Table 2 An overview of the 18 CKD interventions for primary care identified from the primary search
| Â | Intervention type | Author (year) | Main intervention description | Other intervention(s) | Sample size | Country | Summary of findings | Other comments |
|---|---|---|---|---|---|---|---|---|
CKD interventions aimed at healthcare professionals | Educational | Cortes-Sanabria et al. (2008) [28] | Intensive weekly teaching sessions to GP (5Â h weekly for 6Â months) | Validated test at 0 and 6Â months to measure competence | 94 | Mexico | Increased GP competence, led to improved eGFR and BP control, better prescribing | High enrolment rate. 91Â % of GPs increased their clinical competence |
Akbari et al. (2004) [26] | 2Â h of teaching seminars to GPs, with direct access to advice from nephrologist | Automated reporting of eGFR by laboratory | 324 | Canada | Increased recognition of CKD | Limited data for evaluation, early study | ||
Practice group meetings | De Lusignan et al. (2013) [34] | Audit-based education (twice yearly feedback about quality and performance compared with peers) | Education, peer support | 23,311 | UK | Improved BP control and increased use of ACEi. No differences in eGFR | Large study including 93 different practices | |
Humphreys et al. (2012) [16] | Three large practice group meetings with local rapid quality improvement cycles (planned and organised by research collaboration) | Implementation team support | 5509 | UK | CKD recognition, BP control and proteinuria testing all improved | Included 19 different practices | ||
Multidisciplinary management | Scherpbier et al. (2013) [32] | Shared care between nurse practitioners and GPs (with access to nephrologist or nephrology nurse via digital technology) | Education to both groups | 164 | Holland | Decreased BP and serum PTH, increased use of ACEi and statins | Limited supporting data for evaluation | |
Barrett et al. (2011) [25] | Nurse co-ordinated care (with access to nephrologist) |  | 427 | Canada | No difference in rate of decline of eGFR or BP. But an increase in mean eGFR | Most patients ‘extremely satisfied’ with care on questionnaire | ||
Bayliss et al. (2011) [27] | MDT approach (including nephrologist, pharmacy specialist, diabetes educator, dietitian, social worker, and nephrology nurse) | Components included weekly meetings, contact by telephone or email, individualised plans and patient education | 2002 | USA | Rate of decline of eGFR improved. No differences in BP, lipids or HbA1C | Limited data to determine which individual components were effectual | ||
Richards et al. (2008) [33] | Disease management programme (includes patient education, medication review, dietetic advice and social worker) | Desktop guide for clinicians containing clinical management and referral algorithms | 483 | UK | Improved eGFR, BP and cholesterol. | An extra resource. 85Â % enrolment of practices within one area | ||
Patel et al. (2005) [45] | Pharmacists performing medication reviews | Â | 82 | USA | Improvement of CKD recognition. No difference in BP, HbA1C or creatinine clearance | 99Â % of patients had prescription related problems. Only 40.9Â % of advice was accepted | ||
Computer software | Drawz et al. (2012) [36] | Access and training for CKD registries | Educational lecture to both groups, academic detailing | 781 | USA | Increased PTH measurements, but no difference in BP control | Poor uptake: only 5/37 GPs accessed the registry | |
Erler et al. (2012) [35] | Medication alert software with training | 1Â h education to both groups, patient info leaflets | 404 | Germany | Improved prescribing | Lack of contextual integration limited its use | ||
Abdel Kader et al. (2011) [23] | Computer-generated automatic alerts for referral to nephrologist | Two 15Â min educational sessions for GPs in both groups | 248 | USA | No differences in referral to nephrologists or BP control | 97Â % uptake rate of GPs. No dropouts from study | ||
Fox et al. (2008) [30] | Computer decision support software generating a recommended to-do list | Ancillary staff + monthly academic detailing | 180 | USA | Mean eGFR, CKD recognition, anaemia diagnosis all improved | Ancillary staff also did extra work including translating patient guides | ||
Financial | Karunaratne et al. (2013) [29] | National pay for performance scheme (Quality and Outcomes Framework) | Â | 10,040 | UK | Improved BP control, increased use of ACEi | High level buy-in generated engagement | |
CKD interventions aimed at patients | Patient education | Blakeman et al. (2014) [39] | Patient guidebook, telephone guided help from a lay health worker | Booklet and website linking to community resources | 436 | UK | Improved BP control, increased QALYs | 85.7Â % uptake rate |
Thomas et al. (2013) [38] | Leaflet, DVD, self-monitoring diary | Single practitioner education and shadowing session | 116 | UK | Decreased BP | Limited data on level of implementation | ||
Thomas et al. (2014) [37] | Group education session, leaflet, DVD | Practice training and monthly teleconferences. Patient advisory group | 671 | UK | Moderate decreases in BP | Patient advisory group involved in design, grant application, delivering education and feedback | ||
Other | Cottrell et al. (2012) [44] | Mobile phone text messaging BP service | Â | 124 | UK | No changes in BP, improved prescribing | Many more BP readings |