Strengths of primary healthcare regarding care provided for chronic kidney disease.
Elaine Amaral de Paula, Mônica Barros Costa, Fernando Antonio Basile Colugnati and 5 others
PMID 27627122WHAT IT FOUND
Primary care units in Brazil often lacked CKD guidelines, creatinine/GFR documentation and referral knowledge.
Units with better structure and process had more patients with stable kidney function and earlier specialist referral.
Key findings
01Five of 14 primary care units were classified as capable, five as partially capable and four as not capable for preventing, detecting and controlling CKD.
02In the 1,534 medical files, serum creatinine was missing in 398 records and recorded only once in 261 records.
03GFR stabilised in 51% of patients monitored in capable units, while 65% of patients referred by not capable units were already at stage 4 or 5.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study observed 14 primary care units in one city, so the results may not apply to other settings. It was not a randomised trial and did not test whether improving unit structure or process causes better kidney outcomes. Many patient records were missing creatinine, fasting glucose or glycated hemoglobin, so the measured monitoring may be incomplete. The blood pressure difference between capable and partially or not capable units was not significant (p=0.92). The interviews included physicians, supervisors and community health agents, so the findings may not reflect all team members' views.
The easy way to misread this
Do not conclude that improving a unit's structure or process will cause better kidney function or earlier referral. The study observed associations in one city and did not test an intervention.