Nash Danielle M, Brimble Scott, Markle-Reid Maureen, McArthur Eric, Tu Karen, Nesrallah Gihad E, Grill Allan, Garg Amit X
Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada.
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Can J Kidney Health Dis. 2017 May 23;4:2054358117703059. doi: 10.1177/2054358117703059. eCollection 2017.
Patients with chronic kidney disease may not be receiving recommended primary renal care.
To use recently established primary care quality indicators for chronic kidney disease to determine the proportion of patients receiving recommended renal care.
Retrospective cohort study using administrative data with linked laboratory information.
The study was conducted in Ontario, Canada, from 2006 to 2012.
Patients over 40 years with chronic kidney disease or abnormal kidney function in primary care were included.
In total, 11 quality indicators were assessed for chronic kidney disease identified through a Delphi panel in areas of screening, monitoring, drug prescribing, and laboratory monitoring after initiating an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).
We calculated the proportion and cumulative incidence at the end of follow-up of patients meeting each indicator and stratified results by age, sex, cohort entry, and chronic kidney disease stage.
Less than half of patients received follow-up tests after an initial abnormal kidney function result. Most patients with chronic kidney disease received regular monitoring of serum creatinine (91%), but urine albumin-to-creatinine monitoring was lower (70%). A total of 84% of patients age 66 and older did not receive a non-steroidal anti-inflammatory drug prescription of at least 2-week duration. Three quarters of patients age 66 and older were on an ACE inhibitor or ARB, and 96% did not receive an ACE inhibitor and ARB concurrently. Among patients 66 to 80 years of age with chronic kidney disease, 65% were on a statin. One quarter of patients age 66 and older who initiated an ACE inhibitor or ARB had their serum creatinine and potassium monitored within 7 to 30 days.
This study was limited to people in Ontario with linked laboratory information.
There was generally strong performance across many of the quality of care indicators. Areas where more attention may be needed are laboratory testing to confirm initial abnormal kidney function test results and monitoring serum creatinine and potassium after initiating a new ACE inhibitor or ARB.
慢性肾脏病患者可能未接受推荐的初级肾脏护理。
使用最近建立的慢性肾脏病初级护理质量指标来确定接受推荐肾脏护理的患者比例。
利用行政数据及关联实验室信息的回顾性队列研究。
该研究于2006年至2012年在加拿大安大略省进行。
纳入40岁以上在初级护理中患有慢性肾脏病或肾功能异常的患者。
总共评估了11项通过德尔菲小组确定的慢性肾脏病质量指标，涉及筛查、监测、药物处方以及在开始使用血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）后的实验室监测等领域。
我们计算了符合各指标的患者在随访结束时的比例和累积发病率，并按年龄、性别、队列入组情况和慢性肾脏病阶段对结果进行分层。
在首次肾功能检查结果异常后，不到一半的患者接受了后续检查。大多数慢性肾脏病患者接受了血清肌酐的定期监测（91%），但尿白蛋白与肌酐比值的监测较低（70%）。66岁及以上的患者中，共有84%未接受至少为期2周的非甾体抗炎药处方。66岁及以上的患者中有四分之三使用了ACE抑制剂或ARB，且96%未同时使用ACE抑制剂和ARB。在66至80岁患有慢性肾脏病的患者中，65%服用了他汀类药物。66岁及以上开始使用ACE抑制剂或ARB的患者中有四分之一在7至30天内监测了血清肌酐和钾。
本研究仅限于安大略省有关联实验室信息的人群。
在许多护理质量指标方面总体表现良好。可能需要更多关注的领域是确认初始肾功能异常检查结果的实验室检测，以及在开始使用新的ACE抑制剂或ARB后监测血清肌酐和钾。
