title: Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data.
abstract: BACKGROUND
  Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD. Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes.
  
  
  METHODS
  We validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate.
  
  
  RESULTS
  87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM). 85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%. Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD. 84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD.
  
  
  CONCLUSIONS
  Practitioners are less likely to achieve management targets where their confidence is low.
authors.affiliation: Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, Cranmer Terrace, London SW17 0RE, UK. mtahir@nhs.net
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Tahir
authors.forename: Olga
authors.initials: O
authors.lastname: Dmitrieva
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Jeremy
authors.initials: J
authors.lastname: van Vlymen
authors.forename: Tom
authors.initials: T
authors.lastname: Chan
authors.forename: Ramez
authors.initials: R
authors.lastname: Golmohamad
authors.forename: Kevin
authors.initials: K
authors.lastname: Harris
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.forename: Nicola
authors.initials: N
authors.lastname: Thomas
authors.forename: Hugh
authors.initials: H
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007223:Infant; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult