Abstract
BackgroundIn developing countries, accessibility to specialists, and physician to patient contact time is limited. In Thailand, A unique community health service is provided by subdistrict health care officers and Village Health Volunteers (VHVs). If the personnel were trained on proper chronic kidney disease (CKD) care, CKD progression would be delayed.Methods/DesignWe conducted a community-based, cluster randomized controlled trial at Kamphaeng Phet Province, located about 400 kilometers north of Bangkok. Two out of eleven districts of the province were randomly selected. Approximatly 500 stage 3–4 CKD patients from 2 districts were enrolled. Patients in both groups will be treated with standard guidelines. The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network (subdistrict health care officers and VHVs) which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake, blood pressure measurement and drug compliance. Duration of the study is 2 years. The primary outcome is the difference of rate of eGFR decline. The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events, end-stage renal disease (ESRD), etc.DiscussionInsights of this study may set forth a new standard of community-based CKD care.Trial registrationNCT01978951.
Highlights
In developing countries, accessibility to specialists, and physician to patient contact time is limited
Insights of this study may set forth a new standard of community-based chronic kidney disease (CKD) care
We try to search for an appropriate CKD care model which could provide optimal treatment to the rural population
Summary
Accessibility to specialists, and physician to patient contact time is limited. In Thailand, A unique community health service is provided by subdistrict health care officers and Village Health Volunteers (VHVs). It is estimated that the total number of stage 3–4 CKD patients in Thailand is 4.1 millions. With only 450 active nephrologists, the ratio of CKD patients to nephrologists in Thailand is as high as 1:15,000. Each is divided into 5–10 districts and further into 5–10 subdistricts per district. A typical subdistrict consists of 10–15 villages, each consists of 100–150 households. There is one district hospital consisting of 3–5 general practioners providing all basic medical services including maternal and child health care, simple trauma, diabetes and hypertension. Healthcare personnel of each subdistrict involved in various community health activities, for example, antismoking campaign, HIV prevention, etc
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