title: Comparative efficacy of a team-led treatment protocol for the management of renal anaemia.
abstract: OBJECTIVE
  To evaluate the efficacy of a team-led anaemia management protocol based on current guidelines.
  
  
  METHODS
  The effect of a treatment protocol in implementing an anaemia guideline was evaluated in a large teaching hospital, encompassing three (two in-hospital and one satellite) dialysis facilities. Quarterly data were collected, over a 6-year period, on all patients dialysing in these facilities, before and after implementation of an anaemia management treatment protocol. This protocol was developed by a physician-led team and implemented by an anaemia coordinator assisted by the unit staff. The primary outcome measure was the proportion of patients receiving erythropoietin with ferritin levels within the national guidelines target range calculated using data on haemoglobin (Hb), iron studies, dry weight and erythropoietin dose.
  
  
  RESULTS
  Data was collected on >150 patients every quarter between 2005 and 2010 (inclusive). The proportion of patients within the primary outcome target range increased from a nadir of 17% to 51% with evidence of true systematic change. The proportion of patients with Hb values within the unit target range also increased from 46% to 56% (P = 0.25) between the first and last years of the project. These changes were also associated with reduced erythropoietin drug use down to 0.44 μg/kg per week.
  
  
  CONCLUSIONS
  Implementation of a treatment protocol for anaemia management in haemodialysis patients was associated with greater consistency with guideline evidence and lower drug use. Achieving such guideline recommendations for ferritin targets in more than 50% of patients appears feasible.
authors.affiliation: Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Sradha S
authors.initials: SS
authors.lastname: Kotwal
authors.forename: Patrick
authors.initials: P
authors.lastname: Lan
authors.forename: Avril
authors.initials: A
authors.lastname: MacLeod
authors.forename: Meg
authors.initials: M
authors.lastname: Jardine
authors.forename: Paul
authors.initials: P
authors.lastname: Snelling
authors.forename: Jonathon
authors.initials: J
authors.lastname: Craig
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D057186:Comparative Effectiveness Research; D016903:Drug Monitoring / Q000592:standards; D017723:Drug Utilization Review / Q000592:standards; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D019983:Guideline Adherence / Q000592:standards; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000592:standards*; D009517:New South Wales; D010348:Patient Care Team / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015397:Program Evaluation; D006435:Renal Dialysis / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin; D005293:Ferritins
keywords: anaemia; erythropoietin; haemodialysis; treatment protocol