Keohane David M, Dennehy Thomas, Keohane Kenneth P, Shanahan Eamonn
The South West Specialist Training Programme in General Practice, Tralee, Ireland.
Int J Health Care Qual Assur. 2017 Aug 14;30(7):638-644. doi: 10.1108/IJHCQA-09-2016-0145.
Purpose The purpose of this paper is to reduce inappropriate non-steroidal anti-inflammatory prescribing in primary care patients with chronic kidney disease (CKD). Once diagnosed, CKD management involves delaying progression to end stage renal failure and preventing complications. It is well established that non-steroidal anti-inflammatories have a negative effect on kidney function and consequently, all nephrology consensus groups suggest avoiding this drug class in CKD. Design/methodology/approach The sampling criteria included all practice patients with a known CKD risk factor. This group was refined to include those with an estimated glomerular filtration rate (eGFR)<60 ml/min per 1.73m2 (stage 3 CKD or greater). Phase one analysed how many prescriptions had occurred in this group over the preceding three months. The intervention involved creating an automated alert on at risk patient records if non-steroidal anti-inflammatories were prescribed and discussing the rationale with practice staff. The re-audit phase occurred three months' post intervention. Findings The study revealed 728/7,500 (9.7 per cent) patients at risk from CKD and 158 (2.1 per cent) who were subsequently found to have an eGFR<60 ml/min, indicating=stage 3 CKD. In phase one, 10.2 per cent of at risk patients had received a non-steroidal anti-inflammatory prescription in the preceding three months. Additionally, 6.2 per cent had received non-steroidal anti-inflammatories on repeat prescription. Phase two post intervention revealed a significant 75 per cent reduction in the total non-steroidal anti-inflammatories prescribed and a 90 per cent reduction in repeat non-steroidal anti-inflammatory prescriptions in those with CKD. Originality/value The study significantly reduced non-steroidal anti-inflammatory prescription in those with CKD in primary care settings. It also created a CKD register within the practice and an enduring medication alert system for individuals that risk nephrotoxic non-steroidal anti-inflammatory prescription. It established a safe, reliable and efficient process for reducing morbidity and mortality, improving quality of life and limiting the CKD associated health burden.
目的 本文旨在减少慢性肾脏病（CKD）初级护理患者中不恰当的非甾体抗炎药处方。一旦确诊，CKD的管理包括延缓进展至终末期肾衰竭以及预防并发症。众所周知，非甾体抗炎药对肾功能有负面影响，因此，所有肾脏病学共识小组都建议在CKD患者中避免使用这类药物。设计/方法/途径 抽样标准包括所有有已知CKD风险因素的执业患者。该组进一步细化为估算肾小球滤过率（eGFR）<60 ml/分钟/1.73平方米（3期或更严重的CKD）的患者。第一阶段分析了该组在过去三个月内开出了多少处方。干预措施包括如果为有风险的患者记录开具非甾体抗炎药，则创建自动警报，并与执业人员讨论其原理。重新审核阶段在干预后三个月进行。结果 研究发现728/7500（9.7%）的患者有CKD风险，其中158人（2.1%）随后被发现eGFR<60 ml/分钟，表明为3期CKD。在第一阶段，10.2%的有风险患者在过去三个月内接受了非甾体抗炎药处方。此外，6.2%的患者接受了重复开具的非甾体抗炎药。干预后的第二阶段显示，CKD患者开具的非甾体抗炎药总数显著减少了75%，重复开具的非甾体抗炎药处方减少了90%。原创性/价值 该研究显著减少了初级护理环境中CKD患者的非甾体抗炎药处方。它还在执业机构内创建了一个CKD登记册，并为有肾毒性非甾体抗炎药处方风险的个人建立了一个持久的用药警报系统。它建立了一个安全、可靠且高效的流程，以降低发病率和死亡率、改善生活质量并限制与CKD相关的健康负担。
