Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

Kenneth Scott Brimble; Philip Boll; Allan K Grill; Amber Molnar; Danielle M Nash; Amit Garg; Ayub Akbari; Peter G Blake; David Perkins

doi:10.1136/bmjopen-2019-032838

Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation

BMJ Open. 2020 Feb 16;10(2):e032838. doi: 10.1136/bmjopen-2019-032838.

Authors

Kenneth Scott Brimble¹, Philip Boll², Allan K Grill³, Amber Molnar^{4

5}, Danielle M Nash⁵, Amit Garg^{5

6}, Ayub Akbari⁷, Peter G Blake⁶, David Perkins²

Affiliations

¹ Medicine, McMaster University, Hamilton, Ontario, Canada brimbles@mcmaster.ca.
² Nephrology, Trillium Health Partners, Mississauga, Ontario, Canada.
³ Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁶ Medicine, University of Western Ontario, London, Ontario, Canada.
⁷ Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

Objectives: Chronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network's KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology.

Design and setting: The study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph's Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release.

Primary and secondary outcome measures: The primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria.

Results: The proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form.

Conclusions: We did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.

Keywords: chronic kidney disease; knowledge translation; primary care; proteinuria.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Kidney / physiopathology
Kidney Function Tests
Male
Middle Aged
Ontario
Practice Guidelines as Topic*
Primary Health Care / methods*
Prospective Studies
Referral and Consultation / statistics & numerical data*
Renal Insufficiency, Chronic / diagnosis*
Renal Insufficiency, Chronic / physiopathology