@article {Warde19, author = {David R.R. Ward and Ellen Novak and Nairne Scott-Douglas and Sony Brar and Melvin White and Brenda R. Hemmelgarn}, title = {Assessment of the Siksika chronic disease nephropathy-prevention clinic}, volume = {59}, number = {1}, pages = {e19--e25}, year = {2013}, publisher = {The College of Family Physicians of Canada}, abstract = {Objective To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease. Design Qualitative descriptive study. Setting A nephropathy-prevention clinic in Siksika Nation, Alta. Participants First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic. Main outcome measures Changes in blood pressure (BP), hemoglobin A1c, and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy. Results Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5\% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A1c (0.96\%; P \< .01), systolic BP (15.84 mm Hg; P \< .05), diastolic BP (7.16 mm Hg; P \< .001), and low-density lipoprotein (0.62 mmol/L; P \< .01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4\%; P \< .01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9\%; P \< .01), or statin therapy (35.9\%; P \< .01). Conclusion A community-based, nurse practitioner{\textendash}led clinic can improve many clinically relevant factors in patients at risk of developing chronic kidney disease. Studies have shown that achieving treatment targets is associated with a reduced risk of early death and cardiovascular events; the effect in the First Nations population on these hard clinical end points remains to be determined.}, issn = {0008-350X}, URL = {https://www.cfp.ca/content/59/1/e19}, eprint = {https://www.cfp.ca/content/59/1/e19.full.pdf}, journal = {Canadian Family Physician} }