Background
Methods
Rapid realist review and Normalisation Process Theory
Design
Search process
Primary exclusion criteria |
• Studies not written in English |
• Studies that include participants which are not human |
• Studies where the primary focus was not on the management of kidney disease |
• Studies which focussed on participants on renal replacement therapy |
• Studies which were letters, notes, conference abstracts or reviews only |
Secondary exclusion criteria |
• Studies where there was no description of any intervention |
• Studies that did not report any clinical outcomes or results |
• Studies where there were no primary care elements |
• Unable to obtain further information to make assessment |
Search terms used |
((Chronic Kidney Disease or CKD) and (intervention or interventions or tool or tools or strategy or strategies or project or projects or model or models or scheme or schemes or quality improvement or quality improvements) and (Primary care or family practice or general practice)) |
Selection, appraisal and extraction
Analysis and synthesis processes
Results
Intervention type | Author (year) | Main intervention description | Other intervention(s) | Sample size | Country | Summary of findings | Other comments | |
---|---|---|---|---|---|---|---|---|
CKD interventions aimed at healthcare professionals | Educational | Cortes-Sanabria et al. (2008) [28] | Intensive weekly teaching sessions to GP (5 h weekly for 6 months) | Validated test at 0 and 6 months to measure competence | 94 | Mexico | Increased GP competence, led to improved eGFR and BP control, better prescribing | High enrolment rate. 91 % of GPs increased their clinical competence |
Akbari et al. (2004) [26] | 2 h of teaching seminars to GPs, with direct access to advice from nephrologist | Automated reporting of eGFR by laboratory | 324 | Canada | Increased recognition of CKD | Limited data for evaluation, early study | ||
Practice group meetings | De Lusignan et al. (2013) [34] | Audit-based education (twice yearly feedback about quality and performance compared with peers) | Education, peer support | 23,311 | UK | Improved BP control and increased use of ACEi. No differences in eGFR | Large study including 93 different practices | |
Humphreys et al. (2012) [16] | Three large practice group meetings with local rapid quality improvement cycles (planned and organised by research collaboration) | Implementation team support | 5509 | UK | CKD recognition, BP control and proteinuria testing all improved | Included 19 different practices | ||
Multidisciplinary management | Scherpbier et al. (2013) [32] | Shared care between nurse practitioners and GPs (with access to nephrologist or nephrology nurse via digital technology) | Education to both groups | 164 | Holland | Decreased BP and serum PTH, increased use of ACEi and statins | Limited supporting data for evaluation | |
Barrett et al. (2011) [25] | Nurse co-ordinated care (with access to nephrologist) | 427 | Canada | No difference in rate of decline of eGFR or BP. But an increase in mean eGFR | Most patients ‘extremely satisfied’ with care on questionnaire | |||
Bayliss et al. (2011) [27] | MDT approach (including nephrologist, pharmacy specialist, diabetes educator, dietitian, social worker, and nephrology nurse) | Components included weekly meetings, contact by telephone or email, individualised plans and patient education | 2002 | USA | Rate of decline of eGFR improved. No differences in BP, lipids or HbA1C | Limited data to determine which individual components were effectual | ||
Richards et al. (2008) [33] | Disease management programme (includes patient education, medication review, dietetic advice and social worker) | Desktop guide for clinicians containing clinical management and referral algorithms | 483 | UK | Improved eGFR, BP and cholesterol. | An extra resource. 85 % enrolment of practices within one area | ||
Patel et al. (2005) [45] | Pharmacists performing medication reviews | 82 | USA | Improvement of CKD recognition. No difference in BP, HbA1C or creatinine clearance | 99 % of patients had prescription related problems. Only 40.9 % of advice was accepted | |||
Computer software | Drawz et al. (2012) [36] | Access and training for CKD registries | Educational lecture to both groups, academic detailing | 781 | USA | Increased PTH measurements, but no difference in BP control | Poor uptake: only 5/37 GPs accessed the registry | |
Erler et al. (2012) [35] | Medication alert software with training | 1 h education to both groups, patient info leaflets | 404 | Germany | Improved prescribing | Lack of contextual integration limited its use | ||
Abdel Kader et al. (2011) [23] | Computer-generated automatic alerts for referral to nephrologist | Two 15 min educational sessions for GPs in both groups | 248 | USA | No differences in referral to nephrologists or BP control | 97 % uptake rate of GPs. No dropouts from study | ||
Fox et al. (2008) [30] | Computer decision support software generating a recommended to-do list | Ancillary staff + monthly academic detailing | 180 | USA | Mean eGFR, CKD recognition, anaemia diagnosis all improved | Ancillary staff also did extra work including translating patient guides | ||
Financial | Karunaratne et al. (2013) [29] | National pay for performance scheme (Quality and Outcomes Framework) | 10,040 | UK | Improved BP control, increased use of ACEi | High level buy-in generated engagement | ||
CKD interventions aimed at patients | Patient education | Blakeman et al. (2014) [39] | Patient guidebook, telephone guided help from a lay health worker | Booklet and website linking to community resources | 436 | UK | Improved BP control, increased QALYs | 85.7 % uptake rate |
Thomas et al. (2013) [38] | Leaflet, DVD, self-monitoring diary | Single practitioner education and shadowing session | 116 | UK | Decreased BP | Limited data on level of implementation | ||
Thomas et al. (2014) [37] | Group education session, leaflet, DVD | Practice training and monthly teleconferences. Patient advisory group | 671 | UK | Moderate decreases in BP | Patient advisory group involved in design, grant application, delivering education and feedback | ||
Other | Cottrell et al. (2012) [44] | Mobile phone text messaging BP service | 124 | UK | No changes in BP, improved prescribing | Many more BP readings |