosis of CKD was only reported in 19% of these patients (904/4,748). It is therefore evident that there was a "gray area" corresponding to stage 3 CKD (eGFR 30-59 ml/min), in which most CKD diagnoses are missed. The ICD-9 code sensitivity for detecting CKD was significantly higher in patients with diabetes, hypertension, and cardiovascular disease (26.8%, 22.2%, and 23.7%, respectively) than in subjects without diabetes, hypertension, or cardiovascular disease (p < 0.001), but these values are low when the widely described relationship between such comorbidities and CKD is considered. Conclusion Although CKD was common in this patient population at a large inpatient regional hospital, the low rates of CKD detection emphasize the primary role nephrologists must play in continued medical education, and the need for ongoing efforts to train physicians (particularly primary care providers) regarding eGFR interpretation and systematic screening for CKD in high-risk patients (i.e., the elderly, diabetics, hypertensives, and patients with CV disease).
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Affiliation(s)
- Giorgio Gentile
- Department of Nephrology and Dialysis, Santa Maria della Misericordia Hospital, Perugia, Italy.
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Agrawal V, Barnes MA, Ghosh AK, McCullough PA. Questionnaire instrument to assess knowledge of chronic kidney disease clinical practice guidelines among internal medicine residents. J Eval Clin Pract 2009; 15:733-8. [PMID: 19674226 DOI: 10.1111/j.1365-2753.2008.01090.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The National Kidney Foundation published Kidney Disease Outcomes Quality Initiative guidelines that recommend early detection and management of chronic kidney disease (CKD) and timely referral to a nephrologist. Many patients with CKD are seen by primary care doctors who maybe less experienced than a nephrologist to offer optimal early CKD care. It is not known whether postgraduate training adequately prepares a future internist in CKD management. METHODS We developed a 15-item questionnaire instrument to assess knowledge of CKD guidelines among internal medicine residents in USA using an online survey programme. We studied the validity and reliability measures of our instrument. RESULTS The survey was completed by 166 PGY1 (postgraduate year one), 187 PGY2 and 126 PGY3. The questionnaire tested various aspects of CKD including definition, classification, identification of risk factors, laboratory evaluation, development of clinical action plan, identification of complications, anaemia and bone and mineral disorder, referral to a nephrologist and medication use. Validity was supported by the use of official guidelines and an expert panel of nephrologists to develop content and improvement in mean test performance with increasing level of training (PGY1 59.2 +/- 13.5%, PGY2 62.6 +/- 12.3% and PGY3 64.3 +/- 12.2%; P = 0.002). The reliability coefficient for the questionnaire instrument (Cronbach's alpha) was 0.69. CONCLUSION Our brief questionnaire is a valid and reliable instrument to assess knowledge of CKD guidelines among internal medicine residents and identify specific gaps for improvement.
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Affiliation(s)
- Varun Agrawal
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Charles RF, Powe NR, Jaar BG, Troll MU, Parekh RS, Boulware LE. Clinical testing patterns and cost implications of variation in the evaluation of CKD among US physicians. Am J Kidney Dis 2009; 54:227-37. [PMID: 19371991 DOI: 10.1053/j.ajkd.2008.12.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 12/10/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical practice guidelines were established to improve the diagnosis and management of chronic kidney disease (CKD), but the extent, determinants, and cost implications of guideline adherence and variation in adherence have not been evaluated. STUDY DESIGN Cross-sectional survey. SETTINGS & PARTICIPANTS The questionnaire was sent (on paper or through the internet) to a nationally representative sample of 1,200 US primary care physicians and nephrologists. PREDICTOR Provider and patient characteristics. OUTCOMES & MEASUREMENTS Guideline adherence was assessed as present if physicians recommended at least 5 of 6 clinical tests prescribed by the National Kidney Foundation's Kidney Disease Outcomes and Quality Initiative guidelines for a hypothetical patient with newly identified CKD. We also assessed patterns and costs of additional nonrecommended tests for the initial clinical evaluation of CKD. RESULTS Of the 301 (86 family medicine, 89 internal medicine, and 126 nephrology) eligible physicians who responded to the survey (response rate, 32%), most practiced longer than 10 years (54%), were in nonacademic practices (76%), spent greater than 80% of their time performing clinical duties (77%), and correctly estimated kidney function (73%). Overall, 35% of participants were guideline adherent. Compared with nephrologists, internal medicine and family physicians had lower odds of adherence for all recommended testing (odds ratio, 0.6; 95% confidence interval, 0.3 to 1.1; and odds ratio, 0.3; 95% confidence interval, 0.1 to 0.6, respectively). Participants practicing longer than 10 years had lower odds of ordering all recommended testing compared with participants practicing fewer than 10 years (odds ratio, 0.5; 95% confidence interval, 0.3 to 0.9). Eighty-five percent of participants recommended additional tests, which resulted in a 23% increased total per-patient cost of the clinical evaluation. LIMITATIONS Recommendations for a hypothetical case scenario may differ from those of actual patients. CONCLUSIONS Adherence to recommended clinical testing for the diagnosis and management of CKD was poor, and additional testing was associated with substantially increased cost of the clinical evaluation. Improved clarity, dissemination, and uptake of existing guidelines are needed to improve quality and decrease costs of care for patients with CKD.
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Affiliation(s)
- Raquel F Charles
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Israni RK, Shea JA, Joffe MM, Feldman HI. Physician characteristics and knowledge of CKD management. Am J Kidney Dis 2009; 54:238-47. [PMID: 19359079 DOI: 10.1053/j.ajkd.2009.01.258] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 01/22/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many studies suggest that chronic kidney disease (CKD) care is suboptimal in the United States. However, it is not known whether knowledge of CKD management in primary care physicians (PCPs) might have an important role in the suboptimal care and whether PCP characteristics are associated with having adequate knowledge. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Self-administered questionnaire sent to a random sample of 1,550 US PCPs in February 2007. PREDICTOR OR FACTOR PCP characteristics, including age, sex, degree (MD versus DO), primary specialty, board certification, patient volume, percentage of time in patient care spent in the inpatient versus outpatient setting, and number of patients referred to nephrologists in a month. OUTCOMES & MEASUREMENTS Regression analyses of the association between physician characteristics and overall physician knowledge of CKD management, as well as individual subdomains of CKD knowledge related to recognition of CKD and management of hypertension in the setting of CKD. RESULTS 470 of 1,453 (32.4%) eligible PCPs returned a completed survey. PCPs show significant variation in their ability to recognize CKD stages 2 to 4, but most have appropriate blood pressure goals in patients with CKD and are knowledgeable of the role of angiotensin-converting enzyme inhibitors in managing proteinuria. For each 10-year increase in age, the odds of showing satisfactory knowledge of CKD management decreased by 26% (odds ratio, 0.74; 95% confidence interval, 0.60 to 0.92). PCPs with the primary specialty of internal medicine had a more than 3-fold greater odds of showing a satisfactory level of knowledge compared with family practice specialists (odds ratio, 3.40; 95% confidence interval, 2.17 to 5.32). LIMITATIONS The study findings are limited by the potential presence of nonresponse bias, information bias, and results suggesting there are multiple knowledge subdomains that perhaps are not additive. CONCLUSION There is need to improve CKD knowledge in PCPs, especially regarding recognition of CKD at an early stage.
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Affiliation(s)
- Rubeen K Israni
- Renal and Hypertension Division, Department of Medicine, Christiana Care Health System, Newark, DE, USA.
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Powe NR, Boulware LE. Population-based screening for CKD. Am J Kidney Dis 2009; 53:S64-70. [PMID: 19231763 PMCID: PMC2681232 DOI: 10.1053/j.ajkd.2008.07.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/31/2008] [Indexed: 11/11/2022]
Abstract
Organizations both in the United States and globally have advocated for screening for chronic kidney disease with a urine test for proteinuria followed by subsequent testing with creatinine-based estimated glomerular filtration rate determinations. Screening for a disease, such as chronic kidney disease, can have value, but a decision to screen is not a trivial decision. Criteria must be met to balance the aggregate benefits with the risks and costs of a screening test. We discuss how screening for chronic kidney disease meets many of these criteria, but also how the populations to which it is applied must be targeted and the strategies for testing must be clearly defined.
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Affiliation(s)
- Neil R. Powe
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - L. Ebony Boulware
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Agrawal V, Ghosh AK, Barnes MA, McCullough PA. Awareness and Knowledge of Clinical Practice Guidelines for CKD Among Internal Medicine Residents: A National Online Survey. Am J Kidney Dis 2008; 52:1061-9. [DOI: 10.1053/j.ajkd.2008.06.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 06/18/2008] [Indexed: 11/11/2022]
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31
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Tzamaloukas AH, Raj DS. Referral of Patients with Chronic Kidney Disease to the Nephrologist: Why and When. Perit Dial Int 2008. [DOI: 10.1177/089686080802800406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Antonios H. Tzamaloukas
- Renal Section, Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
- New Mexico Veterans Affairs Health Care System Division of Nephrology Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
| | - Dominic S.C. Raj
- New Mexico Veterans Affairs Health Care System Division of Nephrology Department of Medicine University of New Mexico School of Medicine Albuquerque, New Mexico, USA
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Abstract
OBJECTIVES To define the cost of care and evaluate interventions associated with improving outcomes and delaying the progression of chronic kidney disease (CKD). METHODS Using the PubMed database, a systematic review of the literature was conducted describing (i) the cost of care associated with treating earlier stages of CKD, and (ii) the role of early referral, erythropoiesis-stimulating proteins and anti-hypertensive agents in improving clinical outcomes and reducing the cost of CKD. RESULTS The higher costs associated with treatment of the CKD population are largely due to higher rates and duration of comorbidity-driven hospitalizations. Studies suggest that early referral to a nephrologist, use of erythropoiesis-stimulating proteins and anti-hypertensive agents may be associated with better outcomes and lower costs. In some instances, however, higher target haemoglobin levels could have harmful effects in CKD patients. CONCLUSION The substantial costs incurred during earlier stages of CKD increase markedly during the transition to renal replacement and remain elevated thereafter. An increase in awareness among health care providers may result in more timely interventions. More proactive management, in turn, can lead to improved clinical and economic outcomes through the slowing of disease progression and prevention of comorbidities.
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Affiliation(s)
- Samina Khan
- Tufts University School of Medicine, Boston, MA 02459, USA.
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