RT Journal Article
SR Electronic
T1 Assessment of the Siksika chronic disease nephropathy-prevention clinic
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP e19
OP e25
VO 59
IS 1
A1 David R.R. Ward
A1 Ellen Novak
A1 Nairne Scott-Douglas
A1 Sony Brar
A1 Melvin White
A1 Brenda R. Hemmelgarn
YR 2013
UL http://www.cfp.ca/content/59/1/e19.abstract
AB 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 &lt; .01), systolic BP (15.84 mm Hg; P &lt; .05), diastolic BP (7.16 mm Hg; P &lt; .001), and low-density lipoprotein (0.62 mmol/L; P &lt; .01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4%; P &lt; .01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9%; P &lt; .01), or statin therapy (35.9%; P &lt; .01). Conclusion A community-based, nurse practitioner–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.