Documentation and management of CKD in rural primary care

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management. Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine>1.5 mg/dl in males and >1.3 mg/dl in females and an estimated GFR2. Documentation of a CKD diagnosis and laboratory values were abstracted by chart review. Results Of CKD patients, 51.9% had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95% confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95% confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20% of patients with documented CKD (odds ratio=53.20, 95% confidence interval=14.90,189.90). Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population.

Original languageEnglish (US)
Pages (from-to)739-748
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number5
DOIs
StatePublished - May 7 2013

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Documentation
Primary Health Care
Odds Ratio
Confidence Intervals
Creatinine
Nephrology
Clinical Laboratory Techniques
Rural Population
Serum
Cohort Studies
Retrospective Studies
Cross-Sectional Studies
Research

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Documentation and management of CKD in rural primary care. / Rao, Maya K.; Morris, Cynthia; O'Malley, Jean P.; Davis, Melinda; Mori, Motomi (Tomi); Anderson, Sharon.

In: Clinical Journal of the American Society of Nephrology, Vol. 8, No. 5, 07.05.2013, p. 739-748.

Research output: Contribution to journalArticle

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abstract = "Background and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management. Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine>1.5 mg/dl in males and >1.3 mg/dl in females and an estimated GFR2. Documentation of a CKD diagnosis and laboratory values were abstracted by chart review. Results Of CKD patients, 51.9{\%} had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95{\%} confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95{\%} confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20{\%} of patients with documented CKD (odds ratio=53.20, 95{\%} confidence interval=14.90,189.90). Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population.",
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