title: Attainment of guideline targets in EURODOPPS haemodialysis patients: are differences related to a country's healthcare expenditure and nephrologist workforce?
abstract: BACKGROUND
  In the field of chronic kidney disease, global clinical practice guidelines have been developed and implemented with a view to improving patient care and outcomes. The attainment of international and European guideline targets for haemodialysis patients in European countries has not been audited recently. Hence, we sought to establish whether the attainment of the targets set out in guidelines and inappropriate care are similar across European countries and whether inter-country differences are related to disparities in national healthcare expenditures (as a percentage of gross domestic product) and/or the nephrologist workforce per capita.
  
  
  METHODS
  EURODOPPS is the European part of an international, prospective study of a cohort of adult, in-centre, haemodialysed patients. For the current project, 6317 patients from seven European countries were included between 2009 and 2011. Data on laboratory test results and medication prescriptions were extracted from patient records, in order to determine the overall percentage of patients treated according to the international guidelines on anaemia, dyslipidaemia, metabolic acidosis and mineral bone disease. Data related to macroeconomic indices were collected from World Health Organization database and World Bank stats.
  
  
  RESULTS
  Attainment of the targets set in international guidelines was far from complete; only 34.1% of patients attained their target blood pressure and 31.2% attained their target haemoglobin level. Overall, only 5% of the patients attained all of the studied guideline targets. We observed marked inter-country differences in levels of guideline uptake/application and the use of pharmacological agents. The levels of national healthcare expenditures and nephrologist workforce were not correlated with the percentage of patients on-target for ≥50% of the studied variables or with inappropriate care (except for anaemia).
  
  
  CONCLUSIONS
  Our analysis of EURODOPPS data highlighted a low overall level of guideline target attainment in Europe and substantial differences between European countries. These inter-country differences did not appear to be linked to macroeconomic determinants.
authors.affiliation: INSERM U1088, Jules Verne University of Picardy, Amiens, France.|Clinical Research Centre and Division of Clinical Pharmacology, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Liabeuf
authors.affiliation: European Renal Association - European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Karlijn J
authors.initials: KJ
authors.lastname: Van Stralen
authors.affiliation: School of Social and Community Medicine, University of Bristol and UK Renal Registry, Southmead Hospital, Bristol, UK.
authors.forename: Fergus
authors.initials: F
authors.lastname: Caskey
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI, USA.|Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tentori
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI, USA.|Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.affiliation: European Renal Association - European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Sajjad
authors.affiliation: European Renal Association - European Dialysis and Transplant Association Registry, Department of Medical Informatics, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France.|INSERM Unit 1018, CESP, University Paris-Saclay, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris Sud, Villejuif, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
mesh_terms: D000368:Aged; D003695:Delivery of Health Care; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072104:Nephrologists / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D006435:Renal Dialysis
keywords: European; audit; guidelines; haemodialysis; prescription; target