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Can a care bundle approach be used to implement best practice for the management of diabetes and chronic kidney disease in primary care?

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Can a care bundle approach be used to implement best practice for the management of diabetes and chronic kidney disease in primary care?

Care bundle approach to the management of patients with chronic kidney disease and diabetes in primary care.

 

Author: N. Thomas, S. Watson, I. Rafi, K. Barnes, E. George and K. Harris
Journal: Diabetic Medicine  2010  27  (2 SUPPL. 1)  187
Year:  2010

 

Aims and objectives: This quality improvement project aims to improve the management of people with diabetes and Chronic Kidney Disease (CKD) in primary care, using a novel evidence-based intervention called a care bundle. The objectives are to implement the bundle in one GP practice and achieve > 95% compliance with the bundle.

Methods: The bundle, based on NICE guidance for CKD, consists of four practical activities that have to be applied when people with CKD attend for clinic: recording people with CKD 3-5 on a register, measuring proteinuria, prescribing blood pressure tablets if necessary and assessing cardio-vascular risk. The difference between this activity and normal care is that all activities have to be carried out at the same time. One GP practice (practice list size 12000) started to apply the care bundle in April 2009 during a nurse-led clinic for long-term conditions.

Results: 77 patients with CKD attended the clinic between April-September 2009. Of these > 80% had diabetes. A number of tests of change have been implemented to increase compliance with the bundle. These include directly identifying people with diabetes and CKD and calling them to clinic and collecting spot urines rather than early morning urines for proteinuria quantification. Although compliance with BP targets is improving (< 130/80 mmHg for diabetes), 95% compliance with the bundle has yet to be achieved. Conclusions and summary: This approach is being undertaken in primary care for the first time and will be rolled-out to additional practices in 2010. It is hoped this initiative will improve the community care of people with kidney disease, the majority of whom have diabetes. Abstract submitted on behalf of the Quality Improvement in CKD (QICKD) research team.

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