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Selected ICDC and AKDN Projects

1. Online, interactive CKD Clinical Pathway

Background

Chronic kidney disease (CKD) is common, affecting 9% of adults in Canada. However, management of CKD is complex and often suboptimal – in part because many providers are unaware of best practices.

Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the evaluation and management of CKD was released in 2012 and defines CKD based on eGFR (estimate glomerular filtration rate) and albuminuria levels.  Primary care physicians and allied health care professionals (e.g. pharmacists, nurses) play a key role in identification, medical management and referral of adult patients with CKD and thus are an important target population to disseminate the CKD guidelines to. 

Accessing the pathway

Clinical pathways are an effective tool to translate the guidelines into practice in order to optimize care for patients with CKD. The CKD clinical pathway (hyperlink to: www.ckdpathway.ca) is an effective, interactive, online tool that is credible, evidence-based and easy to navigate.

Currently, primary care providers can access the CKD Pathway via webpage: www.ckdpathway.ca.

In 2015, clinicians will be able to access the CKD Pathway via an embedded URL link in a patients eGFR & urine lab test results. 

The CKD Pathway assist you in the following ways:

  1. Diagnosis of CKD (who to test and how to test)
  2. Medical management of CKD (lifestyle and drug therapy)
  3. Referral of patients with CKD to a nephrologist

We want to test patients at risk for CKD, namely those who have

  • Hypertension
  • Diabetes Mellitus
  • Family history of CKD or hereditary kidney disease
  • Vascular disease
  • Multisystem disease (e.g. SLE)

The tests recommended are:

  • eGFR
  • Urine Albumin Creatinine ratio (ACR)
  • Urinalysis

2. Assessing the Impact of Drug Insurance on Clinical and Economic Outcomes in Patients with Chronic Diseases

Appropriate access to pharmaceuticals, along with adherence to pharmacologic regimens, is important in the management of patients with a variety of medical conditions. Although Canadians have universal access to medically necessary care, which includes hospital and physician care, not all Canadians have coverage for medications. This results in direct payments by patients for drugs, which can occur among both those with or without drug insurance that place a financial burden on both patients and their families.

pdfExecutive Summary

Prescription drug expenses in Canada are a health-care barrier

3. ICDC Evaluation of the “Diabetes Essentials” Education Class

“Diabetes Essentials” is an introductory diabetes education class mainly for adults who have been newly diagnosed with type 2 diabetes. The class is part of the Alberta Health Services Living Well with a Chronic Condition program. Diabetes Essentials is offered over 100 times a year in the Calgary area and involves 5 to 8 hours of instruction over a one or two day period. The evaluation of the “Diabetes Essentials” class was conducted by the ICDC as a research priority identified by Alberta Health Services (AHS).

pdfSummary Report and Findings

pdfAssociation between particpation in education and diabetes control

4. ICDC Patient Advisory Committee (PAC)

The ICDC Patient Advisory Committee comprises a group of volunteers with chronic illnesses who provide advice about how the health care system can be improved to make it work better for all Canadians, in particular those living with chronic diseases. The purpose of the Committee is to allow patients with chronic conditions to share their knowledge and experiences about their health with the ICDC team members, who will then use this information to help guide the research focus.

The Committee is comprised of 6 members from Calgary (and surrounding areas) and 5 members from Edmonton (and surrounding areas).

pdfICDC PAC Terms of Reference/Information Sheet

pdfPAC meeting notes (December 18, 2012)

pdfPAC meeting notes (videconference June 11, 2013)

pdfBarriers & Facilitators to Care in Patients with Diabetes - (a) Summary of results of the April 14, 2015 patient focus group (FG), and (b) FG Summary Report for presentation to the Diabetes, Obesity, and Nutrition (DON) SCN.

5. Patient/Public Report Summary - Barriers to Care for People with Chronic Health Conditions (BCPCHC) Survey

Results of the BCPCHC Survey (administered to Western Canadians with one or more chronic diseases to find out how they use the health care system) were translated into a short 4-page summary for patients (pdflink to PDF). Members of the Patient Advisory Committee (PAC) reviewed the summary report and were asked to answer 5 questions based on the summary report (pdflink to PDF of questions).

A videoconference meeting was held on June 11th 2013 with members of the Edmonton and Calgary PAC to review the BCPCHC Summary Report.

6. Barriers to Care for People with Chronic Health Conditions (BCPCHC) Survey

Patients with chronic medical conditions such as diabetes and high blood pressure often follow complex treatment regimens including medications and lifestyle changes. The ability to manage a chronic condition, particularly when living with one or more chronic illness, requires involvement of the patient, the health care system and often other family members or friends in general. Patients may face barriers to optimizing their health across all of these areas.  In collaboration with Statistics Canada, the ICDC conducted a telephone survey exploring the Barriers to Care for People with Chronic Health Conditions (BCPCHC) in 1849 Western Canadians with chronic diseases.

pdfReport Overview

pdfPolicy Brief

pdfBarriers to Care Survey Working Paper

pdfAdditional information about the survey conducted in collaboration with Statistics Canada

Access to primary care and other health care use among western Canadians with chronic conditions

People with chronic disease interested in using email, videoconferences to help manage their diseases

The association between financial barriers and care and outcomes for patients with chronic disease (coming soon!!)

Income and adherence to lifestyle modifications (coming soon!!)

Allied Healthcare providers and after hours care (coming soon!!)

7. Creating a Roadmap for Researchers Working with the Obesity, Diabetes and Nutrition Strategic Clinical Network

This report summarizes a dialogue between the academic, clinical, and policy maker communities held at a workshop in Calgary, Alberta on April 30, 2012. Emerging research and recent changes in the organization and delivery of care to Albertans with diabetes prompted the need for this workshop.

pdfFull Report

pdfResearch Brief

pdfExecutive Summary

pdfExecutive Summary: The Effectiveness of Quality Improvement Initiatives on Diabetes Management-A Systematic Review and Meta-analysis

pdfResearch Brief: The Effectiveness of Quality Improvement Strategies on Diabetes Management

pdfWorkshop presentations

Identifying strategies to improve diabetes care in Alberta, Canada, using the knowledge-to-action cycle.

8. Implementation of CKD Guidelines for Identification and Management of Patients with Proteinuria: A Knowledge Translation Strategy

This project builds on important work published in the Journal of the American Medical Association (JAMA) in 2010 where our group showed that the presence of proteinuria was an inexpensive and important predictor of risk in patients with CKD, compared to use of estimated Glomerular Filtration Rate (eGFR) alone. This risk was most pronounced in specific subgroups.  The results of this work have informed international Clinical Practice Guidelines for management of CKD. Workshop held back in May 2012.

pdfWorkshop presentations

pdfJournal of Nephrology paper

pdfRelated publications [1], [2], [3], [4]

9. Geography as a Relevant Barrier to Chronic Kidney Disease (CKD) Care and Optimal Outcomes

Albertans with CKD who lived more than 2 hours away from routine nephrology care had an approximately 1.5-fold increased risk of premature death, a higher risk of hospitalization, and more rapid progression of kidney disease. Further exploration revealed that such patients were less likely to be referred to nephrologists; to receive potentially beneficial medications; or to have recommended investigations related to their kidney disease or its complications. Therefore, it appeared that the adverse outcomes were causally linked to reduced access to care (distance from Nephrologist care). In response to these results decision makers in Alberta Renal Programs identified challenges with placing nephrology clinics in remote centers -- and recommended further work to inform policy options and identify their economic implications. To inform practice further, our team has done additional novel studies, including an estimate of the cost and cost-effectiveness of placing new nephrology clinics in remote locations.

Related publications [1], [2], [3]

10. How Effective are Alberta Primary Care Networks?

This brief summarizes an evaluation of Alberta Primary Care Networks (PCNs), which was published on December 5th, 2011 in the Canadian Medical Association Journal, a high-impact biomedical journal circulated to over 70,000 physicians twice monthly.

pdfPolicy brief

pdfFull Report

pdfLink to CMAJ article

pdfFor more information on Primary Care Networks, please refer to the Primary Care Initiative website

11. New Research on Statins for Patients at Low Cardiovascular Risk

Statins already represent a significant investment for drug formularies; recent changes in prescription patterns demonstrate considerable potential for increased use among people with low cardiovascular risk. Further increases in statin use will put further pressure on public and private insurance plans as well as out-of-pocket payers. Given that this is an area of identified expertise for our team, we were asked to work with the Canadian Agency for Drugs and Technologies (CADTH) to perform a health technology assessment. This work is published in two related articles at Canadian Medical Association Journal (CMAJ).

pdfExecutive Summary

pdfBriefing Document

pdfCMAJ papers [1], [2]

pdfPAC meeting notes (videconference June 11, 2013)

Funded by the ALBERTA HERITAGE FOUNDATION FOR MEDICAL RESEARCH Endowment Fund