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Aims
To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control.Methods
Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience.Results
There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes.Conclusions
It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage. 相似文献Objectives Perinatal Quality Collaboratives across the United States are initiating projects to improve health and healthcare for women and infants. We compared an evidence-based group prenatal care model to usual individual prenatal care on birth outcomes in a multi-site expansion of group prenatal care supported by a state-wide multidisciplinary Perinatal Quality Collaborative. Methods We analyzed 15,330 pregnant women aged 14–48 across 13 healthcare practices in South Carolina (2013–2017) using a preferential-within cluster matching propensity score method and logistic regression. Outcomes were extracted from birth certificate data. We compared outcomes for (a) women at the intent-to-treat level and (b) for women participating in at least five group prenatal care visits to women with less than five group visits with at least five prenatal visits total. Results In the intent-to-treat analyses, women who received group prenatal care were significantly less likely to have preterm births (absolute risk difference ? 3.2%, 95% CI ? 5.3 to ? 1.0%), low birth weight births (absolute risk difference ? 3.7%, 95% CI ? 5.5 to ? 1.8%) and NICU admissions (absolute risk difference ? 4.0%, 95% CI ? 5.6 to ? 2.3%). In the as-treated analyses, women had greater improvements compared to intent-to-treat analyses in preterm birth and low birth weight outcomes. Conclusions for Practice CenteringPregnancy group prenatal care is effective across a range of real-world clinical practices for decreasing the risk of preterm birth and low birth weight. This is a feasible approach for other Perinatal Quality Collaboratives to attempt in their ongoing efforts at improving maternal and infant health outcomes.
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