Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Carmen A PeraltaLeah Karliner

Abstract

Most adults with chronic kidney disease (CKD) in the United States are cared for by primary care providers (PCPs). We evaluated the feasibility and preliminary effectiveness of an electronic clinical decision support system (eCDSS) within the electronic health record with or without pharmacist follow-up to improve the management of CKD in primary care. Pragmatic cluster-randomized trial. 524 adults with confirmed creatinine-based estimated glomerular filtration rates of 30 to 59mL/min/1.73m2 cared for by 80 PCPs at the University of California San Francisco. Electronic health record data were used for patient identification, intervention deployment, and outcomes ascertainment. Each PCP's eligible patients were randomly assigned as a group into 1 of 3 treatment arms: (1) usual care; (2) eCDSS: testing of creatinine, cystatin C, and urinary albumin-creatinine ratio with individually tailored guidance for PCPs on blood pressure, potassium, and proteinuria management, cardiovascular risk reduction, and patient education; or (3) eCDSS plus pharmacist counseling (eCDSS-PLUS). The primary clinical outcome was change in blood pressure over 12 months. Secondary outcomes were PCP awareness of CKD and use of angiotensin-converting enzyme ...Continue Reading

Citations

Jul 17, 2021·Contemporary Clinical Trials·JoAnn M Sperl-HillenPatrick J O'Connor
Sep 11, 2021·Renal Failure·Carlos R Franco PalaciosPankaj Goyal
Nov 9, 2021·The Cochrane Database of Systematic Reviews·Janet JullDawn Stacey

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