Implementation of A Screening Checklist to Improve the Diagnosis of Chronic Kidney Disease in A Safety Net Clinic Volume 3 - Issue 1

Mary Zapczynski*, Cheryl Adair

• Assistant Professor Northwestern State University of Louisiana, College of Nursing and School of Allied Health, USA

Received: April 22, 2021;  Published: April 29, 2021

Corresponding author: Mary Zapczynski, DNP, APRN, FNP-BC Assistant Professor Northwestern State University of Louisiana, College of Nursing and School of Allied Health, 1800 Line Avenue, Shreveport, Louisiana 71101

DOI: 10.32474/LOJNHC.2021.03.000154

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Abstract

Background: Chronic kidney disease (CKD) is a significant public health problem affecting one in seven American adults. Risk factors for developing CKD are hypertension, diabetes, hyperlipidemia, obesity, heredity, acute kidney injury, age and gender. Hypertension and diabetes are the major causes. Chronic kidney disease is asymptomatic in the early stages. Most affected individuals are unaware of the condition until the disease has progressed. Vulnerable populations are disproportionately affected by CKD. Members of cultural/ethnic minorities, the poor and elderly, migrants are at higher risk for developing CKD and experiencing faster progression. The uninsured/underinsured individuals often seek medical care at safety-net clinics. They are less likely to receive evidence-based care for their CKD or receive a timely referral to nephrology. Early identification of CKD indicators in highrisk individuals and aggressive treatment of underlying causes can stop or slow CKD progression. Late diagnosis is associated with poor outcomes including end stage kidney disease requiring lifelong dialysis or transplant. Most individuals with CKD receive medical care in the primary care setting. Primary care providers are in the optimum position to identify early indicators of CKD and to provide aggressive management of underlying causes. Guidelines for identifying and treating CKD have been available since 2002. Less than 40% of primary care providers adhere to the guidelines. Lack of guideline awareness, time constraints, confusion about the guidelines and fear of incorrectly labeling an individual with CKD are reasons. As a result, chronic kidney disease is under diagnosed and under treated.

Purpose: The purpose of this project was to implement a screening checklist to improve the recognition of chronic kidney disease by providers in a safety net clinic.

Procedure: A screening checklist adapted from the Kidney Disease: Global Outcomes Quality Initiative clinical practice guidelines was implemented in the safety net clinic over three months. Frequency of provider documentation of CKD indicators and diagnoses were measured.

Results: The checklist improved provider recognition of CKD indicators, but did not increase the frequency of CKD diagnoses. Conclusion: The results of the project indicated that a checklist improved provider utilization of CKD guidelines to screen for CKD indicators.

Abstract| Background| Purpose and Significance of Research| Procedure| Data Analysis| Discussion| Recommendations| References|