CKD identification and management: a realist evaluation of an audit-based intervention

Background

Chronic Kidney Disease (CKD) is imposing an increasing burden on the Australian health system. General practice is positioned appropriately to mitigate this burden through appropriate diagnosis and management of patients with CKD.

Aims/Objectives

To identify whether an audit-based intervention leads to a change in the standard of care of patients with CKD in Australian general practice.

Methods

A realist evaluation of factors in the diagnosis, electronic health record (EHR) coding and management of CKD in general practice was undertaken in four participating group general practices. The intervention was a plan-do-study-act cycle which incorporated discussion regarding the identification and management of CKD before and after the cycle. Initial reports were generated from the EHR and given to each participating General Practitioner (GP) for action. At the close of the study a practice report was issued. In this mixed methods study, transcribed focus group discussions and deidentified EHR data were analysed to examine what changed for each practice or GP and why.

Findings

The intervention led to significantly improved EHR CKD coding and co-ordering of urinary albumin-to-creatinine ratio with estimated glomerular filtration rate measurements. The majority of GPs valued the benefits of appropriate EHR coding as an aid to safer prescribing practices, as facilitated by inbuilt EHR clinical decision-making support tools.

Implications for practice

There is a significant shortfall in the identification, coding and management of patients with CKD in general practice. This intervention shows that GPs are willing to undertake quality improvement activities in relation to patients with CKD.