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Tytuł pozycji:

Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial.

Tytuł:
Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial.
Autorzy:
Peralta CA; Department of Medicine, University of California San Francisco, San Francisco, CA; The Kidney Health Research Collaborative, University of California San Francisco, San Francisco, CA; Cricket Health, Inc, San Francisco, CA. Electronic address: .
Livaudais-Toman J; Department of Medicine, University of California San Francisco, San Francisco, CA; Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA.
Stebbins M; Department of Clinical PharmacyUniversity of California San Francisco, San Francisco, CA.
Lo L; Department of Medicine, University of California San Francisco, San Francisco, CA.
Robinson A; Department of Medicine, University of California San Francisco, San Francisco, CA.
Pathak S; Department of Medicine, University of California San Francisco, San Francisco, CA; Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA.
Scherzer R; Department of Medicine, University of California San Francisco, San Francisco, CA; The Kidney Health Research Collaborative, University of California San Francisco, San Francisco, CA.
Karliner LS; Department of Medicine, University of California San Francisco, San Francisco, CA; Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA.
Źródło:
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2020 Nov; Vol. 76 (5), pp. 636-644. Date of Electronic Publication: 2020 Jul 22.
Typ publikacji:
Journal Article; Pragmatic Clinical Trial; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Publication: Philadelphia Pa : W.B. Saunders
Original Publication: New York, N.Y. : Grune & Stratton, c1981-
MeSH Terms:
Decision Support Techniques*
Disease Management*
Electronic Health Records*
Delivery of Health Care/*methods
Primary Health Care/*methods
Renal Insufficiency, Chronic/*therapy
Aged ; Female ; Humans ; Male ; Middle Aged ; United States
References:
JMIR Res Protoc. 2019 Jun 7;8(6):e14022. (PMID: 31199334)
Health Serv Res. 2007 Oct;42(5):1871-94. (PMID: 17850524)
Am J Nephrol. 2012;35(2):191-7. (PMID: 22286715)
Clin J Am Soc Nephrol. 2011 Aug;6(8):1838-44. (PMID: 21784832)
JAMA. 2011 Apr 20;305(15):1545-52. (PMID: 21482744)
J Am Soc Nephrol. 2016 Oct;27(10):2948-2954. (PMID: 27283497)
Am J Kidney Dis. 2018 Aug;72(2):168-177. (PMID: 29699885)
J Gen Intern Med. 2008 Dec;23(12):2058-65. (PMID: 18830762)
Adv Chronic Kidney Dis. 2010 May;17(3):225-36. (PMID: 20439091)
BMC Fam Pract. 2011 Aug 05;12:83. (PMID: 21819552)
JAMA. 2011 Apr 20;305(15):1553-9. (PMID: 21482743)
J Gen Intern Med. 2016 Jan;31(1):22-9. (PMID: 26138006)
J Gen Intern Med. 2011 Apr;26(4):386-92. (PMID: 20922494)
Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1418-1427. (PMID: 28778854)
J Am Soc Nephrol. 2019 Jul;30(7):1261-1270. (PMID: 31097609)
Ir J Med Sci. 2012 Dec;181(4):521-5. (PMID: 22382578)
BMC Med Inform Decis Mak. 2017 Jun 2;17(1):79. (PMID: 28576145)
BMC Nephrol. 2015 Oct 12;16:162. (PMID: 26458541)
Grant Information:
P30 AG015272 United States AG NIA NIH HHS; R18 DK110959 United States DK NIDDK NIH HHS
Contributed Indexing:
Keywords: CKD awareness; CKD detection; CKD management; Chronic kidney disease (CKD); electronic decision support; electronic health record (EHR); nephrology referral; primary care; primary care physician (PCP); randomized clinical trial (RCT); risk stratification
Molecular Sequence:
ClinicalTrials.gov NCT02925962
Entry Date(s):
Date Created: 20200720 Date Completed: 20201208 Latest Revision: 20211102
Update Code:
20240105
PubMed Central ID:
PMC7606321
DOI:
10.1053/j.ajkd.2020.05.013
PMID:
32682696
Czasopismo naukowe
Rationale & Objective: Most adults with chronic kidney disease (CKD) in the United States are cared for by primary care providers (PCPs). We evaluated the feasibility and preliminary effectiveness of an electronic clinical decision support system (eCDSS) within the electronic health record with or without pharmacist follow-up to improve the management of CKD in primary care.
Study Design: Pragmatic cluster-randomized trial.
Setting & Participants: 524 adults with confirmed creatinine-based estimated glomerular filtration rates of 30 to 59mL/min/1.73m 2 cared for by 80 PCPs at the University of California San Francisco. Electronic health record data were used for patient identification, intervention deployment, and outcomes ascertainment.
Interventions: Each PCP's eligible patients were randomly assigned as a group into 1 of 3 treatment arms: (1) usual care; (2) eCDSS: testing of creatinine, cystatin C, and urinary albumin-creatinine ratio with individually tailored guidance for PCPs on blood pressure, potassium, and proteinuria management, cardiovascular risk reduction, and patient education; or (3) eCDSS plus pharmacist counseling (eCDSS-PLUS).
Outcomes: The primary clinical outcome was change in blood pressure over 12 months. Secondary outcomes were PCP awareness of CKD and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and statin therapy.
Results: All 80 eligible PCPs participated. Mean patient age was 70 years, 47% were nonwhite, and mean estimated glomerular filtration rate was 56±0.6mL/min/1.73m 2 . Among patients receiving eCDSS with or without pharmacist counseling (n=336), 178 (53%) completed laboratory measurements and 138 (41%) had laboratory measurements followed by a PCP visit with eCDSS deployment. eCDSS was opened by the PCP for 102 (74%) patients, with at least 1 suggested order signed for 83 of these 102 (81%). Changes in systolic blood pressure were-2.1±1.5mm Hg with usual care, -2.8±1.8mm Hg with eCDSS, and -1.1±1.1 with eCDSS-PLUS (P=0.7). PCP awareness of CKD was 16% with usual care, 26% with eCDSS, and 32% for eCDSS-PLUS (P=0.09). In as-treated analyses, PCP awareness of CKD was significantly greater with eCDSS and eCDSS-PLUS (73% and 69%) versus usual care (47%; P=0.002).
Limitations: Recruitment of smaller than intended sample size and limited uptake of the testing component of the intervention.
Conclusions: Although we were unable to demonstrate the effectiveness of eCDSS to lower blood pressure and uptake of the eCDSS was limited by low testing rates, eCDSS use was high when laboratory measurements were available and was associated with higher PCP awareness of CKD.
Funding: Grants from government (National Institutes of Health) and not-for-profit (American Heart Association) entities.
Trial Registration: Registered at ClinicalTrials.gov with study number NCT02925962.
(Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
Comment in: Am J Kidney Dis. 2020 Nov;76(5):613-615. (PMID: 32978006)

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