Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial
| العنوان: | Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial |
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| المؤلفون: | Lowell Lo, Jennifer Livaudais-Toman, Rebecca Scherzer, Leah S. Karliner, Carmen A. Peralta, Sarita Pathak, Marilyn R. Stebbins, Andrew Robinson |
| المصدر: | American journal of kidney diseases : the official journal of the National Kidney Foundation, vol 76, iss 5 Am J Kidney Dis |
| بيانات النشر: | Elsevier BV, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Male, Kidney Disease, 030232 urology & nephrology, Psychological intervention, nephrology referral, primary care physician, risk stratification, Cardiovascular, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Chronic kidney disease, Electronic Health Records, electronic decision support, Renal Insufficiency, 030212 general & internal medicine, Chronic, Disease Management, electronic health record, Middle Aged, Health Services, Urology & Nephrology, Nephrology, 6.1 Pharmaceuticals, Public Health and Health Services, Female, medicine.medical_specialty, Urinary system, Clinical Trials and Supportive Activities, Clinical Sciences, Renal and urogenital, Pharmacist, Renal function, Article, Decision Support Techniques, primary care, 03 medical and health sciences, Clinical Research, medicine, Humans, Renal Insufficiency, Chronic, Aged, Primary Health Care, business.industry, Prevention, Evaluation of treatments and therapeutic interventions, CKD awareness, randomized clinical trial, medicine.disease, CKD management, United States, CKD detection, Good Health and Well Being, Blood pressure, Emergency medicine, business, Delivery of Health Care, Patient education, Kidney disease |
| الوصف: | Rationale & Objective Most adults with chronic kidney disease (CKD) in the United States are cared for by primary care providers (PCPs). We evaluated the feasibility and preliminary effectiveness of an electronic clinical decision support system (eCDSS) within the electronic health record with or without pharmacist follow-up to improve the management of CKD in primary care. Study Design Pragmatic cluster-randomized trial. Setting & Participants 524 adults with confirmed creatinine-based estimated glomerular filtration rates of 30 to 59 mL/min/1.73 m2 cared for by 80 PCPs at the University of California San Francisco. Electronic health record data were used for patient identification, intervention deployment, and outcomes ascertainment. Interventions Each PCP’s eligible patients were randomly assigned as a group into 1 of 3 treatment arms: (1) usual care; (2) eCDSS: testing of creatinine, cystatin C, and urinary albumin-creatinine ratio with individually tailored guidance for PCPs on blood pressure, potassium, and proteinuria management, cardiovascular risk reduction, and patient education; or (3) eCDSS plus pharmacist counseling (eCDSS-PLUS). Outcomes The primary clinical outcome was change in blood pressure over 12 months. Secondary outcomes were PCP awareness of CKD and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and statin therapy. Results All 80 eligible PCPs participated. Mean patient age was 70 years, 47% were nonwhite, and mean estimated glomerular filtration rate was 56 ± 0.6 mL/min/1.73 m2. Among patients receiving eCDSS with or without pharmacist counseling (n = 336), 178 (53%) completed laboratory measurements and 138 (41%) had laboratory measurements followed by a PCP visit with eCDSS deployment. eCDSS was opened by the PCP for 102 (74%) patients, with at least 1 suggested order signed for 83 of these 102 (81%). Changes in systolic blood pressure were −2.1 ± 1.5 mm Hg with usual care, −2.8 ± 1.8 mm Hg with eCDSS, and −1.1 ± 1.1 with eCDSS-PLUS (P = 0.7). PCP awareness of CKD was 16% with usual care, 26% with eCDSS, and 32% for eCDSS-PLUS (P = 0.09). In as-treated analyses, PCP awareness of CKD was significantly greater with eCDSS and eCDSS-PLUS (73% and 69%) versus usual care (47%; P = 0.002). Limitations Recruitment of smaller than intended sample size and limited uptake of the testing component of the intervention. Conclusions Although we were unable to demonstrate the effectiveness of eCDSS to lower blood pressure and uptake of the eCDSS was limited by low testing rates, eCDSS use was high when laboratory measurements were available and was associated with higher PCP awareness of CKD. Funding Grants from government (National Institutes of Health) and not-for-profit (American Heart Association) entities. Trial Registration Registered at ClinicalTrials.gov with study number NCT02925962 . |
| وصف الملف: | application/pdf |
| تدمد: | 0272-6386 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1d96a1777ab9934a6f7c8f0abda57d63Test https://doi.org/10.1053/j.ajkd.2020.05.013Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....1d96a1777ab9934a6f7c8f0abda57d63 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 02726386 |
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