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The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care

de Lusignan, S; Gallagher, H; Chan, T; Thomas, N; van Vlymen, J; Nation, M; Jain, N; Tahir, A; du Bois, E; Crinson, I; et al. de Lusignan, S; Gallagher, H; Chan, T; Thomas, N; van Vlymen, J; Nation, M; Jain, N; Tahir, A; du Bois, E; Crinson, I; Hague, N; Reid, F; Harris, K (2009) The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care. IMPLEMENTATION SCIENCE, 4 (39). ISSN 1748-5908 https://doi.org/10.1186/1748-5908-4-39
SGUL Authors: Crinson, Iain De Lusignan, Simon Reid, Fiona Dorothy Alexandra

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Abstract

Background: Chronic kidney disease (CKD) is a relatively newly recognised but common longterm condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression. Design: Cluster randomised controlled trial (CRT) Methods: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention.

Item Type: Article
Additional Information: © 2009 de Lusignan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Health Policy & Services, ESTABLISHED CARDIOVASCULAR-DISEASE, COLLECTED COMPUTER-DATA, UNINTENDED CONSEQUENCES, MANAGEMENT, GUIDELINES, MORTALITY, RISK, INFORMATION, FEEDBACK, COHORT
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: IMPLEMENTATION SCIENCE
ISSN: 1748-5908
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Dates:
DateEvent
14 July 2009Published
Web of Science ID: WOS:000268891600002
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URI: http://openaccess.sgul.ac.uk/id/eprint/709
Publisher's version: https://doi.org/10.1186/1748-5908-4-39

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