Effectiveness of Multidisciplinary Care Team on Improving the Stages of Chronic Kidney Disease in Thailand

Abstract

Background: Because of the high prevalence of chronic kidney disease (CKD) in Thailand, the Ministry of Public Health implemented a policy with the concept of multidisciplinary care team (MDC) approach. Objective: To evaluate the effectiveness of MDC in patients who received health service in CKD clinics. Materials and Methods: The present study was a retrospective cohort study carried out among 1,059 CKD patients from 140 hospitals in 12 regional health districts of Thailand between April and July 2017. McNemar test was used to compare laboratory results and the stage changing of CKD before and after patients received the service by multidisciplinary care teams in CKD clinics. Results: Seventy-four percent of subjects were aged more than 60 years. The average duration between the first and the last visit was 28.74 (range of 1 to 210) months. Mean estimated glomerular filtration rate (eGFR) on diagnosis CKD and last follow-up were 32.08±13.58 and 29.19±16.60 mL/minute, respectively. Mean systolic blood pressure on diagnosis CKD and last follow-up were 136.27±20.19 and 133.10±17.64 mmHg, respectively. Of the 1,059 patients, 15.5% improved the stage of CKD and 52.4% was stable. Stage of CKD, eGFR, blood pressure, creatinine, total cholesterol, triglyceride, and low-density lipoprotein cholesterol had statistically significant differences between before and after receiving health service from MDC in the CKD clinic. Conclusion: MCD in CKD clinic had shown the effectiveness in improving the CKD stage and laboratory examination results among the CKD patients. Keywords: Chronic kidney disease; CKD clinic; Multidisciplinary care team; Effectiveness of care