Nephrology, primary care can work together on CKD detection
SCOTTSDALE, Arizona — Nephrologists and primary care clinicians should work together to help detect, diagnose and treat patients with chronic kidney disease, according to an expert at the Southwest Nephrology Conference.
“Data suggests that only 7% of people with CKD are actually aware that they have it, so education is a big issue,” Elizabeth Montgomery, vice president of learning strategies and primary care programs for the National Kidney Foundation, said in her presentation. “The latest data suggests that the national benchmark for CKD, meaning the percentage of people at risk that are actually receiving testing, is somewhere around 13%.”
The NKF created the CKD Change Package as an online compendium of information on CKD guidelines and to help clinicians understand how other practices have successfully implemented CKD guidelines.
Care First, a Blue Cross/Blue Shield health insurer in the Mid-Atlantic region, created a patient-centered medical home program of 1.1 million members. In this population, data suggest around 170,000 to 200,000 people should be diagnosed with CKD. Initially, only 17,000 people were diagnosed with CKD in the program, Montgomery said.
The NKF partnered with the Care First data team and identified 150,000 people in the population with either probable undiagnosed CKD or who were at high risk for CKD.
A pilot program was built to evaluate whether CKD intervention in primary care made a difference in patient outcomes and cost. The NKF educated Care First employees on the basics of CKD and the strategy that Care First designed for CKD detection. Anyone with CKD stage 2 or higher would be put on a care plan to assess whether the intervention slowed disease progression. The results were published in the American Journal of Managed Care to educate clinicians about the importance of CKD testing and risk stratification.
The NKF built an online risk tool for anyone to ascertain information about kidney health. The risk tool asked about diabetes, hypertension, heart disease, weight, height and whether a family member is on dialysis or had a transplant. The goal was to prompt conversations between primary care clinicians and potential CKD patients to educate about and assess for CKD. The link to the system was embedded on frequently accessed pages that included basic CKD questions on the NKF website. A total of 30,000 people eventually clicked into the system; 95% said the content was helpful and they would discuss it with their doctor.
“We are partnered with the VA to test this system. We will have feedback not only from veterans, but from primary care clinicians about the effectiveness, usefulness [and] the design of this program,” Montgomery said. “Right now, we’re in phase 1, which is usability and comprehensibility. Next year, we’ll be in field testing where we then can measure the effectiveness of this on patients understanding that they have CKD.”
The NKF has also launched the 33% Campaign to encourage people to use the online risk calculator to assess their risk for CKD and prompt them to start a conversation with their primary care physician about kidney disease. – by Erin T. Welsh
Montgomery E. Optimizing the detection and management of CKD in primary care. Presented at: Southwest Nephrology Conference; March 6-7, 2020; Scottsdale.
Disclosure: Montgomery reports being employed by the National Kidney Foundation.