Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial results

Abstract

Strict control of systolic blood pressure is known to slow progression of chronic kidney disease (CKD). Here we compared audit-based education (ABE) to guidelines and prompts or usual practice in lowering systolic blood pressure in people with CKD. This 2-year cluster randomized trial included 93 volunteer general practices randomized into three arms with 30 ABE practices, 32 with guidelines and prompts, and 31 usual practices. An intervention effect on the primary outcome, systolic blood pressure, was calculated using a multilevel model to predict changes after the intervention. The prevalence of CKD was 7.29% (41,183 of 565,016 patients) with all cardiovascular comorbidities more common in those with CKD. Our models showed that the systolic blood pressure was significantly lowered by 2.41 mm Hg (CI 0.59–4.29 mm Hg), in the ABE practices with an odds ratio of achieving at least a 5 mm Hg reduction in systolic blood pressure of 1.24 (CI 1.05–1.45). Practices exposed to guidelines and prompts produced no significant change compared to usual practice. Male gender, ABE, ischemic heart disease, and congestive heart failure were independently associated with a greater lowering of systolic blood pressure but the converse applied to hypertension and age over 75 years. There were no reports of harm. Thus, individuals receiving ABE are more likely to achieve a lower blood pressure than those receiving only usual practice. The findings should be interpreted with caution due to the wide confidence intervals.

Chronic kidney disease: identification and management in primary care

“…Similarly, the optimal frequency of BP monitoring is guided more by individual clinical circumstances. Audit-based education is a useful method to support BP monitoring efforts, augment guidelines, and help clinicians achieve systolic BP targets in people with CKD 83. Remote monitoring is an emerging area that may have a role to play among the large population of people with CKD and hypertension 84…”

Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study

“…Data collected for the Quality Improvement in Chronic Kidney Disease (QICKD) trial 35 from 127 primary care practices across England were used to identify and follow-up females with GDM. The trial data comprise routinely collected primary care records between January 2006 and December 2010, from a nationally representative sample of urban, suburban, and rural practices in London, Surrey, Sussex, Leicestershire, the West Midlands, and Cambridgeshire.…”

Improving CKD Diagnosis and Blood Pressure Control in Primary Care: A Tailored Multifaceted Quality Improvement Programme

“…In 2013, the largest study to date, QICKD, reported its outcomes [36]. This was a cluster randomized controlled trial of 93 primary care practices examining an audit-based education strategy.…”