Abstract
BackgroundImproving the quality of care for patients with vascular disease is a priority. Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health. However, awareness of stage 3 CKD amongst patients remains limited. We aimed to identify predictors of patient self-report of CKD to inform tailoring of conversations around CKD in primary care for diverse patient populations.MethodsWe conducted a cross-sectional analysis of baseline data from 436 patients with stage 3 CKD from 24 GP practices taking part in a randomised controlled trial (RCT) evaluating a complex self-management intervention, which aimed to support the maintenance of vascular health in patients with stage 3 CKD. Potential predictors of patient self-report of CKD included demographics, stage of CKD, cardiovascular risk, self-reported co-morbidities, health status, self-management ability, and health service utilisation.ResultsAround half (52%, n = 227) of patients did not self-report CKD. Self-report rates did not appreciably differ by practice. Multivariate analysis revealed that female patients (p = 0.004), and patients with stage 3b CKD (p < 0.001), and with higher anxiety levels (p < 0.001), were more likely to self-report CKD.ConclusionsSelf-report of kidney problems by patients on CKD registers was variable and patterned by sociodemographic factors. Although it cannot be assumed that failure to self-report indicates a lack of awareness of CKD, our data do suggest the need for greater consistency in discussions around kidney health, with meaningful and relevant clinical dialogue that is aligned with existing clinical encounters to enable shared decision making and minimise anxiety.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-014-0196-3) contains supplementary material, which is available to authorized users.
Highlights
IntroductionClinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health
Improving the quality of care for patients with vascular disease is a priority
Practices had a mean list size of 5815 patients and we recruited an average of 16 patients per practice. 58.5% (n = 255) were female and patients were almost all of white ethnicity
Summary
Clinical guidance has emphasised the importance of early identification and active management of chronic kidney disease (CKD) in primary care in order to maintain vascular health. Clinical guidelines emphasise the importance of early identification and active management of CKD in maintaining vascular health in primary care [1]. This reflects evidence that CKD is an independent cardiovascular risk factor and that individuals with stable CKD are approximately 20 times more likely to die greater than that apparent in QOF CKD registers suggesting under-recognition in primary care [6]. A basic prerequisite for shared decision making and effective self-management education and support is awareness of a diagnosis [14]
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