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.
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.
复制标题
英格兰和威尔士的初级保健医生如何管理慢性肾脏疾病的人？国家慢性肾脏疾病审核的结果。
DOI：
10.1093/ndt/gfx280
复制
发表时间：
2018-08-01
期刊：
影响因子：
--
通讯作者：
UK National Chronic Kidney Disease Audit
中科院分区：
文献类型：
--
作者：
Kim LG;Cleary F;Wheeler DC;Caplin B;Nitsch D;Hull SA;UK National Chronic Kidney Disease Audit
在英国，初级保健记录是电子的，要求医生将疾病代码归因于指导护理计划并促进安全处方。我们研究了与肾功能下降患者慢性肾病（CKD）编码相关的因素及其对患者管理的影响。我们在英国审计中从 1039 名全科医生 (GP) 实践中确定了符合 CKD 生化标准的患者（两次估计肾小球滤过率 <60mL/min/1.73 m2，间隔 >90 天）。聚类逻辑回归用于识别与 CKD 编码相关的因素以及审计过程中编码改进的相关因素。我们研究了编码与推荐用于 CKD 的五种干预措施之间的关系：实现血压目标、蛋白尿检测、他汀类药物处方以及流感和肺炎球菌疫苗接种。在 256000 名生化 CKD 患者中，30% 没有 GP CKD 代码。男性、老年患者、患有较严重 CKD、糖尿病或高血压的患者或服用他汀类药物的患者更有可能有 CKD 代码。在审计后继续患有生化 CKD 的患者中，这些相同的特征增加了改进编码的可能性。与 CKD 患者相比，没有任何肾脏诊断的患者接受最佳护理的可能性较小 [例如达到血压目标的比值比为 0.78（95% 置信区间 0.76–0.79）]。年龄较大、男性、糖尿病和高血压与生化 CKD 患者的编码相关。 CKD 编码与接受针对 CKD 推荐的关键初级保健干预措施相关。加大力度激励 CKD 编码可能会改善 CKD 患者的预后。
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 <60 mL/min/1.73 m2 taken >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.
登录
查看更多内容
DOI：
10.1093/ndt/gfw318
发表时间：
2017-04-01
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
作者：
Iwagami M;Tomlinson LA;Mansfield KE;Casula A;Caskey FJ;Aitken G;Fraser SDS;Roderick PJ;Nitsch D
通讯作者：
Nitsch D
影响因子：
2.9
作者：
Aitken GR;Roderick PJ;Fraser S;Mindell JS;O'Donoghue D;Day J;Moon G
通讯作者：
Moon G
影响因子：
2.9
作者：
Nihat, Akin;de Lusignan, Simon;Gallagher, Hugh
通讯作者：
Gallagher, Hugh
影响因子：
2.6
作者：
Jameson, K.;Jick, S.;O'Donoghue, D.
通讯作者：
O'Donoghue, D.
影响因子：
14.6
作者：
Lv, Jicheng;Ehteshami, Parya;Perkovic, Vlado
通讯作者：
Perkovic, Vlado