Sustainability of an electronic technology-based intervention in general practice targeting improved detection and monitoring of the interrelated chronic vascular diseases.

BACKGROUND

Chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease cause substantial morbidity and mortality. Our earlier randomised stepped-wedge trial targeted these conditions using an electronic technology audit tool combined with benchmarking, education, monitoring and support to general practices. This study aimed to determine if changes seen in the original trial persisted 12 months later.

METHODS

The study commenced at completion of the original 80-week trial. Practices received: final training session, resource folder, ongoing electronic technology tool access; other intervention components were withdrawn. Active patients (≥3 visits within last 24 months) aged ≥ 18 years within eight practices were included. Pre-defined variables from the original trial for which the credible interval (CI) did not include one, as well as two additional variables were re-assessed 12 months later. De-identified data were analysed using R version 3.5.1 with Bayesian generalised linear mixed model with practice specific random intercept and linear slope for time. Net effect odds ratio (OR) reflects the combined outcome of the original trial and subsequent follow-up period.

RESULTS

37,813 patients were included at study end. Net OR and 95% CI showed: increased CKD diagnostic testing in those at risk (OR 1.4, CI 1.2-1.6), increased coded CKD diagnosis (OR 1.9, CI 1.6-2.2) and increased uACR testing in patients with T2D (OR 1.9, CI 1.4-2.5). When considering the proportion of patients with CKD on recommended management among all active patients aged ≥ 18 years, there were also increased patients with CKD prescribed ACEI/ARBs (OR 1.8, CI 1.5-2.3) and prescribed statins (OR 1.8, CI 1.4-2.2). There was no sustained increase in T2D diagnostic testing in those at risk.

CONCLUSIONS

Improvements strengthened in five areas including three out of four pre-defined variables that improved in the original trial and two additional variables that also showed improvement in the original trial, suggesting lasting benefits with ongoing electronic technology tool access. Further investigation incorporating control practices and qualitative research investigating which components best promote long-term changes would be beneficial.

REGISTRATION NUMBER: ACTRN12617000335392. Date registered: 3 March 2017.