IMPROVING THE DIAGNOSIS AND MANAGEMENT OF CHRONIC KIDNEY DISEASE IN PRIMARY CARE: POST-HOC ANALYSIS OF THE CHRONIC DISEASE IMPACT STEPPED WEDGE CLUSTER RANDOMISED TRIAL
Julia Jones1,2,3, Vincent Wong1, Koen Simons2, Craig Nelson1,2,3 1Department of Nephrology – Western Health, Melbourne, Victoria, Australia2University of Melbourne, Parkville, Victoria, Australia3Western Health Chronic Disease Alliance, St Albans, Victoria, Australia
Abstract
Aim: To determine the time required for a novel electronic technology-based intervention to impact chronic kidney disease (CKD) detection and management in general practice.
Background: Primary care plays a key role in the diagnosis and management of CKD. The time required for an electronic technology-based intervention to affect detection and management of CKD in general practice is uncertain.
Methods: Post-hoc analysis of the Chronic Disease IMPACT stepped wedge cluster randomised trial, conducted in 9 general practices across Victoria over 64 weeks. The intervention included an electronic audit tool, education, monitoring and support. Practices were randomised to step into the intervention at 16-week intervals. Effect after 16, 32, 48 and 64 weeks on the intervention was assessed with a Bayesian generalised linear mixed model with practice and time-specific random intercepts.
Results: At baseline there were 37,946 patients aged ≥18 years who had attended their practice within 2 years. The maximum effect was reached for CKD diagnostic testing in those at risk after 48 weeks with odds ratio (OR) 2.0 and credible interval (CI) 1.8-2.3. For coded CKD diagnosis, maximum effect was at 64 weeks (OR 1.7, CI 1.4-2). For patients with a coded CKD diagnosis, prescription of angiotensin converting enzyme inhibitors or angiotensin receptor blockers reached maximum effect at 64 weeks (OR 1.6, CI 1.3-2) and prescription of statins, at 48 weeks (OR 1.5 CI 1.2-1.8).
Conclusions: This post-hoc analysis suggests that electronic technology-based interventions supporting audit in general practice may take a year or more to reach its full effect. This knowledge may inform future research assessing such interventions that may otherwise provide insufficient time to assess intervention effects.