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Table 2 An overview of the 18 CKD interventions for primary care identified from the primary search

From: Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review

  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 (5 h weekly for 6 months) Validated test at 0 and 6 months to measure competence 94 Mexico Increased GP competence, led to improved eGFR and BP control, better prescribing High enrolment rate. 91 % of GPs increased their clinical competence
Akbari et al. (2004) [26] 2 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. 85 % enrolment of practices within one area
Patel et al. (2005) [45] Pharmacists performing medication reviews   82 USA Improvement of CKD recognition. No difference in BP, HbA1C or creatinine clearance 99 % of patients had prescription related problems. Only 40.9 % 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 1 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 15 min educational sessions for GPs in both groups 248 USA No differences in referral to nephrologists or BP control 97 % 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)   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 85.7 % 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   124 UK No changes in BP, improved prescribing Many more BP readings
  1. Abbreviations: GP general practitioner, eGFR estimated glomerular filtration rate, BP blood pressure, CKD chronic kidney disease, ACEi angiotensin-converting-enzyme inhibitor, PTH parathyroid hormone, HbA1C glycated haemoglobin, QALYs quality-adjusted life years