Abstract: SA-PO859
Quality of CKD Management in the Canadian Primary Care System
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Author
- Bello, Aminu K., University of Alberta, Edmonton, Alberta, Canada
Group or Team Name
- On behalf of CKD-CPCSSN Team
Background
Although patients with chronic kidney disease (CKD) in Canada are routinely managed in primary care settings, no nationally representative study has assessed the quality of CKD care received by these patients. We evaluated the current state of CKD management in Canadian primary care practices leveraging guideline-concordant quality of metrics.
Methods
This cross-sectional study leveraged electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 2010–2015. We examined the proportion of CKD patients meeting a set of 12 quality indicators in six domains: (a) detection and recognition of CKD, (b) testing and monitoring of kidney function, (c) use of recommended medications, (d) appropriate monitoring after initiation of ACEIs/ARBs, (e) management of blood pressure, and (e) glycemic control in patients with CKD. We also analyzed predictors of divergence from these quality indicators.
Results
The baseline cohort comprised 46,162 patients with CKD Stages 3–5 (defined as those with at least two eGFR measurements < 60mL/min/1.73m2 within a period of at least three months, but not more than 18 months apart). Results show that only four out of 12 quality indicators were met by > 75% of the study cohort: one in the testing and monitoring of kidney function domain (i.e., follow-up serum creatinine measurements), two in the blood pressure management domain, and one in the glycemic control domain. Indicators in the domains of detection and recognition of CKD, testing and monitoring of kidney function (specifically, urine albumin creatinine ratio [UACR] testing), use of recommended medications, and appropriate monitoring after initiation of ACEIs/ARBs were not met. Only 18.4% of patients with CKD received a urine albumin test within six months of their qualifying eGFR measurement and 39.4% had a second measurement within six months of an abnormal baseline urine test (UACR > 2.5mg/mmol).
Conclusion
Management of CKD in primary care settings varies according to quality indicator. Over 75% of patients with CKD received quality-concordant (or guideline concordant) testing and monitoring of kidney function, and achieved blood pressure and glycemic control. Prevalence of albuminuria detection and use of recommendation medications were much lower. These findings reveal priority areas for quality improvement initiatives in primary care.