Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Nash, Danielle M.; Brimble, Scott; Markle‐Reid, Maureen; McArthur, Eric; Tu, Karen; Nesrallah, Gihad; Grill, Allan; Garg, Amit X.

doi:10.1177/2054358117703059

Cited by 25 publications

(38 citation statements)

References 53 publications

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“…14 In the Netherlands, the ACR testing rate was 40% among patients with stage 3 CKD, although a 15-month time frame was used. 15 In Canada, only half of the patients received follow-up ACR tests after an initial abnormal kidney test, 16 while others have reported that ACR monitoring was performed for only 16% of the patients with a low eGFR. 12 In this study, patients with CKD who also had diabetes were better monitored, compared with patients without diabetes.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease monitoring in Australian general practice

Khanam¹,

Kitsos²,

Stankovich³

et al. 2019

Aust J Gen Pract

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Section: Discussionmentioning

confidence: 99%

Chronic kidney disease monitoring in Australian general practice

Khanam¹,

Kitsos²,

Stankovich³

et al. 2019

Aust J Gen Pract

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“…The prescribing of an ACEI or ARB in patients with CKD with albuminuria was slightly lower in Australian general practice compared to that reported in other developed nations [24][25][26][27]. Studies from different provinces of Canada [24][25][26] investigating prescribing in CKD patients reported rates of 74% to 80% for ACEI or ARB prescribing, while a study conducted in the Netherlands found prescribing in 78% and 82% of non-diabetes and diabetes patients, respectively [11]. The reason for the low rate of ACEI/ARB prescribing could be non-concordance to Australian CKD treatment guidelines, including not referring patients to nephrology care [3].…”

Section: Discussionmentioning

confidence: 57%

“…Despite strong evidence for the efficacy of ACEI/ARB to reduce proteinuria and slow progression of CKD to ESKD, less than 70% of Australian adult patients with CKD stages 3-5 with diabetes and microalbuminuria were receiving an ACEI or ARB. The prescribing of an ACEI or ARB in patients with CKD with albuminuria was slightly lower in Australian general practice compared to that reported in other developed nations [24][25][26][27]. Studies from different provinces of Canada [24][25][26] investigating prescribing in CKD patients reported rates of 74% to 80% for ACEI or ARB prescribing, while a study conducted in the Netherlands found prescribing in 78% and 82% of non-diabetes and diabetes patients, respectively [11].…”

Section: Discussionmentioning

confidence: 86%

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Bezabhe

Kitsos

Saunder

et al. 2020

JCM

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Background: Australian patients with chronic kidney disease (CKD) are routinely managed in general practices with multiple medications. However, no nationally representative study has evaluated the quality of prescribing in these patients. The objective of this study was to examine the quality of prescribing in patients with CKD using nationally representative primary care data obtained from the NPS MedicineWise’s dataset, MedicineInsight. Methods: A cross-sectional analysis of general practice data for patients aged 18 years or older with CKD was performed from 1 February 2016 to 1 June 2016. The study examined the proportion of patients with CKD who met a set of 16 published indicators in two categories: (1) potentially appropriate prescribing of antihypertensives, renin-angiotensin system (RAS) inhibitors, phosphate binders, and statins; and (2) potentially inappropriate prescribing of nephrotoxic medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), at least two RAS inhibitors, triple therapy (an NSAID, a RAS inhibitor and a diuretic), high-dose digoxin, and metformin. The proportion of patients meeting each quality indicator was stratified using clinical and demographic characteristics. Results: A total of 44,259 patients (24,165 (54.6%) female; 25,562 (57.8%) estimated glomerular filtration (eGFR) 45–59 mL/1.73 m2) with CKD stages 3–5 were included. Nearly one-third of patients had diabetes and were more likely to have their blood pressure and albumin-to-creatinine ratio monitored than those without diabetes. Potentially appropriate prescribing of antihypertensives was achieved in 79.9% of hypertensive patients with CKD stages 4–5. The prescribing indicators for RAS inhibitors in patients with microalbuminuria and diabetes and in patients with macroalbuminuria were achieved in 69.9% and 62.3% of patients, respectively. Only 40.8% of patients with CKD and aged between 50 and 65 years were prescribed statin therapy. The prescribing of a RAS inhibitor plus a diuretic was less commonly achieved, with the indicator met in 20.6% for patients with microalbuminuria and diabetes and 20.4% for patients with macroalbuminuria. Potentially inappropriate prescribing of NSAIDs, metformin, and at least two RAS inhibitors were apparent in 14.3%, 14.1%, and 7.6%, respectively. Potentially inappropriate prescribing tended to be more likely in patients aged ≥65 years, living in regional or remote areas, or with socio-economic indexes for areas (SEIFA) score ≤ 3. Conclusions: We identified areas for possible improvement in the prescribing of RAS inhibitors and statins, as well as deprescribing of NSAIDs and metformin in Australian general practice patients with CKD.

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“…The prescribing of an ACEI or ARB in patients with CKD with albuminuria was slightly lower (5-10%) in Australian general practice compared to other developed nations (8,(21)(22)(23). Furthermore, the proportion of patients prescribed at least two RAS blockers concurrently was 7.6%, which is double the proportion (3.7%) reported by the Netherlands study (11) using the same indicator.…”

Section: Discussionmentioning

confidence: 68%

“…The prescribing percentage was even lower (62.3%) in those patients with macroalbuminuria. Studies from different provinces of Canada (8,21,22) in CKD reported rates of 74% to 80% for ACEI or ARB prescribing, while the Netherlands study found prescribing in 78% and 82% of non-diabetes and diabetes patients, respectively (11). Similar to our study, the percentages of prescribing of an ACEI or ARB reported by studies in Canada and the Netherlands (8,11,21,22) were higher in CKD patients with diabetes compared to those without diabetes.…”

Section: Discussionmentioning

confidence: 99%

Medication prescribing quality in Australian primary care patients with chronic kidney disease

Bezabhe

Kitsos

Saunder

et al. 2019

Preprint

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Background: Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice from February 01, 2016 and June 01, 2016, using validated indicators. Methods: We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients using clinical and sociodemographic factors. Results: Among 44,259 patients with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5%; P<0.001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions: We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Australian programs working to improve quality use of medication need to focus on improving the appropriate prescribing of recommended preventive medications in patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy. Keywords: chronic kidney disease, drug therapy, quality indicators, inappropriate prescribing, general practice, quality use of medicine, primary care

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Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada

Cited by 25 publications

References 53 publications

Chronic kidney disease monitoring in Australian general practice

Chronic kidney disease monitoring in Australian general practice

Medication Prescribing Quality in Australian Primary Care Patients with Chronic Kidney Disease

Medication prescribing quality in Australian primary care patients with chronic kidney disease

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