scholarly journals Variation in Documenting Diagnosable Chronic Kidney Disease in General Medical Practice: Implications for Quality Improvement and Research

2019 ◽  
Vol 10 ◽  
pp. 215013271983329 ◽  
Author(s):  
Alex Kitsos ◽  
Gregory M. Peterson ◽  
Matthew D. Jose ◽  
Masuma Akter Khanam ◽  
Ronald L. Castelino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Patient Specific ◽  
Free Text ◽  
Specific Information ◽  
Prescription Data ◽  
Quality Of Data ◽  
Data Set ◽  
Australian General Practice

Background: National health surveys indicate that chronic kidney disease (CKD) is an increasingly prevalent condition in Australia, placing a significant burden on the health budget and on the affected individuals themselves. Yet, there are relatively limited data on the prevalence of CKD within Australian general practice patients. In part, this could be due to variation in the terminology used by general practitioners (GPs) to identify and document a diagnosis of CKD. This project sought to investigate the variation in terms used when recording a diagnosis of CKD in general practice. Methods: A search of routinely collected de-identified Australian general practice patient data (NPS MedicineWise MedicineInsight from January 1, 2013, to June 1, 2016; collected from 329 general practices) was conducted to determine the terms used. Manual searches were conducted on coded and on “free-text” or narrative information in the medical history, reason for encounter, and reason for prescription data fields. Results: From this data set, 61 102 patients were potentially diagnosable with CKD on the basis of pathology results, but only 14 172 (23.2%) of these had a term representing CKD in their electronic record. Younger patients with pathology evidence of CKD were more likely to have documented CKD compared with older patients. There were a total of 2090 unique recorded documentation terms used by the GPs for CKD. The most commonly used terms tended to be those included as “pick-list” options within the various general practice software packages’ standard “classifications,” accounting for 84% of use. Conclusions: A diagnosis of CKD was often not documented and, when recorded, it was in a variety of ways. While recording CKD with various terms and in free-text fields may allow GPs to flexibly document disease qualifiers and enter patient specific information, it might inadvertently decrease the quality of data collected from general practice records for clinical audit or research purposes.

scholarly journals Epidemiology of chronic kidney disease in Australian general practice: National Prescribing Service MedicineWise MedicineInsight dataset

Nephrology ◽  
2018 ◽  
Vol 24 (10) ◽  
pp. 1017-1025 ◽  
Author(s):  
Janette Radford ◽  
Alex Kitsos ◽  
Jim Stankovich ◽  
Ronald Castelino ◽  
Masuma Khanam ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Australian General Practice

scholarly journals Chronic kidney disease monitoring in Australian general practice

2019 ◽  
Vol 48 (3) ◽  
pp. 132-137 ◽  
Author(s):  
Masuma A Khanam ◽  
Alex Kitsos ◽  
Jim Stankovich ◽  
Ronald Castelino ◽  
Matthew Jose ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Disease Monitoring ◽  
Australian General Practice

scholarly journals Medication prescribing quality in Australian primary care patients with chronic kidney disease

2019 ◽  
Author(s):  
Woldesellassie Bezabhe ◽  
Alex Kitsos ◽  
Timothy Saunder ◽  
Gregory M. Peterson ◽  
Luke R. Bereznicki ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Quality Indicators ◽  
Enzyme Inhibitor ◽  
Inappropriate Medication ◽  
Inappropriate Prescribing ◽  
Prescribing Quality ◽  
Australian General Practice

Abstract Background: Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice from February 01, 2016 and June 01, 2016, using validated indicators. Methods: We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients using clinical and sociodemographic factors. Results: Among 44,259 patients with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5%; P<0.001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions: We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Australian programs working to improve quality use of medication need to focus on improving the appropriate prescribing of recommended preventive medications in patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy. Keywords: chronic kidney disease, drug therapy, quality indicators, inappropriate prescribing, general practice, quality use of medicine, primary care

Screening and diagnosis of chronic kidney disease in people with type 2 diabetes attending Australian general practice

2018 ◽  
Vol 24 (3) ◽  
pp. 280 ◽  
Author(s):  
Jo-Anne E. Manski-Nankervis ◽  
Sharmala Thuraisingam ◽  
Phyllis Lau ◽  
Irene Blackberry ◽  
Janet K. Sluggett ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Barriers To Screening ◽  
Australian General Practice ◽  
Recorded Diagnosis

Australian guidelines recommend annual screening and monitoring of chronic kidney disease (CKD) in people with type 2 diabetes (T2D). A cross-sectional study utilising data from NPS MedicineWise MedicineInsight program from June 2015 to May 2016 was undertaken to explore: (1) the proportion of patients with T2D attending general practice who have had screening for, or ongoing monitoring of, CKD; (2) the proportion of patients without a documented diagnosis of CKD who have pathology consistent with CKD diagnosis; and (3) the patient factors associated with screening and the recording of a diagnosis of CKD. Of 90550 patients with T2D, 44394 (49.0%) were appropriately screened or monitored. There were 8030 (8.9%) patients with a recorded diagnosis of CKD, whereas 6597 (7.3%) patients had no recorded diagnosis of CKD despite pathology consistent with a diagnosis. Older age and diagnosis of hypertension or hyperlipidaemia were associated with increased odds of CKD diagnosis being recorded. Older patients, males, those with recorded diagnoses of hypertension or hyperlipidaemia and those who had their medical record opened more frequently were more likely to be screened appropriately. Screening and monitoring of CKD appears suboptimal. Research to explore barriers to screening, recording and monitoring of CKD, and strategies to address these, is required.

The profile of patients with chronic kidney disease who regularly present at an Australian general practice

2015 ◽  
Vol 32 (1) ◽  
pp. 183-189 ◽  
Author(s):  
Moyez Jiwa ◽  
Aron Chakera ◽  
Ann Dadich ◽  
Xingqiong Meng ◽  
Epi Kanjo
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Australian General Practice

scholarly journals Medication prescribing quality in Australian primary care patients with chronic kidney disease

2019 ◽  
Author(s):  
Woldesellassie Bezabhe ◽  
Alex Kitsos ◽  
Timothy Saunder ◽  
Gregory M. Peterson ◽  
Luke R. Bereznicki ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Enzyme Inhibitor ◽  
Inappropriate Medication ◽  
Inappropriate Medication Use ◽  
Prescribing Quality ◽  
Patients With Diabetes ◽  
Australian General Practice ◽  
Quality Of Prescribing

Abstract Background Drugs are commonly used in patients with chronic kidney disease (CKD) to treat an underlying cause, or its numerous complications and comorbidities. The objective of this study was to examine the quality of prescribing in patients with CKD in Australian general practice, using validated indicators. Methods We evaluated Australian general practice data obtained from the NPS MedicineWise MedicineInsight dataset for patients with CKD and aged 18 years or older. We used 16 internationally validated prescribing quality indicators focused on medication need, choice and safety in patients with CKD, and we compared results for patients with and without concomitant diabetes. Results Among 44,259 patients aged 18 years or older with evidence of CKD stages 3-5, 13,263 (30%) had documentation of a diagnosis of diabetes. Less than half of all patients (40.8%) with CKD stages 3-5 and aged 50 to 65 years were prescribed a statin. The use of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) was higher in patients with concomitant diabetes (64.1%) compared with those without diabetes (51.5%; P<0.001), yet only 69.9% of the patients with diabetes and microalbuminuria were receiving an ACEI or ARB. There were 7,426 patients (16.8%) with CKD stages 3-5 potentially receiving non-steroidal anti-inflammatory drugs (NSAIDs), including 14.3% of those patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2. Potentially inappropriate medication use was more common in CKD patients living in relatively disadvantaged socioeconomic areas, as well as in regional and remote areas. Conclusions We identified areas for possible improvement in the prescribing of preventive medications, as well as deprescribing of potentially nephrotoxic medication, in patients with CKD stages 3-5. Targets for intervention studies in Australian general practice could include the appropriate prescribing of recommended preventive medications of patients with CKD, such as an ACEI/ARB and statin, and deprescribing of NSAIDs in patients with concurrent ACEI/ARB therapy.

Risk Factor Identification, Classification and Prediction Summary of Chronic Kidney Disease

2020 ◽  
Vol 13 ◽  
Author(s):  
Pramila Arulanthu ◽  
Eswaran Perumal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Diagnosis ◽  
Medical Data ◽  
Machine Learning Algorithms ◽  
World Health ◽  
Medical Field ◽  
Data Set ◽  
Medical Issues ◽  
Health Organization

: The medical data has an enormous quantity of information. This data set requires effective classification for accurate prediction. Predicting medical issues is an extremely difficult task in which Chronic Kidney Disease (CKD) is one of the major unpredictable diseases in medical field. Perhaps certain medical experts do not have identical awareness and skill to solve the issues of their patients. Most of the medical experts may have underprivileged results on disease diagnosis of their patients. Sometimes patients may lose their life in nature. As per the Global Burden of Disease (GBD-2015) study, death by CKD was ranked 17th place and GBD-2010 report 27th among the causes of death globally. Death by CKD is constituted 2·9% of all death between the year 2010 and 2013 among people from 15 to 69 age. As per World Health Organization (WHO-2005) report, 58 million people expired by CKD. Hence, this article presents the state of art review on Chronic Kidney Disease (CKD) classification and prediction. Normally, advanced data mining techniques, fuzzy and machine learning algorithms are used to classify medical data and disease diagnosis. This study reviews and summarizes many classification techniques and disease diagnosis methods presented earlier. The main intention of this review is to point out and address some of the issues and complications of the existing methods. It is also attempts to discuss the limitations and accuracy level of the existing CKD classification and disease diagnosis methods.

scholarly journals Identifying patients with chronic kidney disease from general practice computer records

2005 ◽  
Vol 22 (3) ◽  
pp. 234-241 ◽  
Author(s):  
Simon de Lusignan ◽  
Tom Chan ◽  
Paul Stevens ◽  
Donal O'Donoghue ◽  
Nigel Hague ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease

Derivation and validation of a prognostic model to predict mortality in patients with advanced chronic kidney disease

2018 ◽  
Vol 34 (9) ◽  
pp. 1517-1525 ◽  
Author(s):  
Rebecca J Schmidt ◽  
Daniel L Landry ◽  
Lewis Cohen ◽  
Alvin H Moss ◽  
Cheryl Dalton ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
West Virginia ◽  
Prognostic Model ◽  
Patient Specific ◽  
Karnofsky Performance Score ◽  
Prognostic Information ◽  
Advanced Chronic Kidney Disease ◽  
Derivation Cohort ◽  
C Statistic

Abstract Background Guiding patients with advanced chronic kidney disease (CKD) through advance care planning about future treatment obliges an assessment of prognosis. A patient-specific integrated model to predict mortality could inform shared decision-making for patients with CKD. Methods Patients with Stages 4 and 5 CKD from Massachusetts (749) and West Virginia (437) were prospectively evaluated for clinical parameters, functional status [Karnofsky Performance Score (KPS)] and their provider’s response to the Surprise Question (SQ). A predictive model for 12-month mortality was derived with the Massachusetts cohort and then validated externally on the West Virginia cohort. Logistic regression was used to create the model, and the c-statistic and Hosmer–Lemeshow statistic were used to assess model discrimination and calibration, respectively. Results In the derivation cohort, the SQ, KPS and age were most predictive of 12-month mortality with odds ratios (ORs) [95% confidence interval (CI)] of 3.29 (1.87–5.78) for a ‘No’ response to the SQ, 2.09 (95% CI 1.19–3.66) for fair KPS and 1.41 (95% CI 1.15–1.74) per 10-year increase in age. The c-statistic for the 12-month mortality model for the derivation cohort was 0.80 (95% CI 0.75–0.84) and for the validation cohort was 0.74 (95% CI 0.66–0.83). Conclusions Our integrated prognostic model for 12-month mortality in patients with advanced CKD had good discrimination and calibration. This model provides prognostic information to aid nephrologists in identifying and counseling advanced CKD patients with poor prognosis who are facing the decision to initiate dialysis or pursue medical management without dialysis.

What practice nurses need to know about the NICE chronic kidney disease guidelines

2021 ◽  
Vol 32 (12) ◽  
pp. 468-472
Author(s):  
Peter Ellis
Keyword(s):  
Chronic Kidney Disease ◽  
General Practice ◽  
Kidney Disease ◽  
Kidney Function ◽  
Practice Nurse ◽  
Nice Guidelines ◽  
Practice Nurses ◽  
Health Related ◽  
The Uk

Chronic kidney disease is highly prevalent in the community. Peter Ellis looks at the role of the practice nurse in diagnosing and managing chronic kidney disease in general practice Chronic kidney disease (CKD) is defined as a reduction in kidney function, or damage to kidney structure, which has persisted for greater than 3 months and which is associated with other health-related issues. While there are many causes of CKD, the most prevalent in western societies, including the UK, are diabetes and hypertension. This article identifies the role of the practice nurse in applying the National Institute for Health and Care Excellence (NICE) guidelines for CKD.

Sign in / Sign up

Export Citation Format

Share Document