title: Chronic disease management interventions for people with chronic kidney disease in primary care: a systematic review and meta-analysis.
abstract: Primary care providers manage the majority of patients with chronic kidney disease (CKD), although the most effective chronic disease management (CDM) strategies for these patients are unknown. We assessed the efficacy of CDM interventions used by primary care providers managing patients with CKD.
  
  
  
  The Medline, Embase and Cochrane Central databases were systematically searched (inception to November 2014) for randomized controlled trials (RCTs) assessing education-based and computer-assisted CDM interventions targeting primary care providers managing patients with CKD in the community. The efficacy of CDM interventions was assessed using quality indicators [use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), proteinuria measurement and achievement of blood pressure (BP) targets] and clinical outcomes (change in BP and glomerular filtration rate). Two independent reviewers evaluated studies for inclusion, quality and extracted data. Random effects models were used to estimate pooled odds ratios (ORs) and weighted mean differences for outcomes of interest.
  
  
  
  Five studies (188 clinics; 494 physicians; 42 852 patients with CKD) were included. Two studies compared computer-assisted intervention strategies with usual care, two studies compared education-based intervention strategies with computer-assisted intervention strategies and one study compared both these intervention strategies with usual care. Compared with usual care, computer-assisted CDM interventions did not increase the likelihood of ACEI/ARB use among patients with CKD {pooled OR 1.00 [95% confidence interval (CI) 0.83-1.21]; I2 = 0.0%}. Similarly, education-related CDM interventions did not increase the likelihood of ACEI/ARB use compared with computer-assisted CDM interventions [pooled OR 1.12 (95% CI 0.77-1.64); I2 = 0.0%]. Inconsistencies in reporting methods limited further pooling of data.
  
  
  
  To date, there have been very few randomized trials testing CDM interventions targeting primary care providers with the goal of improving care of people with CKD. Those conducted to date have shown minimal impact, suggesting that other strategies, or multifaceted interventions, may be required to enhance care for patients with CKD in the community.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Galbraith
authors.affiliation: Faculty of Veterinary Medicine, Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Casey
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.|Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.
authors.forename: Maoliosa
authors.initials: M
authors.lastname: Donald
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.|Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.|Interdisciplinary Chronic Disease Collaboration, Calgary, Alberta, Canada.
authors.forename: Min
authors.initials: M
authors.lastname: Jun
mesh_terms: D019468:Disease Management; D018479:Early Intervention, Educational; D061345:Early Medical Intervention; D006801:Humans; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
keywords: chronic disease management; chronic kidney disease; computer-assisted; education-assisted; nephrology; primary care