Research Award Recipients

INTEGRATE-CKD - INcreasing The uptakE of Guideline diRected medicAl TherapiEs in CKD

Co-applicant(s): Ayodele Odutayo, Brendan Smyth, Daniel O'Hara, David Cherney, Kevin Yau, Massimo Nardone, Matthew James, Meg Jardine, Micheli Bevilacqua, Michelle M.Y. Wong, Mohammad Atiquzzaman, Tyrone Harrison

Lay Abstract

Background: People with diabetes and chronic kidney disease (CKD) face a significantly higher risk of heart disease and kidney failure, which can lead to hospitalization or death. In the past five years, new medications - sodium-glucose cotransporter-2 inhibitors (SGLT2i), nonsteroidal mineralocorticoid receptor antagonists (nsMRA), and glucagon-like peptide-1 receptor agonists (GLP-1RA) - have been shown to slow kidney disease progression, reduce heart disease risk, and improve overall patient outcomes. These treatments have been widely recommended and are considered a breakthrough in the management of diabetes and CKD. However, despite strong evidence supporting their benefits, studies worldwide, including our own research of the kidney care clinics in British Columbia, show that these medications are prescribed far less often than they should be. Even patients who meet all the criteria for these therapies often do not receive them, potentially missing out on treatments that could improve their health and quality of life. To understand the reasons behind this gap in care, we interviewed doctors and patients across British Columbia to explore the issues preventing the use of these medications and what can be done to help and increase their use. Our interviews with doctors revealed two key challenges: a lack of awareness or knowledge among healthcare providers about these therapies, and a lack of feedback mechanisms in clinics to encourage their regular use. Doctors emphasized the need for resources in multiple formats, including websites, summaries, and decision support tools to improve prescription behaviours. Similarly, patients shared that the information that they currently receive is either too overwhelming, hard to understand, or not updated often enough, which makes it difficult for them to confidently manage their health. Patients expressed a desire for regularly updated resources from trusted sources, materials that are detailed yet presented with minimal text, and clear information on potential side effects and drug interactions with commonly prescribed medications.

Purpose: This study aims to find out whether an intervention developed with feedback from physicians and patients across the province can help more people receive and fill prescriptions for these important medications.

Methods: We developed an intervention designed to address these problems. This includes educational resources, clinical decision-support tools, strategies to improve communication and feedback within healthcare teams, monthly virtual meetings to discuss real life patient care scenarios, and educational materials for patients. Our study will roll out these resources in kidney care clinics across the province in a stepwise manner, evaluating whether they lead to increased prescription rates over time.

Anticipated Outcomes: We expect the intervention to increase the prescription rates of these medications by at least 10%.

Patient Engagement: Patient-partners have been involved from the beginning, providing feedback to patient resources to help ensure patient resources are clear, relevant, and useful.

Relevance to Patients/Community: By improving access to these effective treatments, our goal is to enhance the quality of care for people with diabetes and CKD, ultimately reducing the risk of kidney failure and heart disease.