Van Gelder Vincent A, Scherpbier-De Haan Nynke D, De Grauw Wim J C, Vervoort Gerald M M, Van Weel Chris, Biermans Marion C J, Braspenning Jozé C C, Wetzels Jack F M
a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , the Netherlands ;
b Department of Nephrology , Radboud University Medical Center , Nijmegen , the Netherlands ;
Scand J Prim Health Care. 2016;34(1):73-80. doi: 10.3109/02813432.2015.1132885. Epub 2016 Feb 6.
Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality.
To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies.
Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults).
CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics.
Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex.
Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model.
Quality of care for chronic kidney disease patients in primary care can be improved. In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients. Quality of care was higher in patients with diabetes. Chronic kidney disease management may be improved by developing strategies similar to diabetes care.
在初级保健中对慢性肾脏病（CKD）进行早期检测和适当管理对于降低发病率和死亡率至关重要。
评估初级医疗保健中CKD的护理质量（QoC）与患者及医疗机构特征的关系，以便制定改进策略。
回顾性研究，使用了2008年至2011年期间47家普通医疗机构（207469名患者，其中162562名是成年人）的数据。
使用源自荷兰初级保健和肾脏病跨学科CKD指南的指标对在全科医生（GP）照料下的患者的CKD管理进行评定，包括（1）肾功能、蛋白尿、血压和血糖监测，（2）代谢参数监测，以及与指南并行的（3）CKD识别。结果指标为（4）达到血压目标。应用多水平逻辑回归分析来确定相关的患者及医疗机构特征。
59728名成年患者有肾功能或蛋白尿数据；9288名患者患有CKD，其中8794名在GP照料之下。42%的CKD患者疾病进展监测完整，2%的患者代谢参数监测完整，43.1%的患者达到了血压目标。全科医生在31.4%的CKD患者中记录了CKD。高护理质量与糖尿病密切相关，在较小程度上与高血压和男性性别相关。
CKD管理的各个方面都存在改进空间。由于接受结构化糖尿病护理的患者护理质量较高，未来的CKD护理可能会从更结构化的初级保健管理中受益，例如根据慢性病护理模式。
初级保健中慢性肾脏病患者的护理质量可以得到改善。与指南建议相比，42%的慢性肾脏病患者疾病进展监测充分，2%的患者代谢参数监测充分，31%的患者肾功能损害识别正确，43%的患者达到血压目标。糖尿病患者的护理质量更高。通过制定类似于糖尿病护理的策略，慢性肾脏病管理可能会得到改善。
