Open Access Open Badges Research article

Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data

Mohammad A Tahir12*, Olga Dmitrieva2, Simon de Lusignan2, Jeremy van Vlymen2, Tom Chan2, Ramez Golmohamad1, Kevin Harris3, Charles Tomson4, Nicola Thomas5 and Hugh Gallagher16

Author Affiliations

1 Primary Care Informatics, Division of Public Health Sciences and Education, St George's - University of London, Cranmer Terrace, London SW17 0RE, UK

2 Department of Health Care Management and Policy, University of Surrey, Guildford, UK, Surrey GU2 7XH

3 University Hospitals of Leicester NHS Trust, John Walls Renal Unit, Leicester General Hospital, Leicester LE5 4PW UK, UK

4 Department of Renal Medicine, Southmead Hospital, Bristol BS10 5NB, UK

5 School of Community and Health Sciences, City University London, 20 Bartholomew Close, London EC1A 7QN, UK

6 SW Thames Renal & Transplantation Unit, St Helier Hospital, Wrythe Lane Carshalton, Surrey SM5 1AA UK, UK

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BMC Family Practice 2011, 12:83  doi:10.1186/1471-2296-12-83

Published: 5 August 2011



Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD.

Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes.


We validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate.


87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM).

85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%.

Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD.

84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD.


Practitioners are less likely to achieve management targets where their confidence is low.

Renal Insufficiency; Chronic; Primary Care; Blood pressure; Family Practice; Quality of Healthcare; Proteinuria; Medical Records systems; computerised; Reimbursement; incentives