How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit
Open Access
- 16 October 2017
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 33 (8), 1373-1379
- https://doi.org/10.1093/ndt/gfx280
Abstract
In the UK, primary care records are electronic and require doctors to ascribe disease codes to direct care plans and facilitate safe prescribing. We investigated factors associated with coding of chronic kidney disease (CKD) in patients with reduced kidney function and the impact this has on patient management. We identified patients meeting biochemical criteria for CKD (two estimated glomerular filtration rates 90 days apart) from 1039 general practitioner (GP) practices in a UK audit. Clustered logistic regression was used to identify factors associated with coding for CKD and improvement in coding as a result of the audit process. We investigated the relationship between coding and five interventions recommended for CKD: achieving blood pressure targets, proteinuria testing, statin prescription and flu and pneumococcal vaccination. Of 256 000 patients with biochemical CKD, 30% did not have a GP CKD code. Males, older patients, those with more severe CKD, diabetes or hypertension or those prescribed statins were more likely to have a CKD code. Among those with continued biochemical CKD following audit, these same characteristics increased the odds of improved coding. Patients without any kidney diagnosis were less likely to receive optimal care than those coded for CKD [e.g. odds ratio for meeting blood pressure target 0.78 (95% confidence interval 0.76–0.79)]. Older age, male sex, diabetes and hypertension are associated with coding for those with biochemical CKD. CKD coding is associated with receiving key primary care interventions recommended for CKD. Increased efforts to incentivize CKD coding may improve outcomes for CKD patients.Keywords
Funding Information
- NCKDA
- Healthcare QI Partnership
- HQIP
- NHS
- National Clinical Audit and Patient Outcomes Programme
- NCAPOP
- Welsh Government
This publication has 15 references indexed in Scilit:
- Contribution of theTTC21Bgene to glomerular and cystic kidney diseasesNephrology Dialysis Transplantation, 2016
- Quality of chronic kidney disease management in primary care: a retrospective studyScandinavian Journal of Primary Health Care, 2016
- Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort studyBMC Family Practice, 2015
- Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010BMJ Open, 2014
- The Need for Improved Identification and Accurate Classification of Stages 3–5 Chronic Kidney Disease in Primary Care: Retrospective Cohort StudyPLOS ONE, 2014
- Prevalence and management of chronic kidney disease in primary care patients in the UKInternational Journal of Clinical Practice, 2014
- Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial resultsKidney International, 2013
- Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysisCMAJ : Canadian Medical Association Journal, 2013
- The relationship of ethnicity to the prevalence and management of hypertension and associated chronic kidney diseaseBMC Nephrology, 2011
- Which factors are associated with higher rates of chronic kidney disease recording in primary care? A cross-sectional survey of GP practicesBritish Journal of General Practice, 2011