Improve prevalence and care following NICE guidelines
PrimaryCare IT has been working hard on a new integrated pathway within EMIS Web for patients with CKD. This means that for every time a eGFR arrives within EMIS Web the level is analysed against our internal concepts. In this way, we ascertain whether the patient has existing CKD, has co-existent diabetes or hypertension and then looks at their ACR in order to guide treatment and ensure progression is noted and that they are appropriately coded. Alerts are also triggered in line with AKI NICE guidelines for more rapid deterioration in eGFR. Once the protocol has analysed the eGFR, it gives the user appropriate information on the suggested management. Useful information for patients newly diagnosed or those experiencing progression is referenced to aid patient understanding.
Why focus on CKD?
Late presentation of people with kidney failure increases morbidity, mortality and associated healthcare costs. Diagnosis of people with kidney disease has improved since the introduction of national estimated GFR reporting and CKD indicators in the primary care Quality and Outcomes Framework, and also because there is increased public and health professional awareness of CKD. However, late presentation was still reported as 19% overall in the Renal Association's 2013 UK Renal Registry report.
The total cost of CKD in England in 2009–10 was estimated at between £1.44 and £1.45 billion, which was approximately 1.3% of all NHS spending in that year. More than half of this amount was spent on renal replacement therapy for the 2% of people with CKD that progresses to kidney failure. It was estimated in the economic model that approximately 7000 excess strokes and 12,000 excess myocardial infarctions occurred in people with CKD in 2009–10 (relative to an age- and gender-matched population without CKD), with an estimated cost of between £174 and £178 million. Strategies aimed at earlier identification and prevention of progression to end-stage kidney disease are clearly needed.
What will this mean for my Practice?
We will work with you to understand how your Practice manages patients currently and make sure that our pathways integrate smoothly and cause minimal interruption whilst ensuring that prompts remind users of treatment targets and the need to move towards diagnosis. We will sign a confidentiality agreement with your practice and then install the protocols on your system. Initial anonymised data searches will be undertaken to allow us to judge the effectiveness of the project and feedback will be given to practices.
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