eprintid: 1569290 rev_number: 45 eprint_status: archive userid: 608 dir: disk0/01/56/92/90 datestamp: 2017-08-09 14:36:00 lastmod: 2021-10-03 23:50:34 status_changed: 2017-08-09 14:36:00 type: article metadata_visibility: show creators_name: Wheeler, DC creators_name: Kim, LG creators_name: Cleary, F creators_name: Caplin, B creators_name: Nitsch, D creators_name: Hull, SA title: How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: G93 keywords: Audit, Chronic Kidney Disease, Coding, Management, Primary Care note: Copyright © The Author 2017. Published by Oxford University Press on behalf of ERAEDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited abstract: BACKGROUND: In the UK, primary care records are electronic and require doctors to ascribe disease codes to direct care plans and facilitate safe prescribing. We investigated factors associated with coding of chronic kidney disease (CKD) in patients with reduced kidney function and the impact this has on patient management. METHODS: We identified patients meeting biochemical criteria for CKD (two estimated glomerular filtration rates <60 mL/min/1.73 m2 taken >90 days apart) from 1039 general practitioner (GP) practices in a UK audit. Clustered logistic regression was used to identify factors associated with coding for CKD and improvement in coding as a result of the audit process. We investigated the relationship between coding and five interventions recommended for CKD: achieving blood pressure targets, proteinuria testing, statin prescription and flu and pneumococcal vaccination. RESULTS: Of 256 000 patients with biochemical CKD, 30% did not have a GP CKD code. Males, older patients, those with more severe CKD, diabetes or hypertension or those prescribed statins were more likely to have a CKD code. Among those with continued biochemical CKD following audit, these same characteristics increased the odds of improved coding. Patients without any kidney diagnosis were less likely to receive optimal care than those coded for CKD [e.g. odds ratio for meeting blood pressure target 0.78 (95% confidence interval 0.76–0.79)]. CONCLUSION: Older age, male sex, diabetes and hypertension are associated with coding for those with biochemical CKD. CKD coding is associated with receiving key primary care interventions recommended for CKD. Increased efforts to incentivize CKD coding may improve outcomes for CKD patients. date: 2017-10-16 date_type: published publisher: Oxford University Press (OUP) official_url: http://dx.doi.org/10.1093/ndt/gfx280 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Article verified: verified_manual elements_id: 1410499 doi: 10.1093/ndt/gfx280 lyricists_name: Caplin, Benjamin lyricists_name: Wheeler, David lyricists_id: BCAPL88 lyricists_id: DWHEE12 actors_name: Dewerpe, Marie actors_id: MDDEW97 actors_role: owner full_text_status: public publication: Nephrology Dialysis Transplantation issn: 0931-0509 citation: Wheeler, DC; Kim, LG; Cleary, F; Caplin, B; Nitsch, D; Hull, SA; (2017) How do primary care doctors in England and Wales code and manage people with chronic kidney disease? Results from the National Chronic Kidney Disease Audit. Nephrology Dialysis Transplantation 10.1093/ndt/gfx280 <https://doi.org/10.1093/ndt%2Fgfx280>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/1569290/24/Kim_how_do_primary_care_doctors_in_England.pdf