scholarly journals A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic

2021 ◽  
Vol 16 (3) ◽  
pp. 68-76
Author(s):  
Jazlan Jamaluddin ◽  
Mohamed Syarif Mohamed Yassin ◽  
Siti Nuradliah Jamil ◽  
Mohd Azzahi Mohamed Kamel ◽  
Mohamad Ya’akob Yusof
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Team Members ◽  
Diagnosis And Management ◽  
Dedicated Team ◽  
Level Monitoring

Introduction: This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Methods: Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. Results: A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (≤ 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Conclusions: Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

scholarly journals Associated Factors of Chronic Kidney Disease among Hyponatraemic Elderly Patients Attending a Primary Care Clinic

2018 ◽  
Author(s):  
Chai Li Tay
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Associated Factors ◽  
Demographic Data ◽  
Primary Care Clinic ◽  
Loop Diuretics ◽  
Care Clinic ◽  
End Stage

Introduction: Chronic kidney disease (CKD) emerges to be an important geriatric health issue. It may progress to end stage renal failure and affect the quality of life. However, little is known about the associated factors of CKD. So this study aimed to determine the associated factors of CKD among hyponatraemic elderly. Methods: This is a retrospective study of hyponatraemic patients aged ≥ 60 years attending outpatient clinic in 2014. Blood test results of glucose, potassium, creatinine, medical history, blood pressure, medication and demographic  data were  captured from patient records. Each patient’s estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI Creatinine Equation. CKD is defined as eGFR of < 60 ml/min/1.73m2. SPSS 21 was used to do the analysis. Results: Totally 257 patients with mean age of 72.9 ± 7.3 years were enrolled in this study. Of them 73 (28.4 %) elderly had CKD. The mean eGFR was 72.62 ± 24.14 ml/min/1.73m2, mean BP was (135.75 ± 18/10) mmHg. Of the participants, 134 (52.1 %) were men, 151 (58.8 %) were diabetics, 247 (96.1 %) had hypertension. The independent associated factors of CKD were increasing age (OR 1.08; 95 % CI 1.03-1.13; p = 0.002), hyperglycaemia (OR 1.10; 95 % CI 1.02-1.18; p = 0.017) and the use of loop diuretics (OR 5.15; 95 % CI 1.52-17.38; p = 0.008). Conclusion: Hyperglycaemia and loop diuretics usage are found to be significantly associated with CKD among elderly patients attending a primary care clinic. Hence every effort should be made to optimise glucose control and cautious in the usage of loop diuretics to retard the decline in renal function.

scholarly journals Management of Chronic Kidney Disease in an Academic Primary Care Clinic

2002 ◽  
Vol 23 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Ajay Israni ◽  
Cynthia Korzelius ◽  
Raymond Townsend ◽  
Douglas Mesler
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Care Clinic ◽  
Care Clinic ◽  
Academic Primary Care

scholarly journals The clinical utility and cost impact of cystatin C measurement in the diagnosis and management of chronic kidney disease: A primary care cohort study

PLoS Medicine ◽  
2017 ◽  
Vol 14 (10) ◽  
pp. e1002400 ◽  
Author(s):  
Adam Shardlow ◽  
Natasha J. McIntyre ◽  
Simon D. S. Fraser ◽  
Paul Roderick ◽  
James Raftery ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cystatin C ◽  
Clinical Utility ◽  
Diagnosis And Management ◽  
Cost Impact

scholarly journals Huddle Up! A Comprehensive Approach to Improving Interdisciplinary Huddle in a VA Geriatric Primary Care Clinic

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 13-13
Author(s):  
Juliana Wilking-Johnson ◽  
Joleen Sussman
Keyword(s):  
Primary Care ◽  
Geriatric Medicine ◽  
Primary Care Clinic ◽  
Post Intervention ◽  
Allied Health Professionals ◽  
Care Clinic ◽  
Team Members ◽  
Needed Information ◽  
Initial Survey ◽  
The Impact

Abstract Spending time in brief meetings or “huddles” is associated with greater job satisfaction and less burnout, especially when team members have mutually agreed upon goals and can participate in decision-making. However, huddles are often unproductive and may have opposite the intended effect if not tailored to the specific team involved. We sent a survey to all members of our VA Geriatric primary care team (including geriatric medicine fellows, social work, psychology, audiology, pharmacy, faculty and support staff) asking them to rate our huddle’s impact on their stress level, efficiency, learning, preparedness and feeling supported at work. Responders indicated if they received needed information and if they understood what information was needed from them. We then held a team meeting to establish mutually agreed upon goals, expectations and organization of huddle, which were then reinforced with visual and timer reminders. After 6 weeks utilizing the new format, we administered a post intervention survey assessing the impact of the change. The initial survey revealed that the geriatric medicine fellows had worse ratings than other trainees, staff, and faculty. Fellows were more likely to say that they did not know what information was needed from them; and they did not receive information needed from others. The follow up survey showed improvement in all scores among geriatrics medicine fellows and allied health professionals, including 100% of respondents indicating they receive needed information. Overall, comments regarding the intervention were positive, demonstrating that a structured, organized huddle tailored to a specific team, can be beneficial.

scholarly journals The Prevalence of Chronic Kidney Disease in Hypertensive Patients in Primary Care in Hong Kong: A Cross-Sectional Study

2020 ◽  
Author(s):  
Shaowei Xu ◽  
Yim Chu Li ◽  
Catherine Xiaorui Chen
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Associated Factors ◽  
Statistical Tests ◽  
Care Clinic ◽  
Hypertensive Patients ◽  
Chinese Adult

Abstract BackgroundTo identify the prevalence of Chronic Kidney Disease (CKD) in Chinese hypertensive population managed in a local public primary care clinic and to explore its associated risk factors. MethodsMedical records of Chinese adult hypertensive patients (> 18 years of age) who had been followed up in a public general outpatient clinic (GOPC) from 1 Jan 2018 to 30 Jun 2018 were retrieved and reviewed, and a sample group was randomly selected. Demographic, clinical parameters including age, gender, smoking status, body weight, height, systolic and diastolic blood pressure, biochemical data, and comorbidities were collected from the Computer Management System (CMS). Estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as eGFR < 60 ml/min/1.73m2 and staged according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Student's t-test was used to analyze continuous variables and the Chi-squared test was used for categorical data. Multivariate Logistic regression was used to examine the association between CKD and variable associated factors. All statistical tests were two-sided, and a P-value of <0.05 was considered significant.ResultsAmong the 993 Chinese hypertensive patients included in the final analysis, 152 were found to have CKD, with overall prevalence being 15.3%. In addition, the prevalence of CKD increased with the ageing of the population. In multivariate analysis, associated factors for CKD included age (OR 4.3 for every 10 years increase), history of congestive heart failure (OR 7.2), diabetes mellitus (OR 1.8), gout (OR 3.2), number of anti-hypertensive medications (OR 1.6) and high-density lipoprotein cholesterol level (OR 0.38). Conclusions15.3% of Chinese adult hypertensive patients have CKD. Associated factors for CKD include older age, concomitant cardiovascular disease, diabetes mellitus, gout, and lipid disorder. Family physicians should make a concerted effort in early recognition of these risk factors for CKD among HT patients.

Vision Screening Among Primary Care Clinic Patients

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 93A-93A
Author(s):  
Lwbba Chait ◽  
Angeliki Makri ◽  
Rawan Nahas ◽  
Gwen Raphan
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Vision Screening ◽  
Care Clinic
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