Evaluating the Impact of Guidelines on Physician Prescription Practices in Chronic Kidney Disease

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ABSTRACT Cardiovascular disease is the leading cause of morbidity and mortality among individuals with chronic kidney disease (CKD). Despite evidence and clinical practice guidelines supporting the use of statins for cardiovascular risk reduction in non-dialysis requiring chronic kidney disease, prevalence of statin prescription among individuals with CKD remains low. Strategies to increase statin use represent an important opportunity to improve cardiovascular outcomes for this population. Reasons underlying the current low rates of statin use remain unclear, thus elucidating these reasons will be important for informing the design of successful implementation strategies. The specific aims of this proposal are intended to examine different factors that influence rates of statin prescription among individuals with CKD. Aim 1 will assess the impact of changes in clinical practice guidelines by examining temporal trends in statin use among individuals with CKD using a nationally representative database. Aims 2 and 3 will examine more granular provider-level factors that may influence statin prescription (i.e., the contribution of nephrology care to cardiovascular risk management, primary care provider (PCP) knowledge of preventive cardiovascular care guidelines, PCP perception of cardiovascular risk in CKD patients) and correlate them with individual practice behaviors, using data from the San Francisco Health Network, a local public health system that disproportionately cares for individuals of low socioeconomic status. The study design will involve cross-sectional analyses of both a large national dataset (the National Health and Nutrition Examination Survey; NHANES) for Aim 1 and a local dataset from the electronic health record of one health delivery system (San Francisco Health Network) for Aims 2 and 3. Aim 3 will also involve a survey of local primary care providers to assess awareness of guidelines and perceptions of cardiovascular risk pertinent to CKD patients.