Study reinforces GP management of patients with chronic kidney disease

High blood pressure and chronic kidney disease (CKD) tend to go hand-in-hand, with significant knock-on effects for patient health.
 
‘When you’ve got CKD, blood pressure control can be harder to obtain than if you don’t have it, so it’s half of the problem,’ Associate Professor of General Practice at the University of Tasmania, Jan Radford, told newsGP.
 
‘And then it’s a circle – high blood pressure works with CKD, so it progresses more quickly if your blood pressure is uncontrolled.
 
‘Also, the risk of heart attack and stroke is increased, so many patients with CKD are often much more likely to die of a heart attack than get to the stage where their kidneys are totally failing.’
 
The fact blood pressure can be so difficult to control in patients with CKD can also lead to a tendency of overmedication.
 
‘With trying to control high blood pressure, you’ll find you’ve got to keep adding blood pressure tablets,’ Associate Professor Radford said. ‘So it’s not unusual for people to need, in the end, about four different types of pills, and sometimes that won’t even do it.
 
‘Then you’re getting to the stage where they’re on lots of everything and [blood pressure] is still not controlled.’
 
Using data from NPS MedicineWise MedicineInsight, Associate Professor Radford and a team from a range of fields in healthcare research, including pharmacy and health statistics, assessed the achievement of guideline-recommended blood pressure levels in patients with CKD and hypertension. They also measured these in relation with a number of variables, including continuity of care in general practice.
 
The results were published in the May edition of the Australian Journal of General Practice (AJGP).
 
The researchers found that continuous care from a GP was associated with positive achievement in blood pressure targets in patients with CKD and hypertension.
 
‘Our research suggests that if you add in continuity of care with the same doctor, you’re likely to achieve your targets,’ Associate Professor Radford said.
 
‘So, in a way, there’s a therapeutic effect of having the same GP that could be thought to be as strong as adding another pill.’
 
While the research only shows association and does not speak to cause, Associate Professor Radford believes some things can perhaps be surmised from its results regarding the importance of continuity of care and the GP–patient relationship.
 
‘As a GP, you understand the context of a patient’s life, all the things that are as much needed as medication; have they been able to reduce their alcohol intake, increase their exercise, reduce their salt? Have they tried to lose some weight; are they seeming to be taking their medication, and is it agreeing with them?’ she said.
 
‘On the other side of the fence, the patient may have a trusting relationship with their doctor and be willing to take their advice and stick with it. So if you’ve got that good rapport, you’re likely to have better primary care; if you and the patient are always the same duo doing the work of controlling blood pressure, then you’re more likely to be working collaboratively and understanding the plan together.’
 
The research also found the positive association between continuity of care and blood pressure control increased the more often the patient saw their GP.
 
‘If you go frequently enough to your GP – for example, a couple of times a year versus once a year –the more often you pop in and have that blood pressure checked, the more likely you are to get to target,’ Associate Professor Radford explained.
 
‘So continuity of care is worth pursuing, from the patient’s perspective.’
 
Associate Professor Radford does also acknowledge the fact the research presents issues for practices to consider.
 
‘I think general practices have to think about how they can enhance that opportunity for continuity of care for patients who want to see the same doctor,’ she said. ‘Because sometimes practices will have the doctor booked up for weeks ahead, such that they can’t be seen.
 
‘So there is this tension. Both sides will have to work to achieve this outcome.’

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