CKD Complex Interventions: Realist Review [Clinical Journal of the American Society of Nephrology (CJASN) Podcast]
CKD Complex Interventions: Realist Review
Clinical Journal of the American Society of Nephrology (CJASN)
Published May 8, 2023 * 00:05:46
Dr. Dominic Taylor provides a summary of his study "Complex Interventions across Primary and Secondary Care to Optimize Population Kidney Health," on behalf of his colleagues.
Please note that this transcript was automatically generated and may contain inaccuracies. It is intended for informational purposes only. Refer to the audio for full context.
----Speaker 1: Thanks for listening to this CJSON podcast. I'm Dominic Taylor, a consultant nephrologist in Bristol, UK and I'm here to talk about an article Complex Interventions across Primary and Secondary Care to Optimise Population Kidney Health. As readers of CJSON are aware, chronic kidney disease is associated with higher cardiovascular risk and risk of developing kidney failure Several evidence-based treatments effectively delay progression of CKD and reduce cardiovascular risk. These include targeted blood pressure reduction, ACE inhibitors or ARBs, statins and SGLT2 inhibitors. Unfortunately, these treatments are not effectively delivered to CKD populations. To increase uptake of these treatments, Multiple complex interventions have been developed. However, these interventions have not been systematically developed or optimized, so it is unclear which aspects of these interventions result in their success. In this study, we used realist synthesis methodology to describe features of these complex interventions. By contrast to traditional systematic reviews, which focus on qualitative outcomes as a measure of intervention success, realist synthesis aims to explain how interventions work, for whom, and under which circumstances. An initial scoping review of literature identified five key intervention components. These included screening of primary care databases to identify high-risk patients, giving management recommendations to primary care clinicians or prompting referral to secondary care, often through automated systems, review of clinical data by nephrologists without a patient-facing appointment, and educational interventions for primary care staff. We performed literature searches and identified 60 studies describing these interventions. Our team reviewed studies to develop lists of context, mechanism, outcome configurations. These describe how a component of an intervention works to deliver an outcome and the contexts within which each mechanism can act. In a series of team meetings, we synthesize this evidence to produce an integrated model describing the function of successful interventions. We found that successful interventions motivate clinicians in primary and secondary care to engage with CKD management activities. They also allow primary care clinicians to learn how to manage CKD effectively, termed learning while doing. Within the structure of successful interventions, this learning occurs during interaction with automated systems, with patients, with educational activities, and with nephrologists. Learning and motivation is promoted by digital and interpersonal interfaces which are easily accessible, as well as the integration of CKD care within existing workflows. These mechanisms combine to allow clinicians to focus on CKD care and to act to implement evidence-based treatment which should promote positive population outcomes. In parallel to these processes, it is necessary that resources in primary and secondary care are reallocated to support the intervention. These mechanisms cannot function without the presence of key contextual factors. These include the perceived credibility of clinical recommendations to primary care clinicians. Geographical contexts also have an effect. Patient engagement is also key to intervention success, but we found only limited data on patient perspectives. This work describes, in detail, the functioning of complex interventions which aim to improve the delivery of evidence-based treatments for people with CKD. We provide a framework which can be used to guide the development of future interventions. We hope that future research can build on this work, developing more detailed frameworks for intervention development, which take into account patient perspectives. This will allow wide-scale rollout of effective interventions of this type to improve the health of a growing worldwide CKD population.
Speaker 2: This podcast is copyrighted by the American Society of Nephrology. All rights reserved. All content in this podcast is for informational purposes only and is not intended to be medical advice. This podcast should not be used in a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified healthcare professional if you have any questions about any medical condition or before taking any drug, changing your diet, or commencing or discontinuing any course of treatment. Thank you for listening to this podcast from the American Society of Nephrology.----Episode URL: https://www.asn-online.org/media/podcast.aspx?ID=454
CKD Complex Interventions: Realist Review
Clinical Journal of the American Society of Nephrology (CJASN)
Published May 8, 2023 * 00:05:46
Dr. Dominic Taylor provides a summary of his study "Complex Interventions across Primary and Secondary Care to Optimize Population Kidney Health," on behalf of his colleagues.
Please note that this transcript was automatically generated and may contain inaccuracies. It is intended for informational purposes only. Refer to the audio for full context.
----Speaker 1: Thanks for listening to this CJSON podcast. I'm Dominic Taylor, a consultant nephrologist in Bristol, UK and I'm here to talk about an article Complex Interventions across Primary and Secondary Care to Optimise Population Kidney Health. As readers of CJSON are aware, chronic kidney disease is associated with higher cardiovascular risk and risk of developing kidney failure Several evidence-based treatments effectively delay progression of CKD and reduce cardiovascular risk. These include targeted blood pressure reduction, ACE inhibitors or ARBs, statins and SGLT2 inhibitors. Unfortunately, these treatments are not effectively delivered to CKD populations. To increase uptake of these treatments, Multiple complex interventions have been developed. However, these interventions have not been systematically developed or optimized, so it is unclear which aspects of these interventions result in their success. In this study, we used realist synthesis methodology to describe features of these complex interventions. By contrast to traditional systematic reviews, which focus on qualitative outcomes as a measure of intervention success, realist synthesis aims to explain how interventions work, for whom, and under which circumstances. An initial scoping review of literature identified five key intervention components. These included screening of primary care databases to identify high-risk patients, giving management recommendations to primary care clinicians or prompting referral to secondary care, often through automated systems, review of clinical data by nephrologists without a patient-facing appointment, and educational interventions for primary care staff. We performed literature searches and identified 60 studies describing these interventions. Our team reviewed studies to develop lists of context, mechanism, outcome configurations. These describe how a component of an intervention works to deliver an outcome and the contexts within which each mechanism can act. In a series of team meetings, we synthesize this evidence to produce an integrated model describing the function of successful interventions. We found that successful interventions motivate clinicians in primary and secondary care to engage with CKD management activities. They also allow primary care clinicians to learn how to manage CKD effectively, termed learning while doing. Within the structure of successful interventions, this learning occurs during interaction with automated systems, with patients, with educational activities, and with nephrologists. Learning and motivation is promoted by digital and interpersonal interfaces which are easily accessible, as well as the integration of CKD care within existing workflows. These mechanisms combine to allow clinicians to focus on CKD care and to act to implement evidence-based treatment which should promote positive population outcomes. In parallel to these processes, it is necessary that resources in primary and secondary care are reallocated to support the intervention. These mechanisms cannot function without the presence of key contextual factors. These include the perceived credibility of clinical recommendations to primary care clinicians. Geographical contexts also have an effect. Patient engagement is also key to intervention success, but we found only limited data on patient perspectives. This work describes, in detail, the functioning of complex interventions which aim to improve the delivery of evidence-based treatments for people with CKD. We provide a framework which can be used to guide the development of future interventions. We hope that future research can build on this work, developing more detailed frameworks for intervention development, which take into account patient perspectives. This will allow wide-scale rollout of effective interventions of this type to improve the health of a growing worldwide CKD population.
Speaker 2: This podcast is copyrighted by the American Society of Nephrology. All rights reserved. All content in this podcast is for informational purposes only and is not intended to be medical advice. This podcast should not be used in a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified healthcare professional if you have any questions about any medical condition or before taking any drug, changing your diet, or commencing or discontinuing any course of treatment. Thank you for listening to this podcast from the American Society of Nephrology.----Episode URL: https://www.asn-online.org/media/podcast.aspx?ID=454
