title: Kidney disease management in UK primary care: guidelines, incentives and information technology.
abstract: The last few years have seen new developments to understand and tackle the significant public health issue posed by chronic kidney disease (CKD). Established renal disease currently consumes 2% of the UK National Health Service budget and predictions are that this figure will increase significantly due to the rising number of people requiring renal replacement therapy fuelled by the ageing population and the diabetes mellitus epidemic. This paper reviews the scale of CKD and discusses the new developments such as staging, referral guidelines and new Department of Health incentives brought about to improve awareness. The importance of Information Technology in assisting the management of renal disease is also outlined. We identify various types of intervention which might be used to do this: feedback in an educational context, the establishment of computerized decision support and enhancement of the patient journey. Many principles may be extended to the management of any chronic disease. While new developments are necessary to improve care, wider implementation is required to be able to see if improved outcomes are achieved.
authors.affiliation: Department of Renal Medicine, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent, CT1 3NG. bernhard.klebe@ekht.nhs.uk
authors.forename: Bernhard
authors.initials: B
authors.lastname: Klebe
authors.forename: Chris
authors.initials: C
authors.lastname: Farmer
authors.forename: Roger
authors.initials: R
authors.lastname: Cooley
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Rachel
authors.initials: R
authors.lastname: Middleton
authors.forename: Donal
authors.initials: D
authors.lastname: O'Donoghue
authors.forename: John
authors.initials: J
authors.lastname: New
authors.forename: Paul
authors.initials: P
authors.lastname: Stevens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D020000:Decision Support Systems, Clinical; D019468:Disease Management; D006801:Humans; D007676:Kidney Failure, Chronic / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D009042:Motivation; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012017:Referral and Consultation; D013222:State Medicine; D006113:United Kingdom