Limits...
The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care.

de Lusignan S, Gallagher H, Chan T, Thomas N, van Vlymen J, Nation M, Jain N, Tahir A, du Bois E, Crinson I, Hague N, Reid F, Harris K - Implement Sci (2009)

Bottom Line: Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years.Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention.ISRCTN56023731.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Community Health Sciences, St George's - University of London, London, SW17 0RE, UK. slusigna@sgul.ac.uk

ABSTRACT

Background: Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression

Design: Cluster randomised controlled trial (CRT) METHODS: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention.

Clinical trials registration: ISRCTN56023731. ClinicalTrials.gov identifier.

No MeSH data available.


Related in: MedlinePlus

The core study sample: a three-arm cluster randomised trial comparing Usual practice with Guidelines and Prompts (GaP) and Audit-based Education (ABE).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2719588&req=5

Figure 1: The core study sample: a three-arm cluster randomised trial comparing Usual practice with Guidelines and Prompts (GaP) and Audit-based Education (ABE).

Mentions: The study has two components: a core cluster randomised trial (CRT) of 75 practices, and a parallel process evaluation and measure of how GP confidence changes over time. The core study is a three-arm CRT of 75 practices. These 75 practices are randomised into three arms of 25 practices comparing usual practice, guidelines and prompts (GaP), and ABE. This sample size is needed to show a difference of 3 mmHg in systolic BP (Figure 1). There is also a parallel study that contains additional practices: four practices form our in-depth process evaluation practices, and two testing each active intervention. Additionally, 10 practices in each arm of the study will complete a confidence questionnaire to assess if/how practitioner confidence changes in the different arms of the study (Figure 2).


The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care.

de Lusignan S, Gallagher H, Chan T, Thomas N, van Vlymen J, Nation M, Jain N, Tahir A, du Bois E, Crinson I, Hague N, Reid F, Harris K - Implement Sci (2009)

The core study sample: a three-arm cluster randomised trial comparing Usual practice with Guidelines and Prompts (GaP) and Audit-based Education (ABE).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2719588&req=5

Figure 1: The core study sample: a three-arm cluster randomised trial comparing Usual practice with Guidelines and Prompts (GaP) and Audit-based Education (ABE).
Mentions: The study has two components: a core cluster randomised trial (CRT) of 75 practices, and a parallel process evaluation and measure of how GP confidence changes over time. The core study is a three-arm CRT of 75 practices. These 75 practices are randomised into three arms of 25 practices comparing usual practice, guidelines and prompts (GaP), and ABE. This sample size is needed to show a difference of 3 mmHg in systolic BP (Figure 1). There is also a parallel study that contains additional practices: four practices form our in-depth process evaluation practices, and two testing each active intervention. Additionally, 10 practices in each arm of the study will complete a confidence questionnaire to assess if/how practitioner confidence changes in the different arms of the study (Figure 2).

Bottom Line: Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years.Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention.ISRCTN56023731.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Community Health Sciences, St George's - University of London, London, SW17 0RE, UK. slusigna@sgul.ac.uk

ABSTRACT

Background: Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression

Design: Cluster randomised controlled trial (CRT) METHODS: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention.

Clinical trials registration: ISRCTN56023731. ClinicalTrials.gov identifier.

No MeSH data available.


Related in: MedlinePlus