Evidence mapPaperPMID 38898462Full record

ArticleBMC primary care2024

Optimising a clinical decision support tool to improve chronic kidney disease management in general practice.

Barbara Hunter, Sandra Davidson, Natalie Lumsden, Sophie Chima, Javiera Martinez Gutierrez, Jon Emery, Craig Nelson, Jo-Anne Manski-Nankervis

Abstract read
In one paragraph

Article in BMC primary care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Barbara HunterDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia. barbara.hunter@unimelb.edu.au.
Sandra DavidsonDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
Natalie LumsdenDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
Sophie ChimaDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
Javiera Martinez GutierrezDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
Jon EmeryDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
Craig NelsonWestern Health Chronic Disease Alliance, Western Health Melbourne, Melbourne, Australia.
Jo-Anne Manski-NankervisDepartment of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation.

methodsFuture Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance.

resultsFuture Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete.

conclusionsThis study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.

Indexed as

Decision Support Systems, ClinicalGeneral PracticeRenal Insufficiency, ChronicCOVID-19Electronic Health RecordsHumansQuality ImprovementVictoriaCardiovascularChronic diseaseChronic kidney diseaseGeneral practiceHealth technologyPatient carePrimary care

Identifiers

PMID38898462
PMCPMC11186183

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.