title: Audit-based education lowers systolic blood pressure in chronic kidney disease: the Quality Improvement in CKD (QICKD) trial results.
abstract: Strict control of systolic blood pressure is known to slow progression of chronic kidney disease (CKD). Here we compared audit-based education (ABE) to guidelines and prompts or usual practice in lowering systolic blood pressure in people with CKD. This 2-year cluster randomized trial included 93 volunteer general practices randomized into three arms with 30 ABE practices, 32 with guidelines and prompts, and 31 usual practices. An intervention effect on the primary outcome, systolic blood pressure, was calculated using a multilevel model to predict changes after the intervention. The prevalence of CKD was 7.29% (41,183 of 565,016 patients) with all cardiovascular comorbidities more common in those with CKD. Our models showed that the systolic blood pressure was significantly lowered by 2.41 mm Hg (CI 0.59-4.29 mm Hg), in the ABE practices with an odds ratio of achieving at least a 5 mm Hg reduction in systolic blood pressure of 1.24 (CI 1.05-1.45). Practices exposed to guidelines and prompts produced no significant change compared to usual practice. Male gender, ABE, ischemic heart disease, and congestive heart failure were independently associated with a greater lowering of systolic blood pressure but the converse applied to hypertension and age over 75 years. There were no reports of harm. Thus, individuals receiving ABE are more likely to achieve a lower blood pressure than those receiving only usual practice. The findings should be interpreted with caution due to the wide confidence intervals.
authors.forename: Simon de
authors.initials: Sd
authors.lastname: Lusignan
authors.affiliation: Department of Health Care Management and Policy, University of Surrey, Guildford, UK. s.lusignan@surrey.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignana
authors.forename: Hugh
authors.initials: H
authors.lastname: Gallagher
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
authors.forename: Tom
authors.initials: T
authors.lastname: Chan
authors.forename: Jeremy
authors.initials: J
authors.lastname: van Vlymen
authors.forename: Aumran
authors.initials: A
authors.lastname: Tahir
authors.forename: Nicola
authors.initials: N
authors.lastname: Thomas
authors.forename: Neerja
authors.initials: N
authors.lastname: Jain
authors.forename: Olga
authors.initials: O
authors.lastname: Dmitrieva
authors.forename: Imran
authors.initials: I
authors.lastname: Rafi
authors.forename: Andrew
authors.initials: A
authors.lastname: McGovern
authors.forename: Kevin
authors.initials: K
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D058006:General Practice / Q000193:education; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy*; D006113:United Kingdom
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