Original InvestigationPathogenesis and Treatment of Kidney DiseaseAutomated Clinical Reminders for Primary Care Providers in the Care of CKD: A Small Cluster-Randomized Controlled Trial
Section snippets
Setting and Participants
The study was conducted at a large academic hospital-based general internal medicine (GIM) clinic where more than 11,000 patients are cared for annually. We approached GIM faculty at regularly scheduled department meetings. Physician faculty members who were not present during those meetings were contacted by telephone or e-mail. Faculty were eligible for study enrollment if they had at least a half-day GIM continuity clinic per week. Faculty without a continuity clinic or who were planning to
Baseline Characteristics
We screened 46 GIM faculty members (Fig 2). Fifteen were excluded due to lack of continuity clinics (N = 11) or pending departure (N = 4). Of 31 eligible physicians, 30 consented to the study and 15 were randomly assigned to the CDSS alert arm. There were no physician dropouts during the study. Provider characteristics in each arm were well matched at baseline (Table 1). Eligible patients in each arm were similar in sociodemographics and comorbid conditions at baseline (Table 1). However, a
Discussion
In this study, the overwhelming majority of PCPs at an outpatient GIM clinic were willing to participate in a randomized pilot trial assessing an automated clinical alert targeting patients with eGFR <45 mL/min/1.73 m2 for renal referrals and albuminuria/proteinuria assessments. Although the intervention did not increase renal referrals, it may have improved proteinuria assessments in patients who lacked one at baseline. A trend toward improved blood pressure control in patients with suboptimal
Acknowledgements
Support: This work was supported by an NKF Foundation Clinical Research Fellowship, Ruth L. Kirschstein National Research Service Award Institutional Research Training Grants T32-DK061296 and Individual Postdoctoral Training Grant F32-DK084676, and by National Institutes of Health (NIH) Grant K23DK090304 (Dr Abdel-Kader); however, the study design, data collection, analysis, interpretation, and manuscript preparation and submission were determined by the authors alone. This publication was also
References (57)
- et al.
The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004
Prev Med
(2007) Are physicians assistants the answer to a shortage of nephrologists?
Am J Kidney Dis
(1999)- et al.
Identification and referral of patients with progressive CKD: a national study
Am J Kidney Dis
(2006) - et al.
CKD: common, harmful, and treatable—World Kidney Day 2007
Am J Kidney Dis
(2007) - et al.
Comprehensive public health strategies for preventing the development, progression, and complications of CKD: report of an expert panel convened by the Centers for Disease Control and Prevention
Am J Kidney Dis
(2009) - et al.
Reporting of estimated GFR in the primary care clinic
Am J Kidney Dis
(2007) Evidence for the effectiveness of techniques to change physician behavior
Chest
(2000)- et al.
Automation, decision support, and expert systems in nephrology
Adv Chronic Kidney Dis
(2008) - et al.
Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and a nephrologist
Am J Kidney Dis
(2006) - et al.
Antihypertensive therapy in the presence of proteinuria
Am J Kidney Dis
(2007)
Impact of estimated GFR reporting on patients, clinicians, and health-care systems: a systematic review
Am J Kidney Dis
Improving acceptance of computerized prescribing alerts in ambulatory care
J Am Med Inform Assoc
A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report
Am J Kidney Dis
The role of primary care in the management of the chronic kidney disease population
Adv Chronic Kidney Dis
Implementing KDOQI CKD definition and staging guidelines in Southern California Kaiser Permanente
Am J Kidney Dis
A new equation to estimate glomerular filtration rate
Ann Intern Med
Prevalence of chronic kidney disease in the United States
JAMA
The burden of adult hypertension in the United States 1999 to 2000: a rising tide
Hypertension
Prevalence and trends in obesity among US adults, 1999-2000
JAMA
Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002
JAMA
Prevalence of overweight and obesity in the United States, 1999-2004
JAMA
Slowing the progression of adult chronic kidney disease: therapeutic advances
Drugs
Clinical practiceStage IV chronic kidney disease
N Engl J Med
Addressing the global shortage of nephrologists
Nat Clin Pract Nephrol
Estimating workforce and training requirements for nephrologists through the year 2010Ad Hoc Committee on Nephrology Manpower Needs
J Am Soc Nephrol
Clinical practice guidelines for chronic kidney disease in adults: part IDefinition, disease stages, evaluation, treatment, and risk factors
Am Fam Physician
The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting
Nephrol Dial Transplant
Primary care physicians' knowledge and practice patterns in the treatment of chronic kidney disease: an Upstate New York Practice-based Research Network (UNYNET) study
J Am Board Fam Med
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Originally published online October 10, 2011.
Trial registration: www.ClinicalTrials.gov; study number: NCT00688285.