Chronic kidney disease (CKD) affects approximately 37 million U.S. adults and less than 25% are aware of their disease. CKD is readily identified with simple blood and urine tests that are often in a patient's health record yet providers usually do not diagnose the CKD and inform the patient. In a randomized clinical trial, Dr. Peralta and colleagues at the University of California in San Francisco randomized 80 primary care providers to an electronic decision support system with or without follow-up by a pharmacist and tested whether the support system improves processes of care including blood pressure management, medication prescribing and patient education. Patients with CKD were identified from electronic health record data and primary care providers in the intervention arm received guidance on lab testing, medication prescribing, patient education and blood pressure management. A total of 80 providers caring for 524 patients with CKD were enrolled in the trial. After a total of 12 months of follow-up, there was no differences in processes of care by implementation of the electronic decision support system with or without a pharmacist. However, awareness of CKD was two-fold higher among the providers randomized to the electronic decision support system with a pharmacist compared to usual care (16% without support system vs. 32% with the support system and pharmacist follow-up). This study demonstrates that implementation of a decision support system within the electronic health records system can increase provider awareness of CKD.
Electronic Decision Support for Management of CKD in Primary Care: A Pragmatic Randomized Trial
Carmen Peralta, MD, MAS, et al