Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

Abstract

BackgroundChronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients AimTo assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and settingA cluster randomised controlled trial in nine general practices in The Netherlands. MethodFive practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m 2 . ResultsData of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = −1.0 to 3.2) compared to −0.2 (95% CI = −3.8 to 3.3)/−0.5 (95% CI = −2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]). ConclusionA shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care.

The impact of advanced nurse practitioners on patient outcomes in chronic kidney disease: A systematic review

“…, ; Scherpbier‐de Haan et al . ). Of these studies, three were from the Netherlands (van Zuilen et al .…”

“…CVD was more frequent in the intervention group (p = 0.02) and smoking was more common in the control group (p = 0.04) of both van Zuilen et al (, ) reports of the MASTERPLAN study. The study of Scherpbier‐de Haan et al () presented a higher percentage of diabetes and CVD in the intervention group (12% more diabetics, 12% more hypertension, 8% more myocardial infarction, 2% more heart failure, 4% more cardiovascular accident and 8% more peripheral vascular disease). However, distribution of age, sex and kidney function was comparable.…”

“…Two studies (Barrett et al, ; Scherpbier‐de Haan et al . ) were set in GP practice, and the two MASTERPLAN reports (van Zuilen et al . , ) were set in outpatient nephrology clinics.…”

“…The study of Scherpbier‐de Haan et al () is also a Dutch trial, specifically set in nine general practices. A total of 164 patients with CKD stages 2–4 and diabetes or hypertension were randomised into two groups at GP practice level.…”

What Patients with Mild-to-Moderate Kidney Disease Know, Think, and Feel about Their Disease: An In-Depth Interview Study

“…Practice nurses can provide important help in this process. 25 Repeating the message without dilution helps encourage a healthier lifestyle and makes patients realize how to influence CKD. Patients want tailored information.…”