title: Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients
  
  
  OBJECTIVE
  To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and setting A cluster randomised controlled trial in nine general practices in The Netherlands.
  
  
  METHODS
  Five practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m(2).
  
  
  RESULTS
  Data of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = -1.0 to 3.2) compared to -0.2 (95% CI = -3.8 to 3.3)/-0.5 (95% CI = -2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]).
  
  
  CONCLUSIONS
  A shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care.
authors.affiliation: GP, Head of Primary Care Specialty Training Department;
authors.forename: Nynke D
authors.initials: ND
authors.lastname: Scherpbier-de Haan
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Gerald M M
authors.initials: GM
authors.lastname: Vervoort
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, and; Australian Primary Health Care Research Institute (APHCRI), Australian National University, Canberra.
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.affiliation: Senior researcher, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jozé C C
authors.initials: JC
authors.lastname: Braspenning
authors.affiliation: Department of Primary and Community Care;
authors.forename: Jan
authors.initials: J
authors.lastname: Mulder
authors.affiliation: Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Jack F M
authors.initials: JF
authors.lastname: Wetzels
authors.affiliation: GP, Department of Primary and Community Care;
authors.forename: Wim J C
authors.initials: WJ
authors.lastname: de Grauw
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000451:nursing*; D003928:Diabetic Nephropathies / Q000150:complications / Q000451:nursing*; D005260:Female; D058006:General Practice / Q000379:methods; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000451:nursing* / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D009398:Nephrology; D064647:Nephrology Nursing / Q000379:methods; D009722:Nurse Practitioners / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D011787:Quality of Health Care; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000451:nursing*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D057911:Angiotensin Receptor Antagonists; D000960:Hypolipidemic Agents; D014815:Vitamins; D014807:Vitamin D