Presentation about the importance of primary care in the management of CRF patients

1. The role of Primary Care
in the management of
CRF patients
Ivan De Paz, MD
Internist
Western Regional Hospital

2. A particular Sunday while working in ERA particular Sunday while working in ER

3. What do you need?What do you need?
I’m here to get admittedI’m here to get admitted

4. SuccessSuccess

5. The problemThe problem
Stevens PE,O’Donoghue DJ,de Lusignan S,et al. Chronic kidney disease management in
the United Kingdom; NEOERICA project results.Kidney Int 2007; 72(1):92–99.
 A small study in Morelia Mexico (n= 3564),
indicates a prevalence of 8.5%
 In the United Kingdom 8.5% of the
population has a diagnosis of CRF stage 3-5
(N=130,226)
 AusDiab in Australia, reports a prevalence of
11.2% (n=11,247)
CRF is now recognized as a public health
problem, because of its association and
interactions with other vascular diseases

6. Role of Primary care in Tx CRF patientsRole of Primary care in Tx CRF patients
 Educating the public
 Early identification
 Integrated management of CRF

7. Primary care in the UKPrimary care in the UK
 Medical students who want to become
General Practitioners (GP), have to complete
a 5 year training after obtaining their
bachelors of medicine & surgery degree.

8. Quality and outcomes frameworkQuality and outcomes framework
 Is the annual reward and incentive
programme detailing GP practice
achievement results
 Rewards Gps for implementing “good
practice”
 Indicators are developed and approved by
the national institute for health and care
excellence (NICE)
 Rewards practices for the provision of quality
care & helps standarise the delivery of
primary care medical services

9. Quality and outcomes frameworkQuality and outcomes framework
 When QOF was implemented, there was a
marked increase in the referrals to secondary
care specialties. (Ex- Nephrology)
 Once the general practitioners confidence in
treating CRF patients increased, the number
of referrals and the quality of referrals
improved

10. Quality and outcomes frameworkQuality and outcomes framework
• Asthma
• Blood pressure
• A- fib
• Cancer
• CKD
• COPD
• Contraception
• CHD
• Dementia
• Depression
• Diabetes
• Epilepsy
• Heart failure
• Hypertension
• Hypothyroidism
• Inmunization
• Mental Health
• Obesity

11. Quality and outcomes frameworkQuality and outcomes framework
• Palliative care
• Peripheral
artery disease
• Rheumatoid
arthritis
• Sec prevention
of CHD
• Smoking
• Stroke

12. Quality and outcomes framework CKDQuality and outcomes framework CKD

14. More patients will be affectedMore patients will be affected

15. High risk populationsHigh risk populations
 Diabetics
 Hypertensives
 Cardiovascular disease
 HIV
 Hepatitis C
 Malignancy
 Nephrolithiasis
 Autoinmune diseases
 Recurrent UTI

16. High risk populationsHigh risk populations
 Family history of Kidney disease
 Sickle cell trait
 Treatment with nephrotoxic drugs
 Obesity

17. Mg/g

18. Universal Lab Reporting of eGFRUniversal Lab Reporting of eGFR
Courtney, A. E., Maxwell, A., & Fogarty, D. (2007). Using estimated glomerular filtration rate (eGFR) to help manage patients with
chronic kidney disease. The Ulster Medical Journal, 76(3), 154-156

19. Universal Lab Reporting of eGFRUniversal Lab Reporting of eGFR
Courtney, A. E., Maxwell, A., & Fogarty, D. (2007). Using estimated glomerular filtration rate (eGFR) to help manage patients with
chronic kidney disease. The Ulster Medical Journal, 76(3), 154-156

20. Calibration of the creatinin assaysCalibration of the creatinin assays
 reduce interlaboratory variation in creatinine
assay calibration and to enable more
accurate estimates of glomerular filtration rate
 Use a creatinine method that has calibration
traceable to an IDMS reference measurement
procedure. Methods based on either
enzymatic or Jaffe method principles should
have calibration traceable to IDMS.

21. Computer recordsComputer records
 Detect patients with CRF stage 3-5
 Comorbidities
 Management
 Small population of patients with CRF have been
coded
 Achieving treatment goals

22. Estimation of GFREstimation of GFR
 Measurement of the creatinin clearance
 Estimation equations based on serum creatinin
 MDRD
 CKD-EPI

23. Integrated
Management
Diabetes Goals
Avoidance of
Nephrotoxics
BP Goals
Nutrition
Reversible conditions
Arrangements for
RRT
AnemiaElectrolites
Cardiovascular
Risk Reduction

24. BNFBNF

25. Take home messageTake home message
 Early Identification of individuals with CRF
 Reduce morbidity, mortality, and disease
progression
 Standarise care provided by Primary care
Physicians
 Create a continuum of care between the different
levels of care in Belize

26. It’s a Small world after allIt’s a Small world after all

27. THANKS