A pilot evidence-based CKD educational intervention targeting Primary Care Providers in a Community Health Care Center in eastern North Carolina

Background

Chronic Kidney Disease (CKD) is a growing public health concern. Approximately 11% of the adult population is reported to have CKD, and 31% of all Medicare and Medicaid expenditures are on kidney disease. While most CKD patients are treated exclusively by primary care providers (PCPs), it is widely recognized that a large proportion of PCPs are unfamiliar with national CKD management guidelines. Aggressive prevention and management of CKD is crucial; if properly managed, CKD patients may never progress to kidney failure. Thus, we conducted a pilot evidence-based CKD educational intervention targeting PCPs in a Community Health Care Center in order to improve clinical practices related to CKD prevention and management. This setting was selected due to its large numbers of diabetic, hypertensive, African American and Latino patients-- which are high risk for developing CKD. It was hypothesized that the educational intervention would result in improved blood clinical management and ultimately, improved blood pressure outcomes in patients.

Methods

Educational sessions were conducted by a team of nephrologists weekly for 6 months (intensive phase) and gradually scaled back to occur quarterly. Changes in individual provider practices were assessed by stratifying a random sample of hypertensive patients (BP ≥ 140/90 mmHg) by provider and comparing blood pressures at baseline and post-intensive phase of the interrvention using paired t-tests. Patients were included if they were 18 y/o and had at least two hypertensive blood pressure readings the years prior to and following the intervention. Analyses were conducted in PASW-18.

Results

An average of 2749 patients was seen by the clinic each month. Of these, 38% were African American, 20% diabetic and 36% hypertensive. Three providers worked during the study period. Twenty-five patients were reviewed per provider (n=75). When comparing individual provider management pre- and post- intervention, significant decreases in systolic blood pressures were observed for all providers (mean=-15.67, SD=6.32). Decreases in diastolic blood pressure were significant for all but one provider (mean = -6.64, SD=3.15).

Discussion

Two providers reduced their patients' average blood pressures to recommended levels (≤140/90 mmHg). The selected CHC is demographically representative of other CHC's in the state, which provides support for similar interventions targeting this type of setting. Future interventions should incorporate control sites, evaluate the cost-effectiveness of the intervention, and examine the impact of coincident staff education.