Improving the identification and care of patients with chronic kidney disease
What did we do?
We worked with the NIHR CLAHRC East Midlands to develop the IMPAKT™ (IMproving Patient care and Awareness of Kidney disease progression Together) website to host a chronic kidney disease (CKD) audit tool alongside a range of supporting resources.
How did we do it?
Excess cardiovascular disease related to CKD is thought to cost the NHS in England £175 million every year. With end stage CKD growing at an estimated 6% each year, diagnosing and treating CKD effectively as early as possible is hugely important. The CLAHRC Greater Manchester team and researchers at CLAHRC East Midlands (formerly CLAHRC Leicestershire, Northamptonshire and Rutland) separately identified early diagnosis of CKD in primary care as a key priority and generated projects independently to address this.
Central to the work in the East Midlands was the development of a software tool, which analysed pre-existing general practice data to identify patients at risk from CKD. The Greater Manchester team designed a collaborative-style intervention to work with teams in local practices to help GPs to identify cases of undiagnosed early stage CKD, and manage diagnosed CKD patients to National Institute for Health and Care Excellence (NICE) recommended guidelines (2008). This involved the use of computer searches developed within each practice.
The synergy between both projects, developed from common clinical interests and complementary skills in both teams, resulted in a collaborative project to create a website to bring together the software tool and the improvement package developed for Greater Manchester practices in the initial projects, under the title of IMPAKT™.
Key outputs and impacts
Over four years, 2,729 additional patients with CKD across 61 GP surgeries in Greater Manchester were identified, and this work continues. Of those, 77% have now had their blood pressure controlled to NICE recommended guidelines. IMPAKT™ has also been used to support a cluster randomised trial of primary care CKD management in Northamptonshire including 48 practices and >30,000 CKD patients.
The tool has now been used by more than 230 GP practices across the UK, mainly concentrated in Greater Manchester, the Midlands, North Wales and West Yorkshire. In addition to its original use, the IMPAKT™ tool has recently been used to conduct an audit across Greater Manchester and Eastern Cheshire (with a 60% coverage rate), in collaboration with the Greater Manchester Academic Health Science Network (AHSN). It was estimated that across the region there are 16,483 uncoded patients that could be diagnosed with CKD immediately, and 43,027 who warrant further investigation for CKD based on previous low eGFR readings. Furthermore, of the 312 practices audited, 28-35% of recorded cases of CKD stages 3-5 were not managed to 2008 NICE CKD guidelines (i.e. did not have a measurement of proteinuria status and/or blood pressure recorded in the 12 months preceding the audit).
We’re currently consulting with Greater Manchester’s clinical commissioning groups to explore options for potential future improvement work in light of these findings.