Process quality indicators for chronic kidney disease risk management: a systematic literature review

Smits, Kirsten P J; Bilo, Henk J. G.; Bouma, Margriet; Navis, Gerjan; Denig, Petra

doi:10.1111/ijcp.12878

Cited by 8 publications

(5 citation statements)

References 46 publications

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“…10 For this reason, this clinical support tool has been used as a reference by several authors, in order to guide, standardize and optimize the conduct of these professionals. 18,19,20,21,22 Due to the fact that there is no instrument available in Brazil to guide the evaluation of pharmacotherapy, specifically in the population of patients with CKD, our group performed the translation and cross-cultural adaptation of PAIR at an initial phase (Chart 1). 23 The present study aimed to validate the PAIR, assessing its reliability, validity and responsiveness, as well as the prevalence of DRP in a sample of patients with CKD undergoing conservative treatment at a local nephrology outpatient service.…”

Section: Abstract Introductionmentioning

confidence: 99%

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

et al. 2020

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Individuals with chronic kidney disease (CKD) use polypharmacy, which, in combination with renal impairment, exposes them to the risk of drug-related problems (DRPs). There are no available tools in Brazil to systematically assess the pharmacotherapy and management of DRPs in this population. Therefore, the objective of this work was to validate the PAIR instrument (Pharmacotherapy Assessment in Chronic Renal Disease) for use in Brazilian Portuguese. This is a retrospective longitudinal observational study. Medical records from 100 CKD patients under conservative treatment, between 2016 and 2017, in a nephrology clinic, were analyzed. PAIR was applied by pharmacists in two consultations of the same patient, with an interval of 6 months. Reliability, conceptual validity, responsiveness of the instrument and prevalence of DRPs in the studied sample were assessed. A mean of 1.26 ± 0.96 DRPs/patient was identified. Inter-rater reliability coefficients (k) ranged from 0.58 to 0.94 and from 0.79 to 1.00 for test-retest, revealing moderate to perfect level of agreement. In conceptual validity, a mean of 1.60 ± 1.24 DRPs/patient was identified by the nephrologist through clinical judgment, compared to 1.33±0.76 DRPs/patient identified by the pharmacist using PAIR (p = 0.07). Therefore PAIR allowed the identification of clinically significant DRPs. In responsiveness, a mean of 1.26 ± 0.96 DRPs/patient was identified at the first consultation and 1.11 ± 1.02 DRPs/patient at the subsequent consultation (p = 0.17) by the pharmacist using PAIR. The number of DRPs between the periods did not change. As a conclusion, the PAIR allowed the identification of clinically significant DRPs in CKD, constituting a new validated instrument to be used in Brazil.

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Section: Abstract Introductionmentioning

confidence: 99%

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

et al. 2020

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“…Nutritional guidance was not very prominent among the primary list of recommendations we based our questionnaire on. This can explain why previous work indicated a lack of QIs concerning lifestyle management [32]. Our final list of QIs included 1 indicator concerning lifestyle management.…”

Section: Principal Findingsmentioning

confidence: 95%

“…In the past QIs for evaluating processes and outcomes of CKD care have been developed and although a systematic review identified 273 QIs, few QIs are available that focus on primary care, integrated management between primary and secondary care and EMR extractability to allow automatic audit and feedback [30][31][32][33]. Patients are also rarely involved in the design of the QIs even though a study which investigated the conservative management of kidney failure indicated that there is a discordance between QIs important for patients and for caregivers [34,35].…”

Section: Introductionmentioning

confidence: 99%

Developing quality indicators for Chronic Kidney Disease in primary care, extractable from the Electronic Medical Record. A Rand-modified Delphi method

Bulck¹,

Vankrunkelsven²,

Goderis³

et al. 2020

BMC Nephrol

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Background: Chronic kidney disease (CKD) is a common chronic condition and a rising public health issue with increased morbidity and mortality, even at an early stage. Primary care has a pivotal role in the early detection and in the integrated management of CKD which should be of high quality. The quality of care for CKD can be assessed using quality indicators (QIs) and if these QIs are extractable from the electronic medical record (EMR) of the general physician, the number of patients whose quality of care can be evaluated, could increase vastly. Therefore the aim of this study is to develop QIs which are evidence based, EMR extractable and which can be used as a framework to automate quality assessment. Methods: We used a Rand-modified Delphi method to develop QIs for CKD in primary care. A questionnaire was designed by extracting recommendations from international guidelines based on the SMART principle and the EMR extractability. A multidisciplinary expert panel, including patients, individually scored the recommendations for measuring high quality care on a 9-point Likert scale. The results were analyzed based on the median Likert score, prioritization and agreement. Subsequently, the recommendations were discussed in a consensus meeting for their in-or exclusion. After a final appraisal by the panel members this resulted in a core set of recommendations, which were then transformed into QIs. Results: A questionnaire composed of 99 recommendations was extracted from 10 international guidelines. The consensus meeting resulted in a core set of 36 recommendations that were translated into 36 QIs. This final set consists of QIs concerning definition & classification, screening, diagnosis, management consisting of follow up, treatment & vaccination, medication & patient safety and referral to a specialist. It were mostly the patients participating in the panel who stressed the importance of the QIs concerning medication & patient safety and a timely referral to a specialist. Conclusion: This study provides a set of 36 EMR extractable QIs for measuring the quality of primary care for CKD. These QIs can be used as a framework to automate quality assessment for CKD in primary care.

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“…O PAIR é o primeiro e único instrumento desenvolvido para farmacêuticos e profissionais de saúde que atuam em nefrologia, com foco na segurança da medicação, que permite a identificação e o manejo de PRMs de forma rápida e sistemática 13 . Por essa razão, essa ferramenta de suporte clínico, tem sido utilizada como referência por diversos autores, a fim de orientar, padronizar e otimizar a conduta desses profissionais [14][15][16][17][18] .…”

Section: Introductionunclassified

“…Além disso, a utilização de um registro padronizado pode gerar dados que permitem avaliar comparativamente o impacto da assistência na qualidade e na segurança do uso de medicamentos, assim como incentivar ações de melhorias entre os serviços de nefrologia 14,16 .…”

Section: Introductionunclassified

Adaptação transcultural do instrumento PAIR: Pharmacotherapy Assessment in Chronic Renal Disease para aplicação no Brasil

Marquito

Sanders-Pinheiro²,

Paula³

2020

Ciênc. saúde coletiva

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Resumo Indivíduos com doença renal crônica (DRC) frequentemente utilizam polifarmácia o que os expõe ao risco de problemas relacionados a medicamentos (PRMs). No Brasil, não existem instrumentos que possam sistematizar a avaliação da farmacoterapia e a gestão de PRMs nesta população. Portanto, o objetivo deste trabalho foi realizar a adaptação transcultural do instrumento PAIR (Pharmacotherapy Assessment in Chronic Renal Disease) para o português brasileiro. O PAIR consiste numa lista de 50 PRMs considerados clinicamente significativos para renais crônicos. O processo de adaptação transcultural envolveu as etapas de tradução, síntese, retrotradução, análise por um comitê de especialistas e pré-teste da versão preliminar. O comitê de 2 farmacêuticos e 2 nefrologistas analisou a equivalência semântica, idiomática, experiencial e conceitual entre as versões original e traduzida. Todos os itens que obtiveram acordo inferior a 80% foram revisados. Foram realizados ajustes de palavras, assim como a exclusão de 6 PRMs devido à não aplicabilidade ao contexto brasileiro. Assim, foi obtida a versão final do PAIR definida como “Avaliação da farmacoterapia na doença renal crônica”, traduzida e adaptada na língua portuguesa do Brasil.

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Process quality indicators for chronic kidney disease risk management: a systematic literature review

Abstract: Based on this review, sufficiently validated QIs can be selected for measuring the quality of CKD care. This review provides insight in QIs that need further validation, and in areas of care where QIs are still lacking.

Cited by 8 publications

References 46 publications

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

Pharmacotherapy assessment in chronic kidney disease: validation of the PAIR instrument for use in Brazil

Developing quality indicators for Chronic Kidney Disease in primary care, extractable from the Electronic Medical Record. A Rand-modified Delphi method

Adaptação transcultural do instrumento PAIR: Pharmacotherapy Assessment in Chronic Renal Disease para aplicação no Brasil

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