Abstract
Introduction: Chronic kidney disease (CKD) is the main health problem in Thailand and worldwide. Patients with CKD can progress to end-stage kidney disease (ESKD) requiring kidney replacement therapy which has high expense and burden to the national health budget. In addition, they have a poor quality of life. The major causes of CKD are diabetes and/or hypertension. There are many interventions, guidelines, and policies to prevent CKD that have been implemented but the number of patients with CKD is increasing leading to an overwhelming workload of healthcare providers especially those who work under public health. The objective of this study aimed to set up system processes of care to prevent CKD in high-risk patients and monitoring method by collaborating with private primary care clinics located in the communities. Methods: The owners of private primary care clinics registered with the National Health Security Office and located in the central part of Thailand were invited to participate voluntarily in the research. After they signed the contract, the healthcare workers in each clinic were trained in processes of intervention to prevent CKD or slow progression of the disease. The healthcare providers in each clinic identified patients with a high risk of CKD, educated them to raise awareness of CKD, invited them to participate in CKD prevention programs which were composed of providing education, counselling to identify individual problem obstructing the achievement to the goal of treatment, positive motivation and empowering them to be able to the self-management to prevent CKD. Each clinic was audited and monitored two times in the pattern of mentoring and coaching. The outcome of patients was determined in the rate of decline estimated glomerular filtration rate (eGFR) compared between pre-and post-intervention. Results: 42 private primary care clinics were participating in this study. The 35 (83.3%) of clinics having patients with diabetes and/or hypertension higher than 100 cases. The number of patients joining in CKD prevention programs at clinics was 847 cases. The ratio of male to female was 397 (46.9%) and 450 (53.1%) cases, respectively. The mean (SD) age of patients was 62.9 ± 10 years (95% confidence interval 62.3-63.6 years). The 66.9% of patients had education levels in illiterate or primary school. 46.4% of patients were unemployed, 31.8% were freelance, 21.4% were private employees, and 0.4% were civil service. Most of the patients were hypertension (51.6%) followed by diabetes and hypertension (40.1%), diabetes (8.1%), and others (0.2%). 46.6% of patients had eGFR less than 60 ml/min/1.73 m2 before starting the intervention. 74% of patients achieved a rate of eGFR decline of less than 5 ml/min/1.73 m2 after 6 months of intervention. Conclusion: The collaboration between the private primary care clinics and academics from the university was successful in setting up the processes of care to delay progression of CKD in high risk patients with diabetes and/or hypertension. They were the main groups of patients in private primary care clinics. In addition, the monitoring method in the pattern of mentoring and coaching was important to get the good collaboration. It would be a strategy to reduce the number of CKD patients, if this model could be expanded to other primary care clinics.
