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Letters

Inequalities in CKD management can be overcome

Sally Hull, Neil Ashman and Gavin Dreyer
British Journal of General Practice 2021; 71 (702): 12. DOI: https://doi.org/10.3399/bjgp21X714389
Sally Hull
Queen Mary University of London, London. Email:
Roles: Reader in Primary Care
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  • For correspondence: s.a.hull@qmul.ac.uk
Neil Ashman
Barts Health NHS Trust, London.
Roles: Consultant Nephrologist
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Gavin Dreyer
Barts Health NHS Trust, London.
Roles: Consultant Nephrologist
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Molokhia et al1 report on chronic kidney disease (CKD) coding in primary care records in a multi-ethnic area of South London, demonstrating lower rates in all ethnic minority groups compared with the white population, which contributes to health inequalities. They also confirm the findings based on the National Chronic Kidney Disease audit2,3 that absence of CKD coding is associated with worse outcomes for blood pressure management and statin prescribing, and is associated with a greater burden of non-steroidal anti-inflammatory drug (NSAID) prescribing.

However, their study was based on a primary care dataset from 2013. Is it possible that Lambeth practices have improved coding rates since then? In East London there were similar low rates of CKD coding prior to 2015, when a quality improvement project promoting coding for CKD as part of a community renal service was introduced.

We combined feedback to practices, using quarterly dashboards to show performance relative to others, and engaged with the clinical commissioning groups (CCGs) to include CKD coding in Local Enhanced Services contracts. Over a 2-year period we showed a sustained rise in CKD coding to >85% across all the CCGs involved in the programme.4

Table 1 shows the dashboard for Newham CCG (with 7822 CKD cases) from July 2020. It illustrates the high rates of coding across all age bands and all ethnic groups, with the highest recording rates in black African and black Caribbean. Results are similar across all participating CCGs.

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Table 1.

Newham CCG dashboard, July 2020

This demonstrates the effectiveness of quality improvement programmes, which can improve the reach of effective interventions and decrease the corrosive effects of health inequalities.

There are further improvements to be made in East London — particularly in the offer of statins to younger people with CKD and improving BP control in those with both diabetes and CKD.

Using the opportunities to work across sectors and incentivise primary care in this way can reduce the impact of cardiovascular and end-stage kidney disease for those ethnic minorities at greatest risk.

  • © British Journal of General Practice 2021

REFERENCES

  1. 1.↵
    1. Molokhia M,
    2. Okoli GN,
    3. Redmond P,
    4. et al.
    (2020) Uncoded chronic kidney disease in primary care: a cross-sectional study of inequalities and cardiovascular disease risk management. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp20X713105.
  2. 2.↵
    1. Nitsch D,
    2. Caplin B,
    3. Hull SA,
    4. et al.
    (2017) National Chronic Kidney Disease Audit: national report (Part 1) (Healthcare Quality Improvement Partnership, London) www.lshtm.ac.uk/files/ckd_audit_report.pdf (accessed 8 Dec 2020).
  3. 3.↵
    1. Kim LG,
    2. Cleary F,
    3. Wheeler DC,
    4. et al.
    (2018) 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. Nephrol Dial Transplant 33, 8, 1373–1379.
    OpenUrl
  4. 4.↵
    1. Hull SA,
    2. Rajabzadeh V,
    3. Thomas N,
    4. et al.
    (2019) Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp19X704105.
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British Journal of General Practice: 71 (702)
British Journal of General Practice
Vol. 71, Issue 702
January 2021
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Inequalities in CKD management can be overcome
Sally Hull, Neil Ashman, Gavin Dreyer
British Journal of General Practice 2021; 71 (702): 12. DOI: 10.3399/bjgp21X714389

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Inequalities in CKD management can be overcome
Sally Hull, Neil Ashman, Gavin Dreyer
British Journal of General Practice 2021; 71 (702): 12. DOI: 10.3399/bjgp21X714389
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