Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD
Trends in kidney function testing in UK primary care since the introduction of the quality and outcomes framework: a retrospective cohort study using CPRD
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DOI：
10.1136/bmjopen-2018-028062
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Perera, Rafael
中科院分区：
文献类型：
--
作者：
Feakins, Benjamin;Oke, Jason;Perera, Rafael
目的了解2005-2013年间英国全科医疗机构中血肌酐和尿蛋白检测的特征，并检验检测频率在人口统计学因素、慢性病的存在以及建议进行肾功能监测的药物处方之间的差异。设计回顾性开放队列研究。建立常规收集的630个英国全科医疗机构的数据，为临床实践研究数据链接。参与者4,573,275名年龄在18岁以上的患者在2005年4月1日至2013年3月31日期间登记在符合标准的医疗机构。在研究开始时，没有患者是肾移植供者或接受者，怀孕或透析中。主要结果衡量每年的血肌酐和尿蛋白检测率以及每年单独和重复检测的患者的百分比。结果所有年龄组的血肌酐检测率呈线性上升。在2009-2010财政年度，蛋白尿检出率大幅上升，但仅限于60岁或以上的患者。对于已确诊的慢性肾脏疾病(CKD)患者，肌酐检测在2006-2007年和2007-2008年迅速增加，蛋白尿检测在2009-2010年迅速增加，这反映了引入质量和结果框架指标。在调整后的分析中，CKD读码与血清肌酐测试率增加高达两倍有关，而其他慢性病和潜在的肾毒性药物与高达六倍的增加相关。血肌酐检测的地区差异反映了国家的边界。结论在九年的时间里，每年进行肾功能检测的患者数量和检测频率都有所增加。初级保健中推荐的CKD治疗方法的变化是主要的决定因素，即使在控制了人口和患者水平的因素后，这种变化仍然存在。未来的研究应该探讨增加检测是否带来了更好的结果。
Objectives To characterise serum creatinine and urinary protein testing in UK general practices from 2005 to 2013 and to examine how the frequency of testing varies across demographic factors, with the presence of chronic conditions and with the prescribing of drugs for which kidney function monitoring is recommended.Design Retrospective open cohort study.Setting Routinely collected data from 630 UK general practices contributing to the Clinical Practice Research Datalink.Participants 4 573 275 patients aged over 18 years registered at up-to-standard practices between 1 April 2005 and 31 March 2013. At study entry, no patients were kidney transplant donors or recipients, pregnant or on dialysis.Primary outcome measures The rate of serum creatinine and urinary protein testing per year and the percentage of patients with isolated and repeated testing per year.Results The rate of serum creatinine testing increased linearly across all age groups. The rate of proteinuria testing increased sharply in the 2009-2010 financial year but only for patients aged 60 years or over. For patients with established chronic kidney disease (CKD), creatinine testing increased rapidly in 2006-2007 and 2007-2008, and proteinuria testing in 2009-2010, reflecting the introduction of Quality and Outcomes Framework indicators. In adjusted analyses, CKD Read codes were associated with up to a twofold increase in the rate of serum creatinine testing, while other chronic conditions and potentially nephrotoxic drugs were associated with up to a sixfold increase. Regional variation in serum creatinine testing reflected country boundaries.Conclusions Over a nine-year period, there have been increases in the numbers of patients having kidney function tests annually and in the frequency of testing. Changes in the recommended management of CKD in primary care were the primary determinant, and increases persist even after controlling for demographic and patient-level factors. Future studies should address whether increased testing has led to better outcomes.