O31
USING AUDIT-BASED EDUCATION TO LOWER BLOOD PRESSURE IN
CHRONIC KIDNEY DISEASE (CKD)IN PRIMARY CARE: RESULTS OF THE
QUALITY IMPROVEMENT IN CKD (QICKD) TRIAL
Gallagher, H¹, Harris, K², Jones, S³, Chan, T³, van Vlymen, J³, Tahir, A³, Thomas, N4,
Jain, N4, Dmitrieva, O³, Rafi, I5 , McGovern, A³, Lusignan, S³
¹South West Thames Renal Unit, St Helier Hospital, Carshalton, ²University Hospital of
Leicester, ³University of Surrey, 4Kidney Research UK, 5St George's University of
London
There is scope to improve the management of people with chronic kidney disease (CKD) in
primary care. This trial compared the effect of two quality improvement interventions, auditbased education (ABE) and the provision of guidelines and prompts (G&P), with usual
practice (UP) in lowering systolic blood pressure (SBP) in people with stages 3-5 CKD who
are managed in primary care. The ABE intervention comprised extraction and analysis of
individual Practice data, which was then discussed with other (usually 3-6) local Practices in a
teaching/peer review session, carried out x2 during the study
We undertook a two year cluster randomised trial in 93 volunteer general practices, covering
a registered population of 691,504 people, randomised into three arms: ABE (30 practices);
G&P (32); UP (31). We collected anonymised routine data and compared the interventions’
effects on the primary outcome measure, SBP, using multilevel models to predict change in
SBP after the intervention. The dataset included demographic (age, index of multiple
deprivation (IMD) score and ethnicity), clinical (including the presence of diabetes and five
cardiovascular comorbidities) and biochemical data.
The mean age of the population was 41.1 years (SD 22.36 years) and the mean IMD 17.4.
Ethnicity was recorded for around half the population and 69% of these had white ethnicity.
The prevalence of CKD Stages 3-5 was 7.29% in the adult population. All cardiovascular
comorbidities were more common in CKD. Although the confidence intervals were wide,
linear mixed models showed a statistically significant lowering of SBP with ABE of 2.4
mmHg (0.59-4.29mmHg, p=0.012) as compared with usual practice, with an odds ratio of
achieving a >5mmHg reduction in SBP of 1.24 (CI 1.05-1.45, p=0.01). The changes within
the G&P arm were not significantly different from those in UP. ABE, male gender, ischemic
heart disease and chronic heart failure were independently associated with greater lowering of
SBP. There were no reports of harm.
We have demonstrated that an intervention of audit-based education appears to be effective in
improving the proportion of people who achieve a reduction in SBP in primary care. The
reduction in SBP achieved, although small, may have a significant clinical impact at the
population level. Further work is required to determine the generalisability and costeffectiveness of this approach.