Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence

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Abstract

Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Results: Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Conclusion: Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.
Original languageEnglish
Pages (from-to)291-300
Number of pages10
JournalDiabetes and Metabolic Syndrome: Clinical Research and Reviews
Volume12
Issue number3
Early online dateDec 2017
DOIs
Publication statusPublished - May 2018

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Chronic Disease Hospitals
Patient Compliance
Chronic Renal Insufficiency
Blood Glucose
Inpatients
Blood Pressure
Health Literacy
Outpatients
Kidney

Cite this

@article{837524323c824a83bc9520463ddd48bf,
title = "Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence",
abstract = "Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Results: Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3{\%} and 93.1{\%} of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9{\%} and 98.8{\%}, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58{\%}, indicating poor control (>7.0{\%} >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7{\%}), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7{\%} vs. 35.3{\%}), and reduction in kidney function (83.3{\%} vs. 30.9{\%}). Conclusion: Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.",
keywords = "Cardiovascular diseases, Diabetes mellitus, Guideline, Inpatients, Kidney diseases",
author = "Gardiner, {Fergus William} and Nwose, {Ezekiel Uba} and Bwititi, {Phillip Taderera} and Judith Crockett and Lexin Wang",
note = "Includes bibliographical references.",
year = "2018",
month = "5",
doi = "10.1016/j.dsx.2017.12.007",
language = "English",
volume = "12",
pages = "291--300",
journal = "Diabetes and Metabolic Syndrome: Clinical Research and Reviews",
issn = "1871-4021",
publisher = "Elsevier BV",
number = "3",

}

TY - JOUR

T1 - Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients

T2 - Clinical inertia and patient adherence

AU - Gardiner, Fergus William

AU - Nwose, Ezekiel Uba

AU - Bwititi, Phillip Taderera

AU - Crockett, Judith

AU - Wang, Lexin

N1 - Includes bibliographical references.

PY - 2018/5

Y1 - 2018/5

N2 - Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Results: Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Conclusion: Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.

AB - Aims: To determine the extent to which targets for blood pressure (BP) (<140.90 mmHg) and random blood glucose level (BGL) (<7.7 mmol/L) control in patients with chronic kidney disease (CKD) are achieved; and the extent clinical inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Methods: Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Results: Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of <140/90 mmHg. The average CKD patient pre-admission BP was 134.8/72.2 mmHg compared to the discharge BP of 129.8/72.2 mmHg. At admission, 63.3% and 93.1% of patients adhered to systolic and diastolic BP recommendations, which significantly (p = < .05) increased at discharge to a systolic and diastolic BP adherence of 83.9% and 98.8%, respectively. The average random hospital BGL was 7.7 mmol/L, indicating good control, whereas the pre-hospital HbA1c average was 7.58%, indicating poor control (>7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = <.05) between clinical inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Conclusion: Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment.

KW - Cardiovascular diseases

KW - Diabetes mellitus

KW - Guideline

KW - Inpatients

KW - Kidney diseases

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U2 - 10.1016/j.dsx.2017.12.007

DO - 10.1016/j.dsx.2017.12.007

M3 - Article

C2 - 29277347

AN - SCOPUS:85038864457

VL - 12

SP - 291

EP - 300

JO - Diabetes and Metabolic Syndrome: Clinical Research and Reviews

JF - Diabetes and Metabolic Syndrome: Clinical Research and Reviews

SN - 1871-4021

IS - 3

ER -