Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, Cranmer Terrace, London SW17 0RE, UK.
BMC Fam Pract. 2011 Aug 5;12:83. doi: 10.1186/1471-2296-12-83.
Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD. Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes.
We validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate.
87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM). 85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%. Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD. 84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD.
Practitioners are less likely to achieve management targets where their confidence is low.
许多慢性病都在基层医疗机构中得到管理，慢性肾脏病（CKD）是最近才加入的。我们正在进行一项 CKD 质量改进干预措施的集群随机研究（QICKD） - 临床试验注册：ISRCTN56023731。CKD 登记册的患病率低于预期，最初的焦点小组研究表明，对 CKD 管理的信心水平存在差异。我们的目标是比较医生对 CKD 与高血压和糖尿病的管理信心和实现质量指标的情况。
我们验证了一个新的问卷来测试信心。我们比较了信心与绩效付费指标（P4P）的实现情况以及循证指南的实施情况。我们的回复率达到了 74%（148/201）。
87%（n = 128）的受访者对管理高血压（HT）有信心，而管理 CKD 中的 HT（HT+CKD）的信心为 59%（n = 87）；对 HT、CKD 和糖尿病（CKD+HT+DM）的信心为 61%（n = 90）。85.2%（P4P）和 62.5%（国家目标）的高血压患者达到目标；在 HT 和 CKD 患者中，这一比例分别为 65.1%和 53.3%；在 HT、CKD 和 DM 患者中，这一比例分别为 67.8%和 29.6%。管理 CKD 中蛋白尿的信心较低（42%，n = 62）。87%的受访者知道 CKD 中的血压治疗阈值，但当蛋白尿因素考虑在内时，只有 53%的人知道。男性全科医生、年轻（<35 岁）和年长（>54 岁）的医生比女性和 35 至 54 岁的医生更有信心管理 CKD。接受血管紧张素调节药物治疗的高血压患者中有 84%达到了 P4P 目标，而 CKD 患者中有 67%达到了这一目标。
医生对管理目标的信心较低时，他们就不太可能实现这些目标。
